title: Human insulin allergy-immediate and late type III reactions in a long-standing IDDM patient.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Laboratory of Medical Investigation (LIM 18), Hospital das Clínicas of University of São Paulo Medical School, Brazil.
authors.forename: M E
authors.initials: ME
authors.lastname: Silva
authors.forename: M J
authors.initials: MJ
authors.lastname: Mendes
authors.forename: M J
authors.initials: MJ
authors.lastname: Ursich
authors.forename: D M
authors.initials: DM
authors.lastname: Rocha
authors.forename: A H
authors.initials: AH
authors.lastname: Brito
authors.forename: R T
authors.initials: RT
authors.lastname: Fukui
authors.forename: G B
authors.initials: GB
authors.lastname: Ruggeri
authors.forename: M
authors.initials: M
authors.lastname: Nery
authors.forename: B L
authors.initials: BL
authors.lastname: Wajchenberg
mesh_terms: D000328:Adult; D003176:Complement C3 / Q000378:metabolism; D003181:Complement C4 / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000276:immunology; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000209:etiology* / Q000517:prevention & control; D006969:Hypersensitivity, Immediate / Q000209:etiology* / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007073:Immunoglobulin E / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007328:Insulin / Q000009:adverse effects* / Q000276:immunology
chemical_list: D003176:Complement C3; D003181:Complement C4; D007004:Hypoglycemic Agents; D007074:Immunoglobulin G; D007328:Insulin; D007073:Immunoglobulin E