ABSTRACT
A 34-year-old woman developed gestational diabetes and was treated with insulin (beef-pork and beef) and oral therapy at various periods. She developed an insulin allergy; however, attempts at desensitization with the commercially available purified pork insulin desensitization kit (Eli Lilly Co.) were not successful. Reactivity to human (recombinant DNA) insulin as well as elevated IgE levels and eosinophilia were also demonstrated. A second desensitization attempt with human (recombinant DNA) insulin using a protocol developed by the authors was successful. This report discusses a desensitization procedure using human insulin in an insulin-allergic patient.
Subject(s)
Drug Hypersensitivity/therapy , Insulin/therapeutic use , Pregnancy in Diabetics/drug therapy , Recombinant Proteins/therapeutic use , Adult , Animals , Cattle , Desensitization, Immunologic , Female , Humans , Insulin/adverse effects , Pregnancy , SwineABSTRACT
One hundred fifty-three pregnant patients were included in this study to verify the amount of drugs ingested during their pregnancies. The results demonstrate that, unknown to the physician, pregnant patients take a variety of pharmacologic agents. The patient's medical record is considered grossly inadequate in documenting an accurate assessment of a patient's exposure to drugs taken during pregnancy. Drug histories were obtained utilizing the hospital pharmacist drug history interview and home diary. Validity testing of the pharmacist's drug history and of the medical record history was not performed. The patient's compliance for utilizing the home diary for drugs or chemicals taken during their pregnancy was 83% (127 patients). It was shown that the usual methods of drug history documentation will identify only 30% of the actual drug exposure to the fetus.
Subject(s)
Drug Utilization , Medical History Taking , Pregnancy Complications/drug therapy , California , Delivery, Obstetric , Female , Fetus/drug effects , Humans , Labor, Obstetric , Medical Records , Pregnancy , TeratogensABSTRACT
Hospitalized patients who received clindamycin or ampicillin were evaluated for gastrointestinal side effects for a period of up to six weeks after therapy was discontinued. Of 104 patients receiving clindamycin therapy, 31 (29.8%) developed diarrhea, and two (1.9%) developed pseudomembranous colitis (PMC). Of 138 patients receiving ampicillin, 24 (17.3%) developed diarrhea, and one (0.7%) developed PMC. Diarrhea persisting for three days or more was noted in 13 (12.5%) of the patients receiving clindamycin and in seven (5.1%) of those receiving ampicillin. The tendency to develop diarrhea was positively correlated with serious illness, abdominal or pelvic sepsis, and total dosage of clindamycin. Examination of stools from a patient with PMC that was associated with clindamycin therapy showed a decrease in the number of anaerobic bacteria from the numbers found in stool cultures of normal controls. Those patients who did not develop diarrhea also had fewer anaerobic bacteria and coliform organisms. Lymphocytes from the patient with PMC were hyporeactive to phytohemagglutinin and hyperreactive to clindamycin.