Solitary pancreas transplantation for life-threatening allergy to human insulin.
We report on a 30-year-old man, with type 1 diabetes mellitus, who developed generalized allergy to insulin consisting of several bouts of tremor, tachycardia, breathlessness and syncope. Strong positive reactions to protamine and metacresol were demonstrated by skin-prick testing. Symptoms persisted despite the use of antihistamine therapy, Actrapid HM Paraben and Monotard (insulin without protamine and metacresol) and immunosuppression (tacrolimus). He underwent a cadaver pancreas transplantation with portal-enteric drainage in June 2003. Following the antithymocyte globulin induction, immunosuppression consisted in tacrolimus and sirolimus without steroids. The patient subsequently reported a complete resolution of his symptoms and excellent glycaemic control. Thirteen months after transplantation, the patient developed oral ulcerations and severe leucopoenia initially attributed to sirolimus, which was subsequently stopped. A hyperglycaemic episode following corticosteroid therapy for acute rejection therapy required the reintroduction of insulin. Allergic manifestations reappeared promptly. Currently, 2 years after transplantation, the patient is euglycaemic without insulin (glycated haemoglobin 5.8%) and he is free of allergic reactions.
Léonet
Jacqueline
J
Department of Diabetology, Centre Medical Amercoeur, Université Catholique de Louvain, Brussels, Belgium.
Malaise
Jacques
J
Goffin
Eric
E
Lefebvre
Chantal
C
Tennstedt
Dominique
D
Vandeleene
Bernard
B
Buysschaert
Martin
M
Squifflet
Jean-Paul
JP
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000276:immunology / Q000628:therapy; D006706:Homeostasis; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology* / Q000628:therapy*; D006969:Hypersensitivity, Immediate / Q000628:therapy*; D007166:Immunosuppressive Agents / Q000633:toxicity; D007328:Insulin / Q000737:chemistry / Q000276:immunology*; D007333:Insulin Resistance; D008297:Male; D016035:Pancreas Transplantation / Q000379:methods*; D011479:Protamines / Q000633:toxicity; D020123:Sirolimus / Q000633:toxicity; D016559:Tacrolimus / Q000633:toxicity
D007166:Immunosuppressive Agents; D007328:Insulin; D011479:Protamines; D020123:Sirolimus; D016559:Tacrolimus