title: Pancreas transplantation for treatment of generalized allergy to human insulin in type 1 diabetes.
abstract: 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%.
authors.affiliation: Université Catholique de Louvain, Brussels, Belgium. jacques.malaise@chir.ucl.ac.be
authors.forename: J
authors.initials: J
authors.lastname: Malaise
authors.forename: J
authors.initials: J
authors.lastname: Leonet
authors.forename: E
authors.initials: E
authors.lastname: Goffin
authors.forename: C
authors.initials: C
authors.lastname: Lefebvre
authors.forename: D
authors.initials: D
authors.lastname: Tennstedt
authors.forename: B
authors.initials: B
authors.lastname: Vandeleene
authors.forename: M
authors.initials: M
authors.lastname: Buysschaert
authors.forename: J P
authors.initials: JP
authors.lastname: Squifflet
mesh_terms: 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
chemical_list: D007328:Insulin