title: Anaphylaxis to subcutaneous neutral protamine Hagedorn insulin with simultaneous sensitization to protamine and insulin.
abstract: We report an insulin-treated diabetic patient who suffered, in a 2-month period, three severe anaphylactic reactions immediately after self-administered subcutaneous injections of neutral protamine Hagedorn (NPH) human recombinant-DNA insulin. These reactions consisted of local and systemic symptoms, including dyspnea and hypotension. A simultaneous sensitization to human insulin and to protamine was demonstrated, both by skin tests and by the determination of serum specific IgE. Suspecting protamine allergy, we performed a test dose to human lente insulin with perfect tolerance. After a 1-year follow-up with lente-insulin treatment, no reactions have occurred, despite treatment interruptions. Therefore, protamine IgE-mediated allergy probably caused our patient's reactions. In conclusion, protamine sensitization should be ruled out in any patient with a history of reactions to subcutaneous protamine-containing insulins, even if insulin sensitization is present.
authors.affiliation: Section of Allergy, Hospital Universitario Ntra. Sra. del Pino, Facultad de Ciencias Médicas y de la Salud, Las Palmas de Gran Canaria, Canary Islands, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Blanco
authors.forename: R
authors.initials: R
authors.lastname: Castillo
authors.forename: J
authors.initials: J
authors.lastname: Quiralte
authors.forename: J
authors.initials: J
authors.lastname: Delgado
authors.forename: I
authors.initials: I
authors.lastname: García
authors.forename: P
authors.initials: P
authors.lastname: de Pablos
authors.forename: T
authors.initials: T
authors.lastname: Carrillo
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000209:etiology*; D003922:Diabetes Mellitus, Type 1 / Q000276:immunology; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000276:immunology*; D007073:Immunoglobulin E / Q000097:blood*; D007336:Insulin, Isophane / Q000276:immunology*; D049528:Insulin, Long-Acting / Q000276:immunology*; D008297:Male; D011479:Protamines / Q000276:immunology*; D012882:Skin Tests
chemical_list: D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D011479:Protamines; D007073:Immunoglobulin E; D007336:Insulin, Isophane