Allergic shock and death associated with protamine administration in a diabetic patient

Chu, Yanqi; Cai, Li Jian; Jiang, Dechun; Jia, Dan; Yan, Suying; Wang, Yuqin

doi:10.1016/j.clinthera.2010.09.010

Cited by 39 publications

(16 citation statements)

References 21 publications

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“…Allergy to fish may predispose to this acute response, because commercial protamine originates from sperm of salmon fished around Japan [ 10 ]. Since protamine is also used to slow down absorption and to prolong action of some insulins, diabetic patients might be prone to fatal allergic reactions [ 10 , 11 ]. European Medicines Agency alerted about potential supply shortage of protamine after Fukushima nuclear plant disaster.…”

Section: Introductionmentioning

confidence: 99%

Nonclinical Evaluation of Novel Cationically Modified Polysaccharide Antidotes for Unfractionated Heparin

et al. 2015

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Protamine, the only registered antidote of unfractionated heparin (UFH), may produce a number of adverse effects, such as anaphylactic shock or serious hypotension. We aimed to develop an alternative UFH antidote as efficient as protamine, but safer and easier to produce. As a starting material, we have chosen generally non-toxic, biocompatible, widely available, inexpensive, and easy to functionalize polysaccharides. Our approach was to synthesize, purify and characterize cationic derivatives of dextran, hydroxypropylcellulose, pullulan and γ-cyclodextrin, then to screen them for potential heparin-reversal activity using an in vitro assay and finally examine efficacy and safety of the most active polymers in Wistar rat and BALB/c mouse models of experimentally induced arterial and venous thrombosis. Efficacy studies included the measurement of thrombus formation, activated partial thromboplastin time, bleeding time, and anti-factor Xa activity; safety studies included the measurement of hemodynamic, hematologic and immunologic parameters. Linear, high molecular weight dextran substituted with glycidyltrimethylammonium chloride groups at a ratio of 0.65 per glucose unit (Dex40-GTMAC3) is the most potent and the safest UFH inhibitor showing activity comparable to that of protamine while possessing lower immunogenicity. Cationic polysaccharides of various structures neutralize UFH. Dex40-GTMAC3 is a promising and potentially better UFH antidote than protamine.

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Section: Introductionmentioning

confidence: 99%

Nonclinical Evaluation of Novel Cationically Modified Polysaccharide Antidotes for Unfractionated Heparin

et al. 2015

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“…The importance of insulin allergy relies on its fundamental role as a lifelong treatment. Several cases have been documented on diabetic patients, allergic to Glargine [ 32 , 33 ], Detemir [ 34 , 35 ], Crystalline [ 14 , 36 ], NPH [ 14 , 37 ], Aspart [ 14 ], Lispro [ 33 ], all available insulins [ 8 , 12 , 15 , 38 ], and even components of such medications such as metacresol [ 24 ] and protamine [ 10 , 19 , 33 ], with or without presence of beta-lactam antibiotic allergy [ 12 ]. Clinical presentation varies, from local cutaneous lesions to anaphylactic shock, either IgE- or IgG-mediated [ 39 ]; see Figure 1 .…”

Section: Discussionmentioning

confidence: 99%

Successful Management of Insulin Allergy and Autoimmune Polyendocrine Syndrome Type 4 with Desensitization Therapy and Glucocorticoid Treatment: A Case Report and Review of the Literature

Rojas

Villalobos

Martínez

et al. 2014

Case Reports in Immunology

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Introduction. Insulin allergy is a rare complication of insulin therapy, especially in type 1 diabetes mellitus (T1DM). Key manifestations are hypersensitivity-related symptoms and poor metabolic control. T1DM, as well as insulin allergy, may develop in the context of autoimmune polyendocrine syndrome (APS), further complicating management. Case Report. A 17-year-old male patient, diagnosed with T1DM, was treated with various insulin therapy schemes over several months, which resulted in recurrent anaphylactoid reactions and poor glycemic control, after which he was referred to our Endocrinology and Immunology Department. A prick test was carried out for all commercially available insulin presentations and another insulin scheme was designed but proved unsuccessful. A desensitization protocol was started with Glargine alongside administration of Prednisone, which successfully induced tolerance. Observation of skin lesions typical of vitiligo prompted laboratory workup for other autoimmune disorders, which returned positive for autoimmune gastritis/pernicious anemia. These findings are compatible with APS type 4. Discussion. To our knowledge, this is the first documented case of insulin allergy in type 4 APS, as well as this particular combination in APS. Etiopathogenic components shared by insulin allergy and APS beg for further research in immunogenetics to further comprehend pathophysiologic aspects of these diseases.

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“…Protamin uzun etkili insülin preparatlarına eklenir ve alerjik reaksiyona sebebiyet verebilir. Önceki protamin maruziyetleri protamin alerjisi için bir risk faktörüdür (24). Protamine erken tip reaksiyonun IgE aracılı veya kompleman aracılı olduğu düşünülmektedir (25,26).…”

Section: Tablo-1: Sık Kullanılan Insülin Preparatları Ve Içerdikleri unclassified

Insulin allergy and the approach to a patient with insulin allergy

Börekçi¹

2016

Journal of Contemporary Medicine

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With the production of recombinant human insulin preparation, insulin allergy incidence has declined steadily. However, in some cases still it can lead to serious lifethreatening condition. Evaluation requires close collaboration with endocrinology and allergy experts. Our purpose in writing this article is to describe the allergic reactions to insulin with the current knowledge and to review the approach and treatment of patients with insulin allergy.

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Allergic shock and death associated with protamine administration in a diabetic patient

Cited by 39 publications

References 21 publications

Nonclinical Evaluation of Novel Cationically Modified Polysaccharide Antidotes for Unfractionated Heparin

Nonclinical Evaluation of Novel Cationically Modified Polysaccharide Antidotes for Unfractionated Heparin

Successful Management of Insulin Allergy and Autoimmune Polyendocrine Syndrome Type 4 with Desensitization Therapy and Glucocorticoid Treatment: A Case Report and Review of the Literature

Insulin allergy and the approach to a patient with insulin allergy

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