{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T17:34:59Z","timestamp":1786988099775,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2020,8,1]],"date-time":"2020-08-01T00:00:00Z","timestamp":1596240000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:p>\n                    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\n                    <jats:italic toggle=\"yes\">et al<\/jats:italic>\n                    . insulin desensitization protocol and subsequently with immunomodulation therapy using steroids (pulse methylprednisolone) and mycophenolate mofetil as well as by installation of insulin pump.\n                  <\/jats:p>","DOI":"10.4103\/jfmpc.jfmpc_148_20","type":"journal-article","created":{"date-parts":[[2020,9,1]],"date-time":"2020-09-01T05:57:47Z","timestamp":1598939867000},"page":"4470-4472","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Exogenous recombinant human insulin-induced severe hypersensitivity reaction precipitating hyperglycemic crisis: A clinical conundrum"],"prefix":"10.4103","volume":"9","author":[{"given":"KU","family":"Lijesh","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College (CMC) Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riddhi Das","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College (CMC) Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"SenthilRaja","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College (CMC) Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Kapoor","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College (CMC) Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas V.","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College (CMC) Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nihal","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College (CMC) Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,8]]},"reference":[{"key":"R1-20260817","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1046\/j.1398-9995.2003.00324.x","article-title":"Allergy to human insulin","volume":"58","author":"Fernandez","year":"2003","journal-title":"Allergy"},{"key":"R2-20260817","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1111\/j.1398-9995.2007.01567.x","article-title":"Insulin allergy: Clinical manifestations and management strategies","volume":"63","author":"Heinzerling","year":"2008","journal-title":"Allergy"},{"key":"R3-20260817","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1111\/pedi.12480","article-title":"Incidence of type 1 diabetes has doubled in Kuwaiti children 0-14 years over the last 20 years","volume":"18","author":"Shaltout","year":"2017","journal-title":"Pediatr Diabetes"},{"key":"R4-20260817","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.diabres.2017.03.014","article-title":"Increasing incidence of type 1 diabetes between 1986 and 2015 in Bauru, Brazil","volume":"127","author":"Negrato","year":"2017","journal-title":"Diab Res Clin Pract"},{"key":"R5-20260817","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1111\/j.1464-5491.2006.01925.x","article-title":"Incidence and trends of childhood Type 1 diabetes worldwide 1990-1999","volume":"23","year":"2006","journal-title":"Diabet 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Diabetes"},{"key":"R12-20260817","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1111\/dme.12194","article-title":"A practical, clinical approach to the assessment and management of suspected insulin allergy","volume":"30","author":"Jacquier","year":"2013","journal-title":"Diabet Med"},{"key":"R13-20260817","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/j.0105-1873.2006.0866g.x","article-title":"Severe adverse cutaneous reaction to insulin due to cresol sensitivity","volume":"55","author":"Rajpar","year":"2006","journal-title":"Contact Dermatitis"},{"key":"R14-20260817","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1056\/NEJMc0808282","article-title":"Rituximab and omalizumab in severe, refractory insulin allergy","volume":"360","author":"Yong","year":"2009","journal-title":"N Engl J Med"},{"key":"R15-20260817","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1111\/j.1432-2277.2006.00282.x","article-title":"Solitary pancreas transplantation for life-threatening allergy to human insulin","volume":"19","author":"L\u00e9onet","year":"2006","journal-title":"Transpl Int"}],"container-title":["Journal of Family Medicine and Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_148_20","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T17:01:01Z","timestamp":1786986061000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_148_20"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8]]},"references-count":15,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_148_20","relation":{},"ISSN":["2249-4863","2278-7135"],"issn-type":[{"value":"2249-4863","type":"print"},{"value":"2278-7135","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8]]},"assertion":[{"value":"2020-01-23","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-06-10","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}