[Desensitization to human recombinant DNA insulin in an adolescent with insulin-dependent diabetes mellitus].
BACKGROUND
Adverse reactions to drugs have increased in the last years, about 15% of all side effects are thought to be immune mediated according to the Coombs and Gell classification they can be type I (immediate) hypersensitivity, type II (cytotoxic) type III (immune complex mediated) or type IV (delay). Allergy to insulin is defined as an immunological response type I, and type II or III to exogenous insulin solutions occurring the 0.1% and 0.2% of the patients.


METHODS
A 13 year old female with a 4-year history of insulin-dependent diabetes mellitus who presented hypersensitivity against recombinant DNA (rDNA) insulin manifested with urticaria and itching. We used a premedication therapy without good response and impossibility to use alternative therapy for her metabolic control, so she needed desensitization with insulin.


METHODS
Skin prick testing with rapid insulin preparations 1:10 W/V dilution were positive. IgE antibodies to insulin weren't presented. IgE serum values were normal. We began the desensitization with a rapid 1:1000 UI insulin solution by intradermal route, than by subcutaneous route until reaching the accumulated doses necessary per day. During the process it appeared a papular rash and itching which were treated with an intravenous antihistaminic without troubles.


RESULTS
The patient tolerated the desensitization procedure very well. For the past 14 months she has been treated uneventfully by subcutaneous administration of rDNA insulin.


CONCLUSIONS
The desensitization against drugs is not a frequently process it only has to be used when it is impossible to substitute the treatment. Our patient showed probably hypersensitivity type 1 to insulin. However, we have to take into account the cytotoxic reaction caused by IgG or IgM antibodies or by immune complex. The desensitization finally was tolerated, 14 months after our patient accepts correctly her daily dose of human recombinant insulin.
Rosas Vargas
M A
MA
Departamento de Alergia e Inmunologia, Hospital Infantil de México Federico Gómez.
Alvarez Amador
M
M
Alvarez Amador
L M
LM
del Río Navarro
B E
BE
Avila Castanón
L
L
Sienra Monge
J J
JJ
D000293:Adolescent; D003888:Desensitization, Immunologic; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000276:immunology; D003875:Drug Eruptions / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000235:genetics / Q000276:immunology* / Q000627:therapeutic use; D011537:Pruritus / Q000139:chemically induced / Q000628:therapy; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use; D012882:Skin Tests; D014581:Urticaria / Q000139:chemically induced / Q000628:therapy
D007328:Insulin; D011994:Recombinant Proteins
Desensibilización a insulina DNA recombinante humana en una adolescente con diabetes mellitus insulinodependiente.