Generalised allergic reaction to human insulin

Abdu, T. A. M.; Wilkins, Justin; Yelland, Michael; Scarpello, J. H. B.

doi:10.1002/(sici)1528-252x(200001)17:1<31::aid-pdi14>3.0.co;2-9

Cited by 4 publications

(6 citation statements)

References 11 publications

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“…IDT with isolated IP compounds proved to be a relevant method in identification of culprit allergens, thus supporting several case reports [1,4,7,10,21,22]. The interpretation of IDT results was based on clinical findings that were supported in 82% (18/22) of cases.…”

Section: Discussionsupporting

confidence: 77%

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A rational clinical approach to suspected insulin allergy: status after five years and 22 cases

Bødtger

Wittrup

2004

Diabetic Medicine

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Section: Discussionsupporting

confidence: 77%

“…Such identification is possible through intradermal testing (IDT) [20]. A commercially available IDT kit containing several potential IP allergens has been used in case reports [1,4,7,10,21,22].…”

Section: Introductionmentioning

confidence: 99%

A rational clinical approach to suspected insulin allergy: status after five years and 22 cases

Bødtger

Wittrup

2004

Diabetic Medicine

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“…The therapeutic approach of patients with insulin allergy has been extensively explored. When a regression of local allergic reactions does not occur spontaneously or after a 2–4‐week antihistaminic therapy, it is recommended to change the insulin type and to propose human insulin analogues [5,8,11,12]. That was totally unsuccessful in our patient.…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, the systemic manifestations of allergy to insulin are broad and vary from urticaria, bronchospasm to anaphylactic reactions and serum sickness disease with arthralgia, myalgia, headaches, fever and gastro‐intestinal symptoms [5–7]. Three mechanisms are involved to explain the local reactions [3,6,8]: degranulation of mast cells in the presence of specific IgE directed against insulin; formation of antigen–antibody (IgG) complexes and complement fixation; delayed hypersensitization with lymphokines release. The most likely explanation for systemic allergy is the development of an immunization against insulin excipients, most often, protamine or metacresol or against insulin itself.…”

Section: Introductionmentioning

confidence: 99%

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Solitary pancreas transplantation for life-threatening allergy to human insulin*

Léonet¹,

Malaise²,

Goffin³

et al. 2006

Transplant Int

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Summary We report on a 30‐year‐old man, with type 1 diabetes mellitus, who developed generalized allergy to insulin consisting of several bouts of tremor, tachycardia, breathlessness and syncope. Strong positive reactions to protamine and metacresol were demonstrated by skin‐prick testing. Symptoms persisted despite the use of antihistamine therapy, Actrapid HM Paraben® and Monotard® (insulin without protamine and metacresol) and immunosuppression (tacrolimus). He underwent a cadaver pancreas transplantation with portal‐enteric drainage in June 2003. Following the antithymocyte globulin induction, immunosuppression consisted in tacrolimus and sirolimus without steroids. The patient subsequently reported a complete resolution of his symptoms and excellent glycaemic control. Thirteen months after transplantation, the patient developed oral ulcerations and severe leucopoenia initially attributed to sirolimus, which was subsequently stopped. A hyperglycaemic episode following corticosteroid therapy for acute rejection therapy required the reintroduction of insulin. Allergic manifestations reappeared promptly. Currently, 2 years after transplantation, the patient is euglycaemic without insulin (glycated haemoglobin 5.8%) and he is free of allergic reactions.

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