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01-02-2012 | Case Report

Allergy to human insulin and specific immunotherapy with glargine; case report with review of literature

Authors: S. Hasani-Ranjbar, M. R. Fazlollahi, A. Mehri, B. Larijani

Published in: Acta Diabetologica | Issue 1/2012

Abstract

Insulin has an important role in the treatment of diabetic patients. Further, it can result in undesirable side effects. One of the problems that are associated with insulin therapy is allergic reactions. Although insulin allergy is uncommon, especially in patients with type-2 diabetes, but when it occurs, its management can be difficult. We report a 55-year-old woman with poorly controlled type-2 diabetes and insulin allergy. She revealed hypersensitivity reactions including urticaria and respiratory symptoms, immediately after injection. So, specific immunotherapy with other insulin preparations was done. Finally, after specific immunotherapy, we were able to treat the patient with short- and long-acting analogs successfully.

Niswender K (2009) Early and aggressive initiation of insulin therapy for type 2 diabetes. What is the evidence? Clin Diabetes 27:60–68. doi:10.2337/diaclin.27.2.60 CrossRef

Weng J, Li Y, Xu W, Shi L, Zhang Q, Zhu D, Hu Y, Zhou Z, Yan X, Tian H, Ran X, Luo Z, Xian J, Yan L, Li F, Zeng L, Chen Y, Yang L, Yan S, Liu J, Li M, Fu Z, Cheng H (2008) Effect of intensive insulin therapy on beta-cell function and glycemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomized parallel-group trial. Lancet 371:1753–1760PubMedCrossRef

Pfutzner A, Schondorf T, Seidel D, Winkler K, Matthaei S, Hamann A, Forst T (2006) Impact of rosiglitazone on beta-cell function, insulin resistance, and adiponectin concentrations: results from a double-blind oral combination study with glimepiride. Metabolism 55:20–25PubMedCrossRef

Alvarsson M, Sundkvist G, Lager I, Berntorp K, Fernqvist-Forbes E, Steen L, Orn T, Holberg MA, Kirksaether N, Grill V (2008) Effects of insulin vs. glibenclamide in recently diagnosed patients with type 2 diabetes: a 4-year follow-up. Diabetes Obes Metab 10:421–429PubMedCrossRef

Heinzerling L, Raile K, Rochlitz H, Zuberbier T, Worm M (2008) Insulin allergy: clinical manifestations and management strategies. Allergy 63:148–155PubMedCrossRef

Wonders J, Eekhoff EM, Heine R, Bruynzeel DP, Rustemeyer T (2005) Insulin allergy: background, diagnosis and treatment. Ned Tijdschr Geneeskd 49:2783–2788

Rajpar SF, Foulds IS, Abdullah A, Maheshwari M (2006) Severe adverse cutaneous reaction to insulin due to cresol sensitivity. Contact Dermat 55:119–120CrossRef

Pföhler C, Müller CS, Hasselmann DO, Tilgen W (2008) Successful desensitization with human insulin in a patient with an insulin allergy and hypersensitivity to protamine: a case report. J Med Case Reports 26:283CrossRef

Fernández L, Duque S, Montalbán C, Bartolomé B (2003) Allergy to human insulin. Allergy 58:1317PubMedCrossRef

10.

Akinci B, Yener S, Bayraktar F, Yesil S (2010) Allergic reactions to human insulin: a review of current knowledge and treatment options. Endocrine 37:33–39PubMedCrossRef

11.

Reisman RE (2009) Clinical significance of insulin allergy and insulin resistance studies: application to drug “desensitization” concept and efficacy. J Allergy Clin Immunol 123:S1–S2

12.

Zhang L, Nakayama M, Eisenbarth GS (2008) Insulin as an autoantigen in NOD/human diabetes. Curr Opin Immunol 20:111–118. doi:10.1016/j.coi.2007.11.005 PubMedCrossRef

13.

Bollinger ME, Hamilton RG, Wood RA (1999) Protamine allergy as a complication of insulin hypersensitivity: a case report. J Allergy Clin Immunol 104:462–465PubMedCrossRef

14.

Schernthaner G (1993) Immunogenicity and allergenic potential of animal and human insulin. Diabetes Care 16:155–165PubMed

15.

Lee AY, Chey WY, Choi J, Jeon JS (2002) Insulin-induced drug eruptions and reliability of skin tests. Acta Derm Venereol 82:114–117PubMedCrossRef

16.

Blanco C, Castillo R, Quiralte J, Delgado J, Garcia I, de Pablos P, Carrillo T (1996) Anaphylaxis to subcutaneous neutral protamine Hagedorn insulin with simultaneous sensitization to protamine and insulin. Allergy 51(6):421–424PubMed

17.

Airaghi L, Lorini M, Tedeschi A (2001) The insulin analog aspart: a safe alternative in insulin allergy. Diabetes Care 24:2000PubMedCrossRef

18.

Barranco R, Herrero T, Tornero P, Barrio M, Frutos C, Rodríguez A, Malvetti V, Luisa Baeza M (2003) Systemic allergic reaction by a human insulin analog. Allergy 58:536–537PubMedCrossRef

19.

Durand-Gonzalez KN, Guillausseau N, Pecquet C, Gayno JP (2003) Glargine insulin is not an alternative in insulin allergy. Diabetes Care 26:2216PubMedCrossRef

20.

JiXiong X, Jianying L, Yulan C, Huixian C (2004) The human insulin analog aspart can induce insulin allergy. Diabetes Care 27:2084–2085PubMedCrossRef

21.

Takata H, Kumon Y, Osaki F, Kumagai C, Arii K, Ikeda Y, Suehiro T, Hashimoto K (2003) The human insulin analogue aspart is not the almighty solution for insulin allergy. Diabetes Care 26:253–254PubMedCrossRef

22.

Moyes V, Driver R, Croom A, Mirakian R, Chowdhury TA (2006) Insulin allergy in a patient with Type 2 diabetes successfully treated with continuous subcutaneous insulin infusion. Diabet Med 23:204–206PubMedCrossRef

23.

Näf S, Esmatjes E, Recasens M, Valero A, Halperin I, Levy I, Gomis R (2002) Continuous subcutaneous insulin infusion to resolve an allergy to human insulin. Diabetes Care 25:634–635PubMedCrossRef

24.

Kaya A, Gungor K, Karakose S (2007) Severe anaphylactic reaction to human insulin in a diabetic patient. J Diabetes Complicat 21:124–127PubMedCrossRef

25.

Asai M, Yoshida M, Miura Y (2006) Immunologic tolerance to intravenously injected insulin. N Engl J Med 354:307–309PubMedCrossRef

26.

Baxter MA (2008) The role of new basal insulin analogues in the initiation and optimisation of insulin therapy in type 2 diabetes. Acta Diabetol 45(4):253–268PubMedCrossRef

27.

Kara C, Kutlu AO, Evliyaoglu O, Bilgili H, Yildirim N (2005) Successful treatment of insulin allergy in 1-year-old infant with neonatal diabetes by lispro and glargine insulin. Diabetes Care 28:983–984PubMedCrossRef

28.

Matheu V, Perez E, Hernández M, Díaz E, Darias R, González AC, García J, Sánchez I, Feliciano L, Caballero A, de la Torre F (2005) Insulin allergy and resistance successfully treated by desensitization with Aspart insulin. Clin Mol Allergy 3:16PubMedCrossRef

29.

Mollar-Puchades MA, Villanueva IL (2009) Insulin glulisine in the treatment of allergy to rapid acting insulin and its rapid acting analogs. Diabetes Res Clin Pract 83:e21–e22PubMedCrossRef

30.

Hara M, Izumida Y, Sato N, Ohashi K, Osuga J, Tobe K, Tsukamoto K, Kadowaki T (2009) Successful desensitization by glargine administration in a patient with insulin allergy: a case report. Diabetes Res Clin Pract 84:e48–e49PubMedCrossRef

31.

Yokoyama H, Fukumoto S, Koyama H, Emoto M, Kitagawa Y, Nishizawa Y (2003) Insulin allergy; desensitization with crystalline zinc-insulin and steroid tapering. Diabetes Res Clin Pract 61:161–166PubMedCrossRef

32.

Raubenheimer PJ, Levitt NS (2004) A case of generalized allergic reaction to human insulin. J Endocrinol Metab Diabetes S Afr 9:18–20

Title: Allergy to human insulin and specific immunotherapy with glargine; case report with review of literature
Authors: S. Hasani-Ranjbar
M. R. Fazlollahi
A. Mehri
B. Larijani
Publication date: 01-02-2012
Publisher: Springer Milan
Published in: Acta Diabetologica / Issue 1/2012
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI: https://doi.org/10.1007/s00592-011-0254-4

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