Insulin allergy and extensive lipoatrophy in child with type 1 diabetes.
Insulin allergy and lipoatrophy in type 1 diabetic patients have been previously reported but the mechanisms are not well documented. Here, we report a case emphasizing the role of abnormal local immune reaction associated with cytokine hyper production. The patient is a 7-year-old boy with a familial history of common variable immunodeficiency. Eight months after the diagnosis of type 1 diabetes, he developed signs of insulin allergy expressed as continuously extensive and profound lipoatrophy contrasting with a well-preserved metabolic control. Specific insulin allergy was confirmed by skin prick tests that showed lymphoid activated cells in the subcutaneous tissue at the site of insulin injection. All therapies reported in the literature (antihistaminic, local steroid, change to lispro insulin, immunosuppressive treatment, subcutaneous insulin pump, peritoneal insulin infusion) were not efficient. It is suggested that familial disorders of immune cell functions with abnormal and excessive cytokine production might explain these adverse effects triggered by insulin with severe allergic reactions and lipoatrophy.
Inserm U 690 'Diabète de l'enfant et développement', Robert Debré Hospital, Paris, France. jacques.beltrand@rdebre.inserm.fr
Jacques
J
Beltrand
Sophie
S
Guilmin-Crepon
Mireille
M
Castanet
Michel
M
Peuchmaur
Paul
P
Czernichow
Claire
C
Levy-Marchal
D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000473:pathology; D004342:Drug Hypersensitivity / Q000209:etiology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use; D008060:Lipodystrophy / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D010375:Pedigree
D007004:Hypoglycemic Agents; D007328:Insulin