Human insulin allergy-immediate and late type III reactions in a long-standing IDDM patient

Human insulin allergy—immediate or late type III reaction—is a rare event. We report the case of a 33-year-old female patient with insulin-dependent diabetes mellitus for 25 years who presented, in the last 8 years, mild but generalized urticaria partially controlled with oral antihistamines. There...

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Bibliographic Details
Published in:	Diabetes research and clinical practice Vol. 36; no. 2; pp. 67 - 70
Main Authors:	Silva, Maria E.R., Mendes, Maria J.M., Ursich, Mileni J.M., Rocha, Dalva M., Brito, Alberto H.M., Fukui, Rosa T., Ruggeri, Gláucia B., Nery, Marcia, Wajchenberg, Bernardo L.
Format:	Journal Article
Language:	English
Published:	Shannon Elsevier Ireland Ltd 01-05-1997 Elsevier Science
Subjects:	Adult Allergy Biological and medical sciences Complement C3 - metabolism Complement C4 - metabolism Diabetes Mellitus, Type 1 - complications Diabetes Mellitus, Type 1 - immunology Drug Hypersensitivity - etiology Drug Hypersensitivity - prevention & control Female Hormones. Endocrine system Humans Hypersensitivity, Delayed - etiology Hypersensitivity, Delayed - prevention & control Hypersensitivity, Immediate - etiology Hypersensitivity, Immediate - prevention & control Hypoglycemic Agents - adverse effects Immunoglobulin E - blood Immunoglobulin G - blood Insulin Insulin - adverse effects Insulin - immunology Insulin-dependent diabetes mellitus Medical sciences Pharmacology. Drug treatments Allergy Insulin Insulin-dependent diabetes mellitus Endocrinopathy Human Immunopathology Replacement therapy Insulin human Autoimmune disease Delayed hypersensitivity Case study Chemotherapy Insulin dependent diabetes Female Immediate hypersensitivity
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Summary:	Human insulin allergy—immediate or late type III reaction—is a rare event. We report the case of a 33-year-old female patient with insulin-dependent diabetes mellitus for 25 years who presented, in the last 8 years, mild but generalized urticaria partially controlled with oral antihistamines. There was no improvement after changing from mixed beef-pork to human insulin. In the last 3 years another allergic manifestation began: small, localized, subdermal and painful non-erythematous nodules with central hematomas at injection sites, occurring 6–8 h after the insulin injection and lasting for 48 h. The following maneuvers had no benefit: (1) Human insulin (NPH or Lente) administered with dexametasone or xylocain locally. (2) Short acting human insulin with or without previous boiling. (3) Anti-histamine cetirizine dihydrochloride—10 mg/day. The allergic symptoms disappeared only after treatment with short acting human insulin (up to 100 U/day) associated to prednisone—40 mg/day and cetirizine dihydrochloride for 4 months. However, after stopping prednisone the urticaria reappeared and it was relieved with insulin desensitization. The pain at the site of injections persisted. Conclusion: This long-standing IDDM patient presented two types of reactions to human insulin: the immediate type (systemic urticaria), treated with antihistamines and desensitization, and the Arthus' type III reaction (nodules and hematomas occurring 6–8 h after the insulin injection) that required glucocorticoid therapy for more than 4 months.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	0168-8227 1872-8227
DOI:	10.1016/S0168-8227(97)00031-4