Continuous subcutaneous insulin infusion allows tolerance induction and diabetes treatment in a type 1 diabetic child with insulin allergy

Hasselmann, C. M.; Pecquet, C.; Raverdy, C.; Sola-Gazagnes, A.; Lobut, Jean‐Bruno; Carel, Jean‐Claude; Tubiana‐Rufi, N.

doi:10.1016/j.diabet.2012.10.002

Cited by 18 publications

(21 citation statements)

References 14 publications

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“…The clinical presentation can range from local injection site reactions to severe anaphylaxis (5). Allergies due to the development of insulin-specific antibodies necessitate insulin desensitization, and several case reports have demonstrated successful desensitization protocols using a series of gradually increasing subcutaneous (SC) doses of a rapid-acting insulin analogue (6)(7)(8), or continuous subcutaneous insulin infusion (CSII) delivered through an insulin pump (9-11). There have only been a few case reports demonstrating successful desensitization with IV insulin alone (12), or in combination with SC insulin delivered by CSII (13,14).…”

Section: Introductionmentioning

confidence: 99%

Rapid Desensitization with Intravenous Insulin in a Patient with Diabetic Ketoacidosis and Insulin Allergy

Shuster¹,

Borici-Mazi

Awad

et al. 2020

AACE Clinical Case Reports

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Objective: We report a case of insulin desensitization in a patient with known allergy to multiple insulin preparations who presented with diabetic ketoacidosis (DKA). Methods: Clinical and laboratory data, and desensitization protocols are presented. Results: A 65-year-old woman with type 2 diabetes and a documented insulin allergy presented with severe DKA. She was managed initially with intravenous (IV) fluids, sodium bicarbonate, and hemodialysis. An intradermal skin test was positive for 0.01 units/mL of human regular insulin. A rapid desensitization protocol for IV human regular insulin was initiated after pretreatment with methylprednisolone, ranitidine, montelukast, and cetirizine. An initial dilution of 1 unit of insulin in 100,000 mL of 0.9% sodium chloride was started at 5 mL/hour IV. The dilution was increased at 60-minute intervals to 1 unit/10,000 mL, 1 unit/1,000 mL, 1 unit/100 mL, 1 unit/10 mL, then 1 unit/1 mL. The dose was then increased from 1 to 7 units/hour (0.1 units/kg body weight/hour). The anion gap closed after 24 hours, and overlapping desensitization was started for subcutaneous (SC) human regular insulin starting with 0.00001 units with a gradual increase to 7 units before meals and 6 units at bedtime over 5 days. There were no anaphylactic reactions to IV or SC insulin. She was discharged with human regular insulin SC 4 times daily, oral montelukast, cetirizine, diphenhydramine as needed, and an epinephrine pen. No allergic reactions were reported at follow-up visits. Conclusion: Rapid insulin desensitization is possible to allow treatment of DKA with human regular insulin IV in patients with known insulin allergy.

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Section: Introductionmentioning

confidence: 99%

Rapid Desensitization with Intravenous Insulin in a Patient with Diabetic Ketoacidosis and Insulin Allergy

Shuster¹,

Borici-Mazi

Awad

et al. 2020

AACE Clinical Case Reports

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“…C. Hasselmann и соавт. [20] при-водят наблюдение 8-летнего мальчика, у которого через 3 мес после установления диагноза сахарного диабета 1-го типа и начала инсулинотерапии отмеча-лось появление в местах инъекций инсулина зудящих волдырей размером 1,5 см, сохранявшихся в течение нескольких дней. На протяжении 7 мес у мальчика наблюдалось два эпизода крапивницы через несколь-ко секунд после инъекций инсулина.…”

Section: обзоры литературыunclassified

Cutaneous manifestations of diabetes mellitus in children

Лимаренко¹

2017

Ross. vestn. perinatol. pediatr.

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Известно, что многие эндокринные заболевания сопровождаются поражением кожи. Если это поражение вызвано исходным гормонально-метабо-лическим дефектом, оно проявляется уже на ранних стадиях заболевания и служит важным диагностиче-ским признаком. Поражение кожи может возникать вследствие вторичных метаболических нарушений как осложнение основного заболевания или быть ос-ложнением лечения [1][2][3].Сахарный диабет -группа метаболических забо-леваний, характеризующихся гипергликемией, кото-рая является следствием недостаточности секреции инсулина или нарушения чувствительности к инсу-лину или обоих этих факторов. В мире насчитывается 175 млн человек, больных сахарным диабетом. По про-гнозам ВОЗ, к 2025 г. количество больных возрастет и составит более 337 млн человек. В последние годы от-мечается рост заболеваемости сахарным диабетом сре-ди детей (особенно моложе 5 лет) и подростков [1,2].Поражения кожи при сахарном диабете могут быть обусловлены метаболическими расстройствами, а также развиваться вследствие инъекций инсулина, в результате присоединения инфекции либо при син-дромальных формах сахарного диабета [2,3]. К пора-жениям кожи, обусловленным метаболическими на-рушениями, относятся: диабетическая дерматопатия, диабетический пузырь, липоидный некробиоз, коль-цевидная гранулема, эруптивные ксантомы, склере-дема, витилиго [3][4][5].Диабетическая дерматопатия представляет собой округлые атрофические, красновато-коричневые пятна диаметром до 1 см, локализующиеся чаще на передней поверхности голеней. Заболевание начинается с папулезных высыпаний. Ведущую роль в патогенезе играет микроангиопатия, а при биопсии выявляют утолщение базальной мембра-ны капилляров.Диабетические пузыри (bullosis diabeticorum) воз-никают внезапно, без предшествующего воспаления и достигают больших размеров. Преимущественная их локализация -конечности. Гистоморфологически выявляют субэпидермальные или внутридермальныеАдрес для корреспонденции: Лимаренко Марина Петровна -к.м.н., доцент кафедры педиатрии Донецкого национального медицинского университета 83003 Украина, Донецк, пр. Ильича, д. 16. Кожные проявления сахарного диабета у детей М.П. ЛимаренкоДонецкий национальный медицинский университет им. М. Горького, Донецк, Украина Cutaneous manifestations of diabetes mellitus in children M.P. LymarenkoM. Gorky Donetsk National Medical University, Donetsk, Ukraine Поражения кожи при сахарном диабете могут быть обусловлены метаболическими расстройствами, а также развиваться вследствие инъекций инсулина, в результате присоединения инфекции либо при синдромальных формах сахарного диабета. К поражениям кожи, обусловленным метаболическими нарушениями, относятся: диабетическая дерматопатия, диабетиче-ский пузырь, липоидный некробиоз, кольцевидная гранулема, эруптивные ксантомы, склередема, витилиго. Нередко у детей и подростков, больных сахарным диабетом, встречаются инфекционные поражения кожи, такие как канди-доз кожи и слизистых (стоматит, вагинит, онихомикоз, паронихия, заеда, кандидоз кожных складок и межпальцевых проме-жутков), бактериальные инф...

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“…Antihistamines and steroids may be used in the treatment of acute reactions and in desensitization. Performing the desensitization process during the honeymoon period may be more appropriate (13).…”

Section: Treatmentmentioning

confidence: 99%

Insulin Allergy

Erdenen¹,

Kantarci²

2016

Istanbul Med J

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Insulin hypersensitivity reactions have been reported in both type 1 and type 2 diabetic patients. Some of these reactions stem from insulin itself, while some result from additive agents. Although reactions to all types of insulin can develop, reactions to human insulin and its analogues are rare. However, vital reactions can be observed. Previously used bovine and porcine insulins are known to be more immunogenic, and reactions to these types of insulin are more commonly observed. Due to the development of the purification process, the rate of these reactions has decreased considerably, from 30%-1% (1, 2). One-third of these reactions are associated with insulin, while the remaining reactions result from different substances that are added to the preparations. The allergic reaction types are named Type I, Type III, and Type IV (1-4). Skin reactions occurring at the injection site reduce the effects of exogenous insulin, stimulate insulin degradation, and/or impair insulin absorption. Thus, diabetes regulation also deteriorates (5).In addition to human insulins (NPH and regular insulins), analogues (lispro, aspart, glargine, detemir, glulisine, and degludec) may also induce allergic reactions. Stimulants may be an epitope of insulin itself and may also be changed by an antigenic epitope during production and purification. During subcutaneous degradation of insulin, different antigenic structures may be formed. Zinc and protamine are added to insulin to extend the duration of action, while metacresol and various contaminants are added as preservatives; these may cause reactions (1, 2). The commercially available insulin types and the additives they contain are presented in Table 1. Protamine is a cationic substance found in fish sperm; it is added to delay the release of insulin from the injection site. Exposure to protamine is a risk factor for allergy. Although fish allergies and vasectomy are believed to create risks in this regard, this situation was found to be only partly significant; no other relationships with other insulin types were observed, and no risk was found in a prospective study (3). However, protamine allergies and long-time use of insulin create risk for the production of insulin antibodies. In poorly controlled diabetes, this possibility should be considered. Although autoantibodies against protamine-heparin complex have been found, the relationship between insulin antibodies and protamine is not clear. This relationship is particularly significant in intermediate and rapid-acting insulins; the relationship between analogue insulins and autoantibodies was found to be contradictory. The time of insulin use, not the duration of diabetes, is significant. Protamine causes the formation of autoantibodies, probably by causing a change in the conformation of insulin. Also, cross-reactivity between human protamine and salmon protamine in insulin or the development of an immunologic response to salmon protamine can cause an allergic reaction. The amount of protamine found in NPH and insulin aspart is...

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Continuous subcutaneous insulin infusion allows tolerance induction and diabetes treatment in a type 1 diabetic child with insulin allergy

Cited by 18 publications

References 14 publications

Rapid Desensitization with Intravenous Insulin in a Patient with Diabetic Ketoacidosis and Insulin Allergy

Rapid Desensitization with Intravenous Insulin in a Patient with Diabetic Ketoacidosis and Insulin Allergy

Cutaneous manifestations of diabetes mellitus in children

Insulin Allergy

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