title: Hypersensitivity to repaglinide.
abstract: Meglitinides (repaglinide and nateglinide) are insulin secretagogues used to treat diabetes mellitus. We present a case of hypersensitivity reaction to repaglinide in a 61-year-old man who developed a maculopapular rash 5 days after treatment. Skin prick tests including repaglinide (0.5 g/mL) and patch tests (0.05% in pet and saline) were performed, and the results were negative. A blind oral challenge test with repaglinide was performed and the therapeutic dose was subsequently taken at home every 24 hours for 7 days. The result was positive with a delayed reaction at day 3. A punch biopsy of the skin lesions revealed drug-induced exanthema. The clinical manifestations, the latency period, the reappearance of cutaneous lesions after rechallenge, and the histopathology report of the skin biopsy suggest a type IV mechanism.
authors.affiliation: Allergy Unit, Hospital Central de la Cruz Roja, Madrid, Spain. projasperezezquera@seaic.org
authors.forename: P
authors.initials: P
authors.lastname: Rojas
authors.forename: L
authors.initials: L
authors.lastname: Sánchez
authors.forename: A
authors.initials: A
authors.lastname: Santos
authors.forename: M P
authors.initials: MP
authors.lastname: Góõmez
authors.forename: H
authors.initials: H
authors.lastname: Blanco
authors.forename: J J
authors.initials: JJ
authors.lastname: Laguna
mesh_terms: D002219:Carbamates / Q000009:adverse effects* / Q000276:immunology* / Q000627:therapeutic use; D003510:Cyclohexanes / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000276:immunology; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology* / Q000276:immunology; D004890:Erythema / Q000276:immunology / Q000473:pathology; D005076:Exanthema / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D000077715:Nateglinide; D010328:Patch Tests / Q000379:methods; D010649:Phenylalanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D010880:Piperidines / Q000009:adverse effects* / Q000276:immunology* / Q000627:therapeutic use
chemical_list: D002219:Carbamates; D003510:Cyclohexanes; D007004:Hypoglycemic Agents; D010880:Piperidines; D000077715:Nateglinide; D010649:Phenylalanine; C072379:repaglinide