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Protamine allergy

Gi Jun Kim, Shin Bum Kim, Seong Il Jo, Jin Kyeong Shin, Hee Sun Kwon, Heekyung Jeong, Jang Won Son, Seong Su Lee, Sung Rae Kim, Byung Kee Kim, Soon Jib Yoo
Allergic reaction to insulin is uncommon since the introduction of human recombinant insulin preparations and is more rare in pregnant than non-pregnant females due to altered immune reaction during pregnancy. Herein, we report two cases of allergic reaction to insulin in gestational diabetes that were successfully managed. One case was a 33-year-old female using isophane-neutral protamine Hagedorn human insulin and insulin lispro. She experienced dyspnea, cough, urticaria and itching sensation at the sites of insulin injection immediately after insulin administration...
September 2015: Endocrinology and Metabolism
Hamid Reza Nouri, Abdolreza Varasteh, Mahmoud Reza Jaafari, Janet M Davies, Mojtaba Sankian
Liposome-protamine-DNA nanoparticles (LPD) are safe, effective, and non-toxic adjuvants that induce Th1-like immune responses. We hypothesized that encapsulation of allergens into liposomes could be an appropriate option for immunotherapy. The present study evaluated the immunotherapeutic potential of a recombinant hybrid molecule (rHM) encapsulated in LPD nanoparticles in a murine model of Chenopodium album allergy. BALB/c mice were sensitized with the allergen in alum, and the immunotherapy procedure was performed by subcutaneous injections of LPD-rHM, rHM, or empty LPD at weekly intervals...
July 2015: Immunologic Research
E McNair, J-A Marcoux, C Bally, J Gamble, D Thomson
Heparin resistance (unresponsiveness to heparin) is characterized by the inability to reach acceptable activated clotting time values following a calculated dose of heparin. Up to 20% of the patients undergoing cardiothoracic surgery with cardiopulmonary bypass using unfractionated heparin (UFH) for anticoagulation experience heparin resistance. Although UFH has been the "gold standard" for anticoagulation, it is not without its limitations. It is contraindicated in patients with confirmed heparin-induced thrombocytopenia (HIT) and heparin or protamine allergy...
April 2016: Perfusion
Simone Brück, Christian Skrabal, Karl Träger, Helmut Reinelt
Protamine is a protein mainly used to reverse anticoagulant effects of heparin during cardiac or vascular surgery with extracorporeal circulation. Adverse events after protamine administration are rare but if they occur they can be catastrophic. Based on a case report with an elective cardiac surgery patient with known allergy to fish, we discuss the related events and risk factors for an adverse reaction after protamine. The patient management and its outcome are presented.
June 2014: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Hidenao Nishimura, Katsumi Iizuka, Jun Takeda
Insulin autoantibodies can be produced by insulin injections but rarely cause severe side effects such as glucose instability and insulin allergy. We study the characteristics of insulin autoantibody-positive diabetic patients with a medical history of insulin therapy using single and multiple (adjusted for age, sex, type of diabetes) logistic regression analyses. Associations between insulin autoantibodies and age, sex, type of diabetes, HbA1c, and serum creatinine were not significant, but the association between insulin autoantibodies and duration of insulin use was significant...
2014: Endocrine Journal
Isabella Pali-Schöll, Helen Szöllösi, Philipp Starkl, Bernhard Scheicher, Caroline Stremnitzer, Alexander Hofmeister, Franziska Roth-Walter, Anna Lukschal, Susanne C Diesner, Andreas Zimmer, Erika Jensen-Jarolim
The currently applied immunotherapy of type I allergy with aluminum hydroxide (alum) as adjuvant elicits - among other side effects - an initial IgE-boost. In contrast, CpG-oligodeoxynucleotides (ODNs) drive the immune response toward Th1. The biodegradable material protamine can spontaneously form nanoparticles together with such ODNs. Our aim was to investigate the immune response induced by protamine-based nanoparticles (proticles) with CpG-ODN as an allergen delivery system. Proticles complexed with Ara h 2 extracted from raw peanuts as model allergen were injected subcutaneously into naïve BALB/c mice...
November 2013: European Journal of Pharmaceutics and Biopharmaceutics
C Hasselmann, C Pecquet, E Bismuth, C Raverdy, A Sola-Gazagnes, J-B Lobut, J-C Carel, N Tubiana-Rufi
AIM: 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. CASE REPORT: 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...
April 2013: Diabetes & Metabolism
N Yoshida, M Okubo, K Ishiguro, Y Mori
BACKGROUND: Insulin allergy is a not uncommon condition even though human insulin and insulin analogues are widely used. However, the development of insulin allergy after bone marrow transplantation has not been reported. CASE REPORT: A 44-year-old Japanese woman had aplastic anaemia and secondary haemochromatosis. She was diagnosed with having diabetes at age 32 years and had been treated with human insulin. At age 34 years, bone marrow transplantation was performed...
October 2012: Diabetic Medicine: a Journal of the British Diabetic Association
S Caimmi, D Caimmi, F Cardinale, L Indinnimeo, G Crisafulli, D G Peroni, G L Marseglia
Anesthesia may often be considered as a high-risk procedure and anaphylaxis remains a major cause of concern for anesthetists who routinely administer many potentially allergenic agents. Neuromuscular blocking agents, latex and antibiotics are the substances involved in most of the reported reactions. Besides these three agents, a wide variety of substances may cause an anaphylactic reaction during anesthesia. Basically all the administered drugs or substances may be potential causes of anaphylaxis. Among them, those reported the most in literature include hypnotics, opioids, local anesthetics, colloids, dye, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Iodinated Contrast Media (ICM), antiseptics, aprotinin, ethylene oxyde and formaldehyde, and protamine and heparins...
July 2011: International Journal of Immunopathology and Pharmacology
Mohammad K Ghazavi, Graham A Johnston
Insulin reactions occur rarely but are of tremendous clinical importance. The first was reported in 1922 as a callus reaction at the injection site of insufficiently purified bovine insulin. Porcine insulin was subsequently found to be less allergenic than bovine insulin. Increasingly pure insulins have decreased the risk of adverse reactions, and the production of recombinant insulin with the same amino sequence as human insulin saw a large decrease in adverse reactions. Currently, the prevalence of allergic reactions to insulin products appears to be approximately 2%, and less than one-third of these events have been considered related to the insulin itself...
May 2011: Clinics in Dermatology
Yan-Qi Chu, Li-Jian Cai, De-Chun Jiang, Dan Jia, Su-Ying Yan, Yu-Qin Wang
BACKGROUND: Insulin is used to treat patients with both type 1 and type 2 diabetes mellitus. Allergic reactions to insulin might be triggered by insulin itself or inactive ingredients in the insulin formulation, including proteins such as protamine in neutral protamine Hagedorn (NPH) insulin. The use of highly purified animal insulin and human recombinant insulin has reduced the incidence of anaphylactic reactions to insulin from ~30% to <1%. OBJECTIVE: We report a case of fatal allergic shock after the administration of protamine in a patient with a history of allergy to fish and a protamine-containing insulin...
September 2010: Clinical Therapeutics
Andreas Koster, Ulrich Rosendahl, Eberhard von Hodenberg, Jürgen Ennker
A patient with impaired left ventricular function was scheduled for coronary artery bypass grafting. The patient's history revealed a life-threatening allergy to fish proteins. Therefore, because of the threat of cross-reactivity to protamine, a standard anticoagulation protocol with heparin/protamine was disapproved. Instead, complete coronary artery revascularization was successfully performed off-pump using bivalirudin as the anticoagulant.
July 2010: Annals of Thoracic Surgery
D Anne Moneret-Vautrin, P Michel Mertes
The incidence of hypersensitivity reactions to anesthetics is estimated 1 in 13,000 anesthetics up to 1 in 3,180. The rate of mortality ranges between 3 and 9%. 90% of reactions appear at anesthesia induction. Cardiovascular collapse and bronchospasm are more frequent in IgE-dependent reactions. The leading causes are neuromuscular blocking agents (50-70% of cases). IgE-dependent reactions are predominant. Previous sensitization by other compounds containing quaternary ions is suspected. Cross-reactions are frequent...
2010: Chemical Immunology and Allergy
Fumiko Kawasaki, Shinji Kamei, Fuminori Tatsumi, Sumiko Hamamoto, Masashi Shimoda, Kazuhito Tawaramoto, Makoto Shigeto, Yukiko Kanda, Mitsuru Hashiramoto, Michihiro Matsuki, Kohei Kaku
A 29-year-old woman was diagnosed as having type 1 diabetes mellitus and received insulin aspart and NPH insulin (NovolinN). On day 22, she had leg edema and right abdominal pain. The serum hepatobiliary enzyme levels were markedly elevated. Computed tomography revealed gallbladder edema. After an injection of human regular insulin and NPH insulin (HumacartN), the elevated liver enzyme levels were no longer observed. Challenge testing demonstrated that protamine was the cause of her allergy. Furthermore, tests revealed increased VEGF levels...
2009: Internal Medicine
C Collins, A O'Donnell
The operating theatre exposes patients to myriad potential agents which could result in a life-threatening anaphylactic reaction. Anaesthetic drugs, blood products, and latex are only some of the possible allergens. Reactions are deemed to be anaphylactic when immediate sensitivity is combined with cardiovascular collapse. A patient who had a known allergy to shellfish presented for first time cardiopulmonary bypass. The perfusion team were concerned that there was a realistic possibility that an adverse reaction to protamine could occur...
November 2008: Perfusion
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
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...
March 2009: Clinical Therapeutics
Claudia Pföhler, Cornelia Sl Müller, Dirk O Hasselmann, Wolfgang Tilgen
INTRODUCTION: Insulin allergy may occur in patients treated with subcutaneous applications of insulin preparations. Besides additives in the insulin preparation such as protamine, cresol, and phenol, the insulin molecule itself may be the cause of the allergy. In the latter case, therapeutic options are rare. CASE PRESENTATION: A 68-year-old man with poorly controlled type 2 diabetes mellitus received different insulin preparations subcutaneously while on oral medication...
2008: Journal of Medical Case Reports
Manuel García de Los Ríos, Carlos Wolff, Erika Duarte
BACKGROUND: Biophasic insulin aspart (InAsBi) is a mixture of 30% of rapid acting soluble aspart insulin and 70% aspart insulin retarded with protamine. The soluble portion reduces postprandial serum glucose rises and the retarded portion reduces basal glucose levels. AIM: To assess the efficacy of biphasic insulin aspart in diabetics with a bad metabolic control. MATERIAL AND METHODS: Multicentríc study that included diabetic patients with a glycosilated hemoglobin over 7% that were transferred to treatment with InAsBi, given in one to three daily doses, according to glycemic control and followed for 12 weeks...
October 2007: Revista Médica de Chile
Julia M Martínez Gómez, Stefan Fischer, Noèmi Csaba, Thomas M Kündig, Hans P Merkle, Bruno Gander, Pål Johansen
PURPOSE: Allergen-specific immunotherapy (SIT) requires dozens of subcutaneous injections over 3 to 5 years in order to control IgE-mediated hypersensitivity, which is a T-helper 2 (Th2)-associated pathology. This study investigates the use of poly(lactide-co-glycolide) (PLGA) microparticles combined with immunostimulatory oligodeoxynucleotide (CpG), as well as protamine in SIT. MATERIALS AND METHODS: We prepared microparticle formulations with the major allergen of bee venom, phospholipase A2 (PLA2), and analyzed the effect of co-encapsulated or admixed CpG in both naïve and bee venom allergic mice...
October 2007: Pharmaceutical Research
R P Radermecker, A J Scheen
The purification of animal insulin preparations and the use of human recombinant insulin have markedly reduced the incidence but not completely suppressed the occurrence of insulin allergy manifestations. Advances in technologies concerning the mode of delivery of insulin, i.e. continuous subcutaneous insulin infusion (CSII), and the use of insulin analogues, resulting from the alteration in the amino acid sequence of the native insulin molecule, may influence the immunogenicity and antigenicity of native insulin...
July 2007: Diabetes/metabolism Research and Reviews
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