title: Failure of multiple therapies in the treatment of a type 1 diabetic patient with insulin allergy: a case report.
abstract: OBJECTIVE
  To describe the clinical manifestations of insulin allergy and explain a systematic management approach.
  
  
  METHODS
  We present the clinical, laboratory, and pathologic findings of a type 1 diabetic patient with allergy to subcutaneous insulin and briefly review the related literature.
  
  
  RESULTS
  An 18-year old woman with type 1 diabetes mellitus had an insulin allergy and developed subcutaneous nodules after insulin administration. Human and analogue insulins were used, but painful nodule formation persisted. Treatment with antihistamines, steroids, and omalizumab and insulin desensitization were ineffective. The patient required pancreatic transplant because glycemic control could not be achieved due to the insulin allergy.
  
  
  CONCLUSIONS
  Insulin allergy is not a common condition and can be challenging in patients with type 1 diabetes. Therefore, identifying patients with true insulin allergy and applying a stepwise approach to their treatment is important.
authors: Wright State University Boonshoft School of Medicine, Dayton, Ohio 45430, USA.
authors: Thomas
authors: T
authors: Koroscil
authors: Yasmin
authors: Y
authors: Kagzi
authors: Dawn
authors: D
authors: Zacharias
mesh_terms: D000293:Adolescent; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use; D016035:Pancreas Transplantation
chemical_list: D007328:Insulin