Calcitonin


Cacitonin is a 32 amino acid polypeptide synthesized by the parafollicular cells of the thyroid. It inhibits bone resorbtion and increases urinary calcium and phosphor output. Three types of calcitonin are used, i.e. natural porcine, synthetic salmon and synthetic human calcitonin, for the treatment of Paget’s disease, hypercalcemia, hyperparathyroidism, and osteoporosis.
 
Incidence
Reported incidence varies from 6% to less than 1/30000.
 
Clinical manifestations
General: anaphylactic shock.
 
Cutaneous: pruritus, rash, angioedema, urticaria.
 
Respiratory: bronchospasm.
 
Diagnostic methods
Skin tests: scratch and intradermal (1/1000 and 1/100) were positive in one patient presenting anaphylactic shock with porcine calcitonin.
 
In vitro tests: detection of IgE against porcine calcitonin (RAST) was positive in one case.
 
Mechanisms
Immediate IgE hypersensitivity.
 
Management
Avoidance.
 
Use other types of calcitonin (synthetic salmon or human calcitonin).
 
Negative skin-tests do not exclude allergic manifestations induced by calcitonin.

References

  1. Piccone U, Pala M, Caprari M, "Schock anafillattico da calcitonina. Descrizione di un caso e revisione della letteratura", Minerva Cardioangiol., 1994; 42 (9): 435-41 
  2. Cuskey J, Dubois L, du Buske L, "Induction of urticaria and angioedema by synthetic salmon calcitonin", J. Allergy Clin. Immunol., 1991; 87 (1): A359. 
  3. Pirson F, Tafforeau M, Birnbaum J, Vervloet D, Charpin J, "Réaction anaphylactique à la calcitonine", Rev. fr. Allergol., 1988; 28 (3): 248–9.

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.