title: Continuous subcutaneous insulin infusion allows tolerance induction and diabetes treatment in a type 1 diabetic child with insulin allergy.
abstract: OBJECTIVE
  Insulin allergy is a rare but serious and challenging condition in patients with type 1 diabetes (T1D). This is a case report of an 8-year-old boy with T1D and an allergy to insulin.
  
  
  METHODS
  Three months after being diagnosed with T1D, the patient developed progressive skin reactions to insulin, characterized by small 1.5-cm pruritic wheals at injection sites that persisted for several days. Seven months after diagnosis, he experienced two episodes of generalized urticaria with systemic symptoms that were seen within a few seconds of insulin injection. Examination revealed lipoatrophy of the thighs. Intradermal skin tests were positive for protamine, glargine and lispro. The patient was started on a continuous subcutaneous insulin infusion (CSII) tolerance induction protocol, consisting of a very low basal rate that was progressively increased, with the first bolus given under medical supervision, and was well tolerated for 4 months. After this period of time, the skin wheals reappeared, localized to the infusion sites, but without urticaria or any other generalized reactions. Intradermal skin tests were repeated and were again positive. Serum insulin-specific IgE measured 30 months after the first allergic reactions were positive. After 3 years, pump therapy is ongoing and blood glucose control has remained relatively good (HbA1c 7.6%).
  
  
  CONCLUSIONS
  In T1D children with insulin allergy, CSII can successfully be used to both induce insulin tolerance and allow diabetes insulin therapy, although insulin desensitization cannot always be fully achieved. The induction protocol was easily manageable partly due to the "honeymoon" period that the patient was still in, but it should nonetheless be used even when the patient has higher insulin requirements.
authors.affiliation: Department of Pediatric Endocrinology and Diabetology, Robert Debré Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Hasselmann
authors.forename: C
authors.initials: C
authors.lastname: Pecquet
authors.forename: E
authors.initials: E
authors.lastname: Bismuth
authors.forename: C
authors.initials: C
authors.lastname: Raverdy
authors.forename: A
authors.initials: A
authors.lastname: Sola-Gazagnes
authors.forename: J-B
authors.initials: JB
authors.lastname: Lobut
authors.forename: J-C
authors.initials: JC
authors.lastname: Carel
authors.forename: N
authors.initials: N
authors.lastname: Tubiana-Rufi
mesh_terms: D001786:Blood Glucose; D002648:Child; D003923:Diabetes Mellitus, Lipoatrophic / Q000188:drug therapy / Q000276:immunology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D004342:Drug Hypersensitivity / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D055104:Infusions, Subcutaneous / Q000009:adverse effects*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D007332:Insulin Infusion Systems; D008297:Male; D013848:Thigh; D016896:Treatment Outcome; D014581:Urticaria
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin