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Andrew Gough - One of the best experts on this subject based on the ideXlab platform.

  • rituximab and omalizumab in severe refractory Insulin Allergy
    The New England Journal of Medicine, 2009
    Co-Authors: Patrick F.k. Yong, Rifat Malik, Sefina Arif, Mark Peakman, Stephanie A. Amiel, Mohammad A. A. Ibrahim, Andrew Gough
    Abstract:

    To the Editor: We describe the sequential use of two targeted biologic agents to treat a patient with severe systemic Insulin Allergy accompanied by marked metabolic dysregulation and corticosteroid toxicity. In 1996, a 50-year-old woman received the diagnosis of type 1 diabetes. Shortly after Insulin therapy was initiated, a generalized urticarial rash (resulting in excoriation, bleeding, and disrupted sleep) developed. Insulin Allergy was diagnosed on the basis of positive skin-prick tests and a level of Insulin-specific IgE of 5.75 kU per liter (normal value, <0.70 kU per liter). Until 2000, she was treated with a standard stepwise approach of trying . . .

  • Rituximab and Omalizumab in Severe, Refractory Insulin Allergy
    The New England journal of medicine, 2009
    Co-Authors: Patrick F.k. Yong, Rifat Malik, Sefina Arif, Mark Peakman, Stephanie A. Amiel, Mohammad A. A. Ibrahim, Andrew Gough
    Abstract:

    To the Editor: We describe the sequential use of two targeted biologic agents to treat a patient with severe systemic Insulin Allergy accompanied by marked metabolic dysregulation and corticosteroid toxicity. In 1996, a 50-year-old woman received the diagnosis of type 1 diabetes. Shortly after Insulin therapy was initiated, a generalized urticarial rash (resulting in excoriation, bleeding, and disrupted sleep) developed. Insulin Allergy was diagnosed on the basis of positive skin-prick tests and a level of Insulin-specific IgE of 5.75 kU per liter (normal value,

Haruko Kitaoka - One of the best experts on this subject based on the ideXlab platform.

Bay Quang Nguyen - One of the best experts on this subject based on the ideXlab platform.

  • Successful management of severe diabetic ketoacidosis in a patient with type 2 diabetes with Insulin Allergy: a case report.
    BMC endocrine disorders, 2019
    Co-Authors: Anh Dat Nguyen, Chinh Quoc Luong, Chi Van Nguyen, Quan Huu Nguyen, Ton Duy Mai, Hieu Chi Chu, Van Khoa Dieu Nguyen, Tuan Anh Nguyen, Dinh Van Nguyen, Bay Quang Nguyen
    Abstract:

    Background Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that requires immediate treatment. Allergic reaction to Insulin is rare, especially when using recombinant human Insulin. The clinical presentation of Insulin Allergy can range from minor local symptoms to a severe generalized allergic reaction such as anaphylaxis. A limited number of cases have been reported on the treatment of severe DKA in patients with type 2 diabetes with Insulin Allergy. Here, we describe a patient with type 2 diabetes with Insulin Allergy in which severe DKA resolved after the initiation of continuous intravenous (IV) recombinant human Insulin infusion. Case presentation A 58-year-old man with type 2 diabetes initiated subcutaneous Insulin administration (SIA) after failure of oral antidiabetic treatment. Symptoms of an allergic reaction developed, including pruritic wheals appearing within 10 min of injection and lasting over 24 h. Both skin prick and intradermal tests were positive with different types of Insulin. Two days before admission, he stopped SIA because of allergic symptoms and then experienced weakness and upper abdominal pain. On admission, he was in severe metabolic acidosis with a pH of 6.984 and bicarbonate of 2.5 mmol/litre. The blood glucose level was 20.79 mmol/litre, BUN 4.01 mmol/litre, creatinine 128 μmol/litre, and urinary ketone 11.44 mmol/litre. Over 24 h, metabolic acidosis was refractory to IV fluids, bicarbonate and potassium replacement, as well as haemodialysis. Ultimately, he received continuous IV recombinant human Insulin infusion at a rate of 0.1 units/kg/hour, in combination with haemodiafiltration, and no further allergic reactions were observed. On day 5, ketonaemia and metabolic acidosis completely resolved. He had transitioned from IV Insulin infusion to SIA on day 14. He was discharged on day 21 with SIA treatment. Three months later, he had good glycaemic control but still had allergic symptoms at the Insulin injection sites. Conclusions In this patient, SIA caused an allergic reaction, in contrast to continuous IV Insulin infusion for which allergic symptoms did not appear. Continuous IV recombinant human Insulin infusion in combination with haemodiafiltration could be an option for the treatment of severe DKA in patients with diabetes with Insulin Allergy.

  • Successful management of severe diabetic ketoacidosis in a patient with type 2 diabetes with Insulin Allergy: a case report
    2019
    Co-Authors: Anh Dat Nguyen, Chinh Quoc Luong, Hieu Chu Chi, Van Khoa Dieu Nguyen, Chi Van Nguyen, Anh Tuan Nguyen, Quan Huu Nguyen, Ton Duy Mai, Dinh Van Nguyen, Bay Quang Nguyen
    Abstract:

    Abstract BackgroundDiabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that requires immediate treatment. Allergic reaction to Insulin is rare, especially when using recombinant human Insulin. The clinical presentation of Insulin Allergy can range from minor local symptoms to a severe generalized allergic reaction such as anaphylaxis. A limited number of cases have been reported on the treatment of severe DKA in patients with type 2 diabetes with Insulin Allergy. Here, we describe a patient with type 2 diabetes with Insulin Allergy in which severe DKA resolved after the initiation of continuous intravenous (IV) recombinant human Insulin infusion.Case presentationA 58-year-old man with type 2 diabetes initiated subcutaneous Insulin administration (SIA) after failure of oral antidiabetic treatment. Symptoms of an allergic reaction developed, including pruritic wheals appearing within 10 minutes of injection and lasting over 24 hours. Both skin prick and intradermal tests were positive with different types of Insulin. Two days before admission, he stopped SIA because of allergic symptoms and then experienced weakness and upper abdominal pain. On admission, he was in severe metabolic acidosis with a pH of 6.984 and bicarbonate of 2.5 mmol/litre. The blood glucose level was 20.79 mmol/litre, BUN 4.01 mmol/litre, creatinine 128 µmol/litre, and urinary ketone 11.44 mmol/litre. Over 24 hours, metabolic acidosis was refractory to IV fluids, bicarbonate and potassium replacement, as well as haemodialysis. Ultimately, he received continuous IV recombinant human Insulin infusion at a rate of 0.1 units/kg/hour, in combination with haemodiafiltration, and no further allergic reactions were observed. On day 5, ketonaemia and metabolic acidosis completely resolved. He had transitioned from IV Insulin infusion to SIA on day 14. He was discharged on day 21 with SIA treatment. Three months later, he had good glycaemic control but still had allergic symptoms at the Insulin injection sites.ConclusionsIn this patient, SIA caused an allergic reaction, in contrast to continuous IV Insulin infusion for which allergic symptoms did not appear. Continuous IV recombinant human Insulin infusion in combination with haemodiafiltration could be an option for the treatment of severe DKA in patients with diabetes with Insulin Allergy.

  • 2465-PUB: Successful Management of Severe Diabetic Ketoacidosis in a Type 2 Diabetes Patient with Insulin Allergy
    Diabetes, 2019
    Co-Authors: Anh Dzung Nguyen, Chinh Quoc Luong, Chi Van Nguyen, Quan Huu Nguyen, Ton Duy Mai, Hieu Chi Chu, Van Khoa Dieu Nguyen, Tuan Anh Nguyen, Dinh Van Nguyen, Bay Quang Nguyen
    Abstract:

    Objective: To report an episode of severe diabetic ketoacidosis (DKA) in a type 2 diabetes mellitus (DM) patient with Insulin Allergy treated by continuous intravenous (IV) regular Insulin infusion. Methods: We describe the clinical features, laboratory data, and management of severe DKA in a type 2 DM patient with Insulin Allergy. Results: A 58-year-old man with type 2 DM initiated subcutaneous Insulin administration (SIA) after failure of oral antidiabetic therapies. Symptoms of an allergic reaction then developed, especially distinct at the injection site. Pruritic wheals appeared within 10 minutes of injection and lasted over 24 hours. Both skin prick and intradermal tests were positive with different types of Insulin. Two days before admission, he stopped SIA because of allergic symptoms, and then experienced weakness and upper abdominal pain. On admission, his heart rate was 130 beats/min, temperature 37°C, blood pressure 150/90 mmHg, and respiratory rate 28 breaths/min. Blood glucose level was 374.6 mg/dL, pH 6.984, bicarbonate 2.5 mmol/L, lactate 1.5 mmol/L, BUN 24.1 mg/dL, creatinine 1.46 mg/dL, and urinary ketone was 66.48 mg/dL. Over 24 hours, the metabolic acidosis was refractory to IV fluids, bicarbonate and potassium replacement, as well as hemodialysis. Ultimately, he received continuous IV regular Insulin infusion at an initial rate of 0.1 units/kg/hour, no further allergic reactions were observed. On the day 5, ketonemia and metabolic acidosis completely resolved. He had transition from IV Insulin infusion to SIA on day 14. He was discharged on the day 21 with the treatment of SIA. Three months later, he had a good glycemic control, but has still appeared allergic symptoms at the injection sites of Insulin. Conclusion: In this patient, SIA caused an allergic reaction in contrast to continuous IV Insulin infusion, for which allergic symptoms did not appear. Thus, identical Insulin molecules could behave in markedly different ways depending on the route of injection. Disclosure A.D. Nguyen: None. C.Q. Luong: None. H.C. Chu: None. V.K. Nguyen: None. C.V. Nguyen: None. T.A. Nguyen: None. Q.H. Nguyen: None. T.D. Mai: None. D.V. Nguyen: None. B.Q. Nguyen: None. T.H. Tran: None. N.N. Nguyen: None. S.N. Do: None.

Patrick F.k. Yong - One of the best experts on this subject based on the ideXlab platform.

  • rituximab and omalizumab in severe refractory Insulin Allergy
    The New England Journal of Medicine, 2009
    Co-Authors: Patrick F.k. Yong, Rifat Malik, Sefina Arif, Mark Peakman, Stephanie A. Amiel, Mohammad A. A. Ibrahim, Andrew Gough
    Abstract:

    To the Editor: We describe the sequential use of two targeted biologic agents to treat a patient with severe systemic Insulin Allergy accompanied by marked metabolic dysregulation and corticosteroid toxicity. In 1996, a 50-year-old woman received the diagnosis of type 1 diabetes. Shortly after Insulin therapy was initiated, a generalized urticarial rash (resulting in excoriation, bleeding, and disrupted sleep) developed. Insulin Allergy was diagnosed on the basis of positive skin-prick tests and a level of Insulin-specific IgE of 5.75 kU per liter (normal value, <0.70 kU per liter). Until 2000, she was treated with a standard stepwise approach of trying . . .

  • Rituximab and Omalizumab in Severe, Refractory Insulin Allergy
    The New England journal of medicine, 2009
    Co-Authors: Patrick F.k. Yong, Rifat Malik, Sefina Arif, Mark Peakman, Stephanie A. Amiel, Mohammad A. A. Ibrahim, Andrew Gough
    Abstract:

    To the Editor: We describe the sequential use of two targeted biologic agents to treat a patient with severe systemic Insulin Allergy accompanied by marked metabolic dysregulation and corticosteroid toxicity. In 1996, a 50-year-old woman received the diagnosis of type 1 diabetes. Shortly after Insulin therapy was initiated, a generalized urticarial rash (resulting in excoriation, bleeding, and disrupted sleep) developed. Insulin Allergy was diagnosed on the basis of positive skin-prick tests and a level of Insulin-specific IgE of 5.75 kU per liter (normal value,

Tatsuya Fujikawa - One of the best experts on this subject based on the ideXlab platform.