A case report of severe adverse reaction of exenatide: Anaphylactic shock

Abstract

Background: Anaphylactic shock is the severe state of the allergic reaction, which is rapid in onset and fatal. This is the first study that discusses the anaphylactic shock of exenatide reexposure in the patient who has interrupted exenatide treatment. Patient concerns: A 47-year-old man was treated with exenatide owing to high blood glucose and obesity. Then he developed localized urticarial on the face, white lip, hands tremble, nausea, vomit, chest stuffiness, dizziness, accompanying with confusion and dyspnea. His blood glucose was 4.6 millimole per liter (mmol/L) and blood pressure was 85/50 millimeters of mercury (mm Hg). Diagnosis: Exenatide-induced anaphylactic shock was considered. Interventions: The emergency electrocardiogram was performed. The patient was treated with dexamethasone sodium phosphate and calcium gluconate, combined with exenatide withdrawal. He also received oral antiallergic agents and intravenous nutrition treatment. Outcomes: After antishock treatment, the clinical response gradually alleviated. Lessons: Although exenatide is not prone to anaphylaxis, it is the synthetic peptide that can induce antibody formation. Exenatide has immunogenicity with the potential to elicit an allergic reaction upon administration. Clinicians should always pay more attention to the anaphylactic shock of exenatide, when prescribing for diabetics.

Identifying patients at risk of anaphylaxis

“…Recently published reports have presented cases of anaphylactic reaction to exenatide and dulaglutide that are glucagon like peptide-1 (GLP-1) receptor agonists used for the management of type 2 diabetes. 58 , 59 …”