Abstract
IntroductionInsulin allergy to human insulin preparations during the treatment of diabetes is suggested to occur at rates ranging from <1.0% to 2.4%. These reactions vary from mild localized reactions, which resolve with repeated exposure, to life-threatening anaphylaxis and death. The management of persistent insulin allergy in type 1 diabetes mellitus is particularly complicated because ongoing treatment with insulin is essential.Case presentationWe present the case of a 12-year-old Caucasian girl with localized allergy to the insulin excipient metacresol, and the subsequent desensitization therapy using continuous subcutaneous insulin infusion with simultaneous intravenous insulin infusion.ConclusionsThis is the first documented case of allergy to the metacresol component of insulin in the pediatric type 1 diabetes literature. We describe an approach to diagnosis and management of metacresol allergy in type 1 diabetes.
Highlights
Insulin allergy to human insulin preparations during the treatment of diabetes is suggested to occur at rates ranging from
We present a case of allergic reaction to the insulin excipient metacresol
An allergic reaction to human insulin seemed less probable because the human insulin molecule differs between preparations
Summary
Less common since the introduction of human insulin [1], is still an issue in the management of diabetes. At 6 weeks from diabetes diagnosis, her aspart injections began to cause pain and localized erythema. Subcutaneous testing was conducted on all available insulin preparations (ProtaphaneW, ActrapidW, lispro, aspart, glulisine, glargine, Humulin NPHW, Humulin RW, detemir). An allergic reaction to human insulin seemed less probable because the human insulin molecule differs between preparations To explore this fully, Novo NordiskW diluting medium, which does not contain insulin but does have similar excipients to insulin aspart, was the step. Within 2 hours of commencement the infusion was stopped due to immediate localized urticaria followed by substantial pain. At this stage, 3 days of oral prednisone 20mg was added. By 168 hours, small (
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