Lijesh K U, Gupta Riddhi Das, SenthilRaja M, Kapoor Nitin, Paul Thomas V, Thomas Nihal
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College (CMC) Vellore, Tamil Nadu, India.
J Family Med Prim Care. 2020 Aug 25;9(8):4470-4472. doi: 10.4103/jfmpc.jfmpc_148_20. eCollection 2020 Aug.
Hypersensitivity reactions against exogenous insulin are a rare clinical entity after the advent of recombinant human insulin; however, there are still case reports wherein patients develop hypersensitivity reactions against insulin. We present the case of a type 1 diabetes mellitus patient who developed type 1 hypersensitivity reaction against subcutaneous insulin. He had recurrent episodes of diabetic ketoacidosis after developing hypersensitivity reactions against insulin, requiring multiple hospital admissions. When he presented to us, he was on both insulin infusion and subcutaneous insulin, requiring a daily insulin dose of about 800 units and having severe insulin hypersensitivity reactions and hyperglycemia. He had multiple subcutaneous erythematous nodules at the insulin injection sites, however, had no evidence of systemic allergy. Investigations revealed eosinophilic leukocytosis, and high IgE levels and skin biopsy showing evidence of insulin hypersensitivity. He was desensitized to insulin according to Heinzerling . insulin desensitization protocol and subsequently with immunomodulation therapy using steroids (pulse methylprednisolone) and mycophenolate mofetil as well as by installation of insulin pump.
重组人胰岛素问世后，对外源性胰岛素的超敏反应是一种罕见的临床病症；然而，仍有病例报告显示患者会出现针对胰岛素的超敏反应。我们报告了一例1型糖尿病患者，该患者对皮下注射胰岛素发生了1型超敏反应。在对胰岛素产生超敏反应后，他反复出现糖尿病酮症酸中毒发作，需要多次住院治疗。当他前来就诊时，正在接受胰岛素输注和皮下注射胰岛素治疗，每日胰岛素剂量约800单位，且有严重的胰岛素超敏反应和高血糖。他在胰岛素注射部位有多个皮下红斑结节，但无全身过敏迹象。检查发现嗜酸性粒细胞增多、IgE水平升高，皮肤活检显示有胰岛素超敏反应的证据。根据海因策林胰岛素脱敏方案对他进行了胰岛素脱敏治疗，随后使用类固醇（静脉注射甲泼尼龙）和霉酚酸酯进行免疫调节治疗，并安装了胰岛素泵。
