Journal List > Allergy Asthma Respir Dis > v.3(4) > 1059119

Choi, Kwon, Park, Bae, Oh, Lee, Moon, Park, Won, Ko, Rhee, and Kim: Allergic reaction to recombinant human insulin

Abstract

Insulin-induced allergy is a rare adverse drug reaction since the introduction of recombinant human insulin. However, recombinant insulin-induced allergy is still being reported in 0.1% to 2% of all patients treated with insulin. This allergic reaction varies from mild localized skin reactions to life-threatening anaphylaxis. It has been shown that one-third of insulin allergy cases is related to insulin itself and the remaining occur due to preservatives contained in the insulin preparations, such as protamine, zinc, or metacresol. This case report describes a 75-year-old woman with poorly controlled diabetes who experienced insulin allergy. She complained of urticaria with itching after the injection of insulin. Allergic skin tests showed positive responses to all available human insulin preparations, and specific IgE to human insulin was also detected, which suggested that her urticaria was developed by insulin itself. This is the first case of insulin allergy that was sensitive to all available human insulin preparations and confirmed by the presence of specific IgE to human insulin. It is important to remember that allergic reactions to insulin may be directly associated with adherence and can be the reason of poor glucose control.

Figures and Tables

Fig. 1

After insulin injection, wheal and flare reaction were induced in thigh.

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Fig. 2

Intradermal skin test showed positive responses to regular insulin, lispro, aspart, and glargine. The reagents of insulin were used as 1:1, 1:10, 1:100, and 1:1000 dilution.

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Fig. 3

Peripheral blood eosinophil count is inversely proportional to glycosylated hemoglobin (HbA1c). This result could be related to poor compliance with insulin injection.

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Table 1

The result of allergic skin test of recombinant human insulins

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Prick test Intradermal test
Concentration Wheal (mm) Concentration Wheal (mm)
Histamine 1.7 mg/mL 5 × 5 0.17 mg/mL 12 × 8
Normal saline - -
Protamine 10 mg/mL 3 × 3 1 mg/mL 8 × 10
Regular insulin 100 IU/mL 7 × 7 10 IU/mL 15 × 14
Lispro 100 IU/mL 8 × 8 10 IU/mL 20 × 10
Aspart 100 IU/mL 7 × 7 10 IU/mL 18 × 17
Glargine 100 IU/mL 5 × 5 10 IU/mL 12 × 13

The result of intradermal test is obtained by using a 1:10 dilution.

References

1. Pfohler C, Muller CS, Hasselmann DO, Tilgen W. Successful desensitization with human insulin in a patient with an insulin allergy and hypersensitivity to protamine: a case report. J Med Case Rep. 2008; 2:283.
2. Hong JH, Lee JH, Shin JH, Kim DP, Ko BS, Kim BJ, et al. Maintenance of insulin therapy by desensitization in insulin allergy patient. Korean Diabetes J. 2008; 32:529–531.
crossref
3. Kim MH, Lim KH, Park HK, Kim BK, Kang MK, Kwon JW, et al. A case of change of insulin-specific antibodies following desensitization in insulin hypersensitivity patients. Korean J Asthma Allergy Clin Immunol. 2010; 30:63–67.
4. Oh TK, Jung JI, Hahn Z, Kim MK. A case of human insulin allergy induced by rapid acting human recombinant insulin, humulin-R. Korean J Asthma Allergy Clin Immunol. 2006; 26:155–158.
5. Castera V, Dutour-Meyer A, Koeppel M, Petitjean C, Darmon P. Systemic allergy to human insulin and its rapid and long acting analogs: successful treatment by continuous subcutaneous insulin lispro infusion. Diabetes Metab. 2005; 31:391–400.
crossref
6. Sohn I, Kim YY, Kang SY. Two cases of insulin allergy. J Asthma Allergy Clin Immunol. 1981; 1:126–130.
7. Kim SY, Kim YY, Lee HK, Kang SY. A case of insulin allergy treated by desensitization. J Asthma Allergy Clin Immunol. 1982; 2:35–40.
8. Lee AY, Chey WY, Choi J, Jeon JS. Insulin-induced drug eruptions and reliability of skin tests. Acta Derm Venereol. 2002; 82:114–117.
crossref
9. Adachi A, Fukunaga A, Horikawa T. A case of human insulin allergy induced by short-acting and intermediate-acting insulin but not by long-acting insulin. Int J Dermatol. 2004; 43:597–599.
crossref
10. Radermecker RP, Scheen AJ. Allergy reactions to insulin: effects of continuous subcutaneous insulin infusion and insulin analogues. Diabetes Metab Res Rev. 2007; 23:348–355.
crossref
11. Asai M, Yoshida M, Miura Y. Immunologic tolerance to intravenously injected insulin. N Engl J Med. 2006; 354:307–309.
crossref
12. Bodtger U, Wittrup M. A rational clinical approach to suspected insulin allergy: status after five years and 22 cases. Diabet Med. 2005; 22:102–106.
crossref
13. Ghazavi MK, Johnston GA. Insulin allergy. Clin Dermatol. 2011; 29:300–305.
crossref
14. Ben Ammar I, Ksouri H, Trabelsi N, Mellouli F, Ben Mami F, Dakhli S, et al. Generalized allergy due to zinc in insulin treated with zinc-free insulin. Acta Diabetol. 2012; 49:239–241.
crossref
15. Wheeler BJ, Taylor BJ. Successful management of allergy to the insulin excipient metacresol in a child with type 1 diabetes: a case report. J Med Case Rep. 2012; 6:263.
crossref
16. Clerx V, Van Den, Kochuyt A, Goossens A. Drug intolerance reaction to insulin therapy caused by metacresol. Contact Dermatitis. 2003; 48:162–163.
crossref
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Jung Min Kim
https://orcid.org/http://orcid.org/0000-0002-1848-3747

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