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• W2051277251 abstract "RationaleImmune mediated drug allergy to synthesized insulin is rare. Occasionally individuals present with immediate hypersensitivity reactions (HSRs) to multiple forms of insulin and require desensitization. Current protocols rely on subcutaneous administration of insulin. We describe an intravenous desensitization protocol in a 50-year-old woman with adult onset, insulin-dependent diabetes mellitus and diabetic ketoacidosis. She had a history of epinephrine-requiring, anaphylactic reactions to multiple medications including subcutaneous administration of regular, intermediate and long-acting insulin.MethodsIn-vitro IgE to human insulin was negative and her baseline tryptase level was normal. Skin prick testing was negative to regular insulin at 1U/mL. Intradermal testing is equivalent to a drug challenge for insulin, but she declined because of her recurrent anaphylaxis and overall medical fragility. Our patient was pre-medicated with montelukast, cetirizine, famotidine and diphenhydramine prior to desensitization. Serial solutions of regular insulin were prepared at 1:10,000, 1:1,000, 1:100, 1:10 and 1:1 of the standard 1U/mL concentration. We began at a dose equivalent to 0.00005 U/hr and doubled doses every 30 minutes until achieving a goal dose of 0.5 U/hr.ResultsThe patient completed this protocol without manifestation of HSRs and the transition from intravenous to subcutaneous administration of regular insulin was uneventful.ConclusionsPatients with insulin-dependent diabetes mellitus and immediate HSRs to multiple forms of insulin require desensitization. Existing protocols use subcutaneous administration of insulin, but not all patients can tolerate this method. We have demonstrated that this intravenous desensitization protocol can be used to successfully achieve immunological tolerance of subcutaneous insulin. RationaleImmune mediated drug allergy to synthesized insulin is rare. Occasionally individuals present with immediate hypersensitivity reactions (HSRs) to multiple forms of insulin and require desensitization. Current protocols rely on subcutaneous administration of insulin. We describe an intravenous desensitization protocol in a 50-year-old woman with adult onset, insulin-dependent diabetes mellitus and diabetic ketoacidosis. She had a history of epinephrine-requiring, anaphylactic reactions to multiple medications including subcutaneous administration of regular, intermediate and long-acting insulin. Immune mediated drug allergy to synthesized insulin is rare. Occasionally individuals present with immediate hypersensitivity reactions (HSRs) to multiple forms of insulin and require desensitization. Current protocols rely on subcutaneous administration of insulin. We describe an intravenous desensitization protocol in a 50-year-old woman with adult onset, insulin-dependent diabetes mellitus and diabetic ketoacidosis. She had a history of epinephrine-requiring, anaphylactic reactions to multiple medications including subcutaneous administration of regular, intermediate and long-acting insulin. MethodsIn-vitro IgE to human insulin was negative and her baseline tryptase level was normal. Skin prick testing was negative to regular insulin at 1U/mL. Intradermal testing is equivalent to a drug challenge for insulin, but she declined because of her recurrent anaphylaxis and overall medical fragility. Our patient was pre-medicated with montelukast, cetirizine, famotidine and diphenhydramine prior to desensitization. Serial solutions of regular insulin were prepared at 1:10,000, 1:1,000, 1:100, 1:10 and 1:1 of the standard 1U/mL concentration. We began at a dose equivalent to 0.00005 U/hr and doubled doses every 30 minutes until achieving a goal dose of 0.5 U/hr. In-vitro IgE to human insulin was negative and her baseline tryptase level was normal. Skin prick testing was negative to regular insulin at 1U/mL. Intradermal testing is equivalent to a drug challenge for insulin, but she declined because of her recurrent anaphylaxis and overall medical fragility. Our patient was pre-medicated with montelukast, cetirizine, famotidine and diphenhydramine prior to desensitization. Serial solutions of regular insulin were prepared at 1:10,000, 1:1,000, 1:100, 1:10 and 1:1 of the standard 1U/mL concentration. We began at a dose equivalent to 0.00005 U/hr and doubled doses every 30 minutes until achieving a goal dose of 0.5 U/hr. ResultsThe patient completed this protocol without manifestation of HSRs and the transition from intravenous to subcutaneous administration of regular insulin was uneventful. The patient completed this protocol without manifestation of HSRs and the transition from intravenous to subcutaneous administration of regular insulin was uneventful. ConclusionsPatients with insulin-dependent diabetes mellitus and immediate HSRs to multiple forms of insulin require desensitization. Existing protocols use subcutaneous administration of insulin, but not all patients can tolerate this method. We have demonstrated that this intravenous desensitization protocol can be used to successfully achieve immunological tolerance of subcutaneous insulin. Patients with insulin-dependent diabetes mellitus and immediate HSRs to multiple forms of insulin require desensitization. Existing protocols use subcutaneous administration of insulin, but not all patients can tolerate this method. We have demonstrated that this intravenous desensitization protocol can be used to successfully achieve immunological tolerance of subcutaneous insulin." @default.
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• W2051277251 date "2015-02-01" @default.
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• W2051277251 title "Novel Protocol for Successful Intravenous Insulin Desensitization in a Patient with Insulin Dependent Diabetes Mellitus" @default.
• W2051277251 doi "https://doi.org/10.1016/j.jaci.2014.12.1339" @default.
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