Pancreas transplantation for treatment of generalized allergy to human insulin in type 1 diabetes.
We report the case of a 29-year-old man with a 14-year history of type 1 diabetes, normal renal function, and mild diabetic retinopathy. The patient progressively developed a generalized allergic reaction to two insulin excipients--protamine and metacresol--with systemic manifestations of tremor, tachycardia, vertigo, shortness of breath, and short episodes of unconsciousness causing him to be out of work. In June 2003, he received a vascularized cadaveric pancreas transplant using induction with polyclonal antibodies along with tacrolimus and sirolimus but without steroids. A hyperglycemic episode following corticosteroid therapy for rejection treatment required reintroduction of insulin therapy with prompt reappearance of allergic manifestations. Now, the patient is euglycemic without insulin or allergic manifestations and a glycated hemoglobin of 6.4%.
Malaise
J
J
Université Catholique de Louvain, Brussels, Belgium. jacques.malaise@chir.ucl.ac.be
Leonet
J
J
Goffin
E
E
Lefebvre
C
C
Tennstedt
D
D
Vandeleene
B
B
Buysschaert
M
M
Squifflet
J P
JP
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000276:immunology* / Q000601:surgery*; D004342:Drug Hypersensitivity; D006801:Humans; D007328:Insulin / Q000009:adverse effects*; D008297:Male; D016035:Pancreas Transplantation; D016896:Treatment Outcome
D007328:Insulin