Abstract
Meglitinides (repaglinide and nateglinide) are insulin secretagogues used to treat diabetes mellitus. We present a case of hypersensitivity reaction to repaglinide in a 61-year-old man who developed a maculopapular rash 5 days after treatment. Skin prick tests including repaglinide (0.5 g/mL) and patch tests (0.05% in pet and saline) were performed, and the results were negative. A blind oral challenge test with repaglinide was performed and the therapeutic dose was subsequently taken at home every 24 hours for 7 days. The result was positive with a delayed reaction at day 3. A punch biopsy of the skin lesions revealed drug-induced exanthema. The clinical manifestations, the latency period, the reappearance of cutaneous lesions after rechallenge, and the histopathology report of the skin biopsy suggest a type IV mechanism.
MeSH terms
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Carbamates / adverse effects*
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Carbamates / immunology*
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Carbamates / therapeutic use
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Cyclohexanes / therapeutic use
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Diabetes Mellitus, Type 2 / drug therapy
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Diabetes Mellitus, Type 2 / immunology
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Drug Hypersensitivity / diagnosis*
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Drug Hypersensitivity / etiology*
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Drug Hypersensitivity / immunology
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Erythema / immunology
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Erythema / pathology
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Exanthema / chemically induced*
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Exanthema / immunology
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Exanthema / pathology
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Humans
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Hypoglycemic Agents / adverse effects*
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Hypoglycemic Agents / immunology
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Hypoglycemic Agents / therapeutic use
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Male
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Middle Aged
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Nateglinide
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Patch Tests / methods
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Phenylalanine / analogs & derivatives
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Phenylalanine / therapeutic use
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Piperidines / adverse effects*
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Piperidines / immunology*
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Piperidines / therapeutic use
Substances
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Carbamates
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Cyclohexanes
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Hypoglycemic Agents
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Piperidines
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Nateglinide
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Phenylalanine
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repaglinide