Severe insulin allergy after percutaneous transluminal coronary angioplasty |
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| Authors: | Chun Wang Zhen-Yu Ding Shi-Qing Shu Yi Liu Yu-Cheng Chen Xing-Wu Ran Zhen-Mei An Hao-Ming Tian Nan-Wei Tong Xiu-Jun Li Ye-Rong Yu |
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| Affiliation: | 1. Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Sichuan, People''s Republic of China;2. Division of Thoracic Cancer, Cancer Center, West China Hospital, Sichuan University, Sichuan, People''s Republic of China;3. Department of Cardiovasology, West China Hospital, Sichuan University, Sichuan, People''s Republic of China;1. Division of Endocrinology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China;2. Department of Clinical Medicine, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China;3. Division of Endocrinology and Metabolism, Chengdu Fifth People''s Hospital, Chengdu, Sichuan 611130, China;4. Chengdu Yincao Community Hospital, Chengdu, Sichuan 611130, China;5. Chengdu Aerospace Hospital, Chengdu, Sichuan 610100, China;6. Laboratory of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China;1. Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;2. Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;1. Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL, United States;2. Department of Pharmacology and Toxicology, Georgia Regents University, Augusta, Georgia, United States;3. The Malcom Randall VAMC, Gainesville, FL, United States;3. Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio 44106;6. Department of Medicine, Case Western Reserve University, Cleveland, Ohio 44106;4. The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Victoria 3052, Australia;5. Department of Medical Biology, University of Melbourne, Parkville, Victoria 3010, Australia |
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| Abstract: | Background: Insulin therapy is essential for type 1 and inadequately controlled type 2 diabetic patients. Insulin allergies have become less common since the introduction of highly purified human recombinant insulin. There are rare reports of severe insulin allergic reactions after percutaneous transluminal coronary angioplasty (PTCA) in patients with type 2 diabetes who had no previous allergic reactions. To better understand the causes and presentation of this rare acute reaction, we present the following observed case.Case summary: A 63-year-old Chinese man (height, 172 cm; weight, 68.5 kg) with a 17-year history of type 2 diabetes and hypertension was first admitted to the West China Hospital, Sichuan University, Sichuan, People's Republic of China, for uncontrolled type 2 diabetes. He used regular human insulin, neutral protamine Hagedorn insulin, or premixed insulin without any allergic reactions. Four months later, PTCA was performed because of an acute myocardial infarction. The patient was administered 50 mg of protamine after active abdominal bleeding due to a right external iliac artery rupture. Three months later, recurrent raised, pruritic erythema occurred at the insulin injection site immediately after injection. Four weeks later, he experienced an attack of generalized urticaria at multiple previous injection sites (abdomen, upper arms, thighs) after injecting premixed insulin. It was accompanied by dizziness and palpitations. During the following 3 months, the symptoms recurred 3 times; one time, the patient reported losing consciousness for 2 to 3 minutes. The results of a skin prick test found that he was allergic to human recombinant insulin and insulin lispro. The allergy was resolved by changing his treatment regimen from insulin to oral hypoglycemic agents. A Naranjo score of 10 suggested a definite relationship (score ≥9) between the adverse drug reaction and the insulin administration.Conclusions: We present a definite case of allergy associated with insulin and insulin lispro administration. The patient had not experienced anaphylactic reactions prior to PTCA and protamine administration. |
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