Failure of multiple therapies in the treatment of a type 1 diabetic patient with insulin allergy: a case report.
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.
Koroscil
Thomas
T
Wright State University Boonshoft School of Medicine, Dayton, Ohio 45430, USA.
Kagzi
Yasmin
Y
Zacharias
Dawn
D
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
D007328:Insulin