Successful desensitization with human insulin in a patient with an insulin allergy and hypersensitivity to protamine: a case report

<p>Abstract</p> <p>Introduction</p> <p>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.</p> <p>Case presentation</p> <p>A 68-year-old man with poorly controlled type 2 diabetes mellitus received different insulin preparations subcutaneously while on oral medication. Six to eight hours after each subcutaneous application, he developed pruritic plaques with a diameter of >15 cm at the injection sites that persisted for several days. Allergologic testing revealed positive reactions against every insulin preparation and against protamine. Investigation of serum samples demonstrated IgG antibodies against human and porcine insulin. We treated the patient with human insulin using an ultra-rush protocol beginning with 0.004 IU and a rapid augmentation in dose up to 5 IU. Therapy was accompanied by antihistamine therapy. Subsequent conversion to therapy with glargine insulin (6 IE twice daily) was well-tolerated.</p> <p>Conclusion</p> <p>As reported in this case, desensitization with subcutaneously administered human insulin using an ultra-rush protocol in patients with an insulin allergy may present an easy form of therapy that is successful within a few days.</p

The genomes of two key bumblebee species with primitive eusocial organization

Background: The shift from solitary to social behavior is one of the major evolutionary transitions. Primitively eusocial bumblebees are uniquely placed to illuminate the evolution of highly eusocial insect societies. Bumblebees are also invaluable natural and agricultural pollinators, and there is widespread concern over recent population declines in some species. High-quality genomic data will inform key aspects of bumblebee biology, including susceptibility to implicated population viability threats. Results: We report the high quality draft genome sequences of Bombus terrestris and Bombus impatiens, two ecologically dominant bumblebees and widely utilized study species. Comparing these new genomes to those of the highly eusocial honeybee Apis mellifera and other Hymenoptera, we identify deeply conserved similarities, as well as novelties key to the biology of these organisms. Some honeybee genome features thought to underpin advanced eusociality are also present in bumblebees, indicating an earlier evolution in the bee lineage. Xenobiotic detoxification and immune genes are similarly depauperate in bumblebees and honeybees, and multiple categories of genes linked to social organization, including development and behavior, show high conservation. Key differences identified include a bias in bumblebee chemoreception towards gustation from olfaction, and striking differences in microRNAs, potentially responsible for gene regulation underlying social and other traits. Conclusions: These two bumblebee genomes provide a foundation for post-genomic research on these key pollinators and insect societies. Overall, gene repertoires suggest that the route to advanced eusociality in bees was mediated by many small changes in many genes and processes, and not by notable expansion or depauperation

The IDEMIX model: Parameterization of internal gravity waves for circulation models of ocean and atmosphere

The IDEMIX conceptIDEMIXconcept is an energetically consistent framework to describe wave effects in circulation models of ocean and atmosphere. It is based on the radiative transfer equation for an internal gravity wave field in physical and wavenumber space and was shown to be successful for ocean applications. An improved IDEMIX model for the ocean will be constructed and extended by a new high-frequency, high vertical wavenumber compartment, forcing by mesoscale eddy dissipation, anisotropic tidal forcing, and wave--mean flow interaction. It will be validated using observational and model estimates. A novel concept for gravity wave parameterization in atmospheric circulation models is developed. As for the ocean, the wave field is represented by the wave energy density in physical and wavenumber space, and its prognostic computation is performed by the radiative transfer equation. This new concept goes far beyond conventional gravity wave schemes which are based on the single-column approximation and, in particular, on the strong assumptions of a stationary mean flow and a stationary wave energy equation. The radiative transfer equation has---to our knowledge---never been considered in the atmospheric community as a framework for subgrid-scale parameterization. The proposed parameterization will, for the first time, (1) include all relevant sources continuously in space and time and (2) accommodate all gravity wave sources (orography, fronts, and convection) in a single parameterization framework. Moreover, the new scheme is formulated in a precisely energy-preserving fashion. The project will contribute to a transfer of knowledge from the oceanic community to the atmospheric community and vice versa. We give a brief description of the oceanic and atmospheric internal wave fields, the most important processes of generation and interactions, and the ingredients of the model IDEMIX