Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042109 (urticaria)
 6,569 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Reactions to intravenous protamine include rash, urticaria, bronchospasm, hypotension, and/or pulmonary artery pressure elevation. We have previously shown that in diabetic patients receiving daily protamine-insulin injections, the presence of anti-protamine IgE or IgG antibodies are significant risk factors for acute, life-threatening reactions when protamine is given intravenously. To study protamine reactions further, we measured serum anti-protamine IgE and IgG antibody levels, in-vitro basophil histamine release and intracutaneous skin testing to protamine serially in an NPH-insulin dependent diabetic who had a severe, protracted anaphylactic reaction to protamine. At the time of his protamine reaction, his serum contained 8.5 ng/ml of anti-protamine IgE and 1.3 micrograms/ml of anti-protamine IgG antibody. One month following the reaction both anti-protamine IgE and IgG increased to 16 ng/ml (twofold rise) and 90.5 micrograms/ml (70-fold rise), respectively. With time, both anti-protamine IgE and IgG antibody declined. Serial intradermal skin tests using protamine sulphate did not discriminate between the protamine reactor and nine normal control subjects who had no prior exposure nor any demonstrable serum IgE antibody to protamine. In-vitro basophil histamine release to protamine sulphate was inconclusive in discriminating between the protamine reactor and normal control subjects. We postulate that protamine may be an incomplete or univalent antigen that must first combine with a tissue macromolecule or possibly heparin to become a complete multivalent antigen capable of eliciting IgE antibody-dependent mediator release.
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PMID:Serial immunological investigations in a patient who had a life-threatening reaction to intravenous protamine. 170 34

A woman treated for 15 days with bovine insulin for gestational diabetes presented with severe urticaria of the chest and back, distant from the injection site. She had neither local reaction nor general manifestations. Replacement of bovine NPH insulin by biosynthetic human NPH was followed by regression of urticaria. We isolated the circulating immune complex (CIC), mainly of IgG class, from the patient's serum. It disappeared when bovine insulin administration had been ceased for 48 h. There were no specific IgE-insulin-antibodies. The IgG-CIC were dissociated. Insulin was identified by RIA in the CIC. Insulin characterization was carried out by high-performance liquid chromatography (HPLC), which showed that the insulin in the complexes was injected bovine insulin.
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PMID:Circulating immune complexes containing bovine insulin in a patient with systemic allergic manifestations. 295 56

The incidence of adverse reactions to protamine sulfate range from 0.06% to 27% and vary from mild urticaria to anaphylactic shock and death. In a retrospective analysis of 2996 patients, only four subjects experienced an adverse reaction due to protamine. Two individuals were NPH-insulin-dependent diabetics and two patients had exposure to protamine only during cardiac catheterization. Skin test titrations to protamine were done in three of four patients. One patient had a positive reaction at a 100-micrograms/mL dilution whereas the other two patients had positive reactions at 1000 micrograms/mL. In a comparable number of normal subjects, the threshold for a positive immediate skin response was 1000 micrograms/mL. Since the observed incidence of adverse reactions was 2.9% in NPH-insulin-dependent diabetics and 0.07% in non-diabetics, this represents a nearly 40-fold increased risk for diabetic patients (P less than .005). Skin testing appears to have limited applicability in the assessment of protamine sensitivity.
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PMID:Adverse reactions to protamine sulfate during cardiac surgery in diabetic and non-diabetic patients. 317 70

Two insulin-dependent diabetic subjects treated with pork and beef insulin during a period of 6 mo developed severe local reactions. Both patients had an important allergic history (asthma, urticaria, drug reactions, rhinitis). Skin-testing revealed type I allergy to beef and pork insulin. Specific IgE-insulin binding was demonstrated with both insulins. After negative skin testing with NPH Lilly human insulin (recombinant DNA), treatment was started with this compound and remained successful during a period of 6-9 mo. In one patient a local reaction occurred when regular human insulin (recombinant DNA) was added to NPH in order to obtain better control. Skin testing with regular human insulin was positive, but not with NPH human insulin alone. The mechanism of this phenomenon remains unsolved.
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PMID:Insulin allergy treated with human insulin (recombinant DNA). 676 30

This is the case of a 62-year-old man referred for the evaluation of insulin allergy. This patient had reacted to the subcutaneous injection of Novolin 70/30 (Squibb, Princeton, N.J.) and Humulin NPH (Eli Lilly, Indianapolis, Ind.). These reactions were characterized by the immediate onset of diffuse pruritic urticaria and angioedema with progression to hypotension as well as a local reaction. Past history also included anaphylactic shock after intravenous administration of protamine sulfate used for heparin reversal during arterial bypass surgery. Immediate hypersensitivty skin testing to protamine containing (NPH) insulin and protamine sulfate USP were strongly positive, while Lente insulin (Eli Lilly, Indianapolis, Ind.) and controls were negative. RAST tests revealed the titers > 24 ng/ml of protamine specific IgE with 98 percent inhibition and 1163 ng/ml of protamine specific IgG with 29 percent inhibition, while levels of insulin specific antibodies were negligible. Subsequently, the patient was treated with non-protamine containing insulin preparation, Lente insulin, without further incident. This study confirms the diagnosis of Type I hypersensitivity to protamine sulfate masquerading as insulin allergy.
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PMID:Anaphylaxis to protamine masquerading as an insulin allergy. 845 92