Insulin Allergy Research Articles

Low molecular weight protamine/insulin formulation with potential to attenuate protamine-masqueraded insulin allergy

Huining He, Allan E. David, Jian Zhang, Yoon Shin Park, Jianxin Wang, Yongzhuo Huang, Jingkang Wang, and Victor C. Yang* Tianjin Key Laboratory for Modern Drug Delivery and High Efficiency, Tianjin University, Tianjin 300072, P. R. China Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109-1065, USA State Key Laboratory for Chemical Engineering and School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, P. R. China Industrial Science & Technology Network Inc., York, PA 17404, USA Department of Pharmaceutics, School of Pharmacy, Fudan University, Shanghai 201203, P. R. China Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, P. R. China Tianjin Key Laboratory on Technologies Enabling Development of Clinical Therapeutics and Diagnostics, School of Pharmacy, Tianjin Medical University, Tianjin 300070, P. R. China

インスリン即時型アレルギーならびにimmunological insulin resistanceによる血糖コントロール悪化に対しステロイド療法とCSIIが著効した1例

インスリン即時型アレルギーならびにimmunological insulin resistanceによる血糖コントロール悪化に対しステロイド療法とCSIIが著効した1例

ウシ, ブタ, およびヒトインスリンに対して, アレルギーとインスリン抵抗性を示したインスリン依存型糖尿病の1例

ウシ, ブタ, およびヒトインスリンに対して, アレルギーとインスリン抵抗性を示したインスリン依存型糖尿病の1例

Pan-insulin allergy and severe lipoatrophy complicating Type 2 diabetes

Insulin allergy is a rare complication of insulin use. Localized lipoatrophy is also known to occur following subcutaneous injections of insulin. A 53-year-old non-obese female patient with Type 2 diabetes displayed local allergic-type symptoms to all available insulin preparations. This was complicated by the development of severe lipoatrophy on her abdominal and thigh injection sites and subsequently resulted in suboptimal glycaemic control. Whilst uncommon, insulin allergy and lipoatrophy can cause major problems in diabetic management. Potential pathophysiological mechanisms and a stepwise approach to management are discussed.

速効型, 中間型インスリンにはアレルギー反応を示したが, 遅効型インスリンには示さなかったNIDDMの1例

速効型, 中間型インスリンにはアレルギー反応を示したが, 遅効型インスリンには示さなかったNIDDMの1例

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

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.

Generalized allergy due to zinc in insulin treated with zinc-free insulin

Allergy to insulin became a rare complication due to the introduction of recombinant human insulin preparations. Nevertheless, allergic reactions to components of such preparations can occur. We report a case of a 61-year-old man with an atopic background and affected by diabetes mellitus type 2 since 27 years, who experienced generalized allergy to insulin at the moment of switching oral anti-diabetics to insulin. Prick tests revealed an allergy specifically to zinc, and the patient was treated with zinc-free glulisine insulin. After 8 months of such treatment, patient's glucose is stable and he never experienced allergic reactions to insulin injections. Even insulin allergy due specifically to zinc is rare, such complication must be assessed especially in a patient suffering from multiple allergies.

The increase of plasma galectin-9 in a patient with insulin allergy: a case report

Allergic reaction to insulin is known to be associated with eosinophilia and hyper IgE. Recent report showed that eosinophilia is related with the increased synthesis of galectin-9 (GAL-9) and osteopontin (OPN). Here, we examined plasma levels of GAL-9 and OPN first time in a case of 65-year old patient with insulin allergy. Insulin aspart & insulin aspart 30 mix were given to the patient and an elevation of the eosinophil count (8440/μl, 17.6 fold) and a moderate increase of IgE (501 U/ml, reference range: 10-350 U/ml), eotaxin-3 (168 pg/ml, 2 fold), histamine (0.95 ng/ml, 5.3 fold) were found 33 days later. The plasma levels of GAL-9 and OPN were 22.5 and 1.7 fold higher than the cut-off point, respectively. After one month cessation of insulin therapy, elevations of the eosinophil count (3,480/μl; 7.3 fold), and OPN (1.4 fold) still occurred but the GAL-9 levels became normal. Therefore, we noted the increases of GAL-9 and OPN in plasma for the first time in a patient with insulin allergy and propose that GAL-9 reflects the conditions of allergy more accurately.

Immunologic Tolerance to the Insulin Analogue Glulisine

Systemic allergy to insulin is a rare but severe condition. The introduction of human insulin analogues lispro and aspart has considerably decreased the severity of a reaction to insulin (1). However, cases of an allergic reaction to these analogues have also been reported (2). We describe the case of a patient in which severe systemic allergy subsided after glulisine, the latest insulin analogue, was administered. A 33-year-old man was referred to our hospital for the management of type 1 diabetes and insulin allergy. Previously, we showed that intravenous administration using a portable device …

Insulin Allergy Whose Local/systemic Reactions were Reduced by Desensitization with Long-acting Insulin Analog, Glargine.

Insulin Allergy Whose Local/systemic Reactions were Reduced by Desensitization with Long-acting Insulin Analog, Glargine.

Allergic reactions to human insulin: a review of current knowledge and treatment options

Although the incidence of insulin allergy decreased after the introduction of recombinant human insulin preparations, it is still a major problem which may be life-threatening in some cases. In this article, we attempted to review current knowledge concerning allergic reactions to human insulin and discuss the available treatment options of insulin allergy.

Serum sickness‐like reactions associated with type III insulin allergy responding to plasmapheresis

Diabetic MedicineVolume 26, Issue 6 p. 659-660 Serum sickness-like reactions associated with type III insulin allergy responding to plasmapheresis F. Bayraktar, F. Bayraktar Division of Endocrinology and Metabolism, Department of Internal MedicineSearch for more papers by this authorB. Akinci, B. Akinci Division of Endocrinology and Metabolism, Department of Internal MedicineSearch for more papers by this authorF. Demirkan, F. Demirkan Division of Haematology, Department of Internal Medicine, Dokuz Eylul University Medical School, IzmirSearch for more papers by this authorS. Yener, S. Yener Division of Endocrinology and Metabolism, Department of Internal MedicineSearch for more papers by this authorS. Yesil, S. Yesil Division of Endocrinology and Metabolism, Department of Internal MedicineSearch for more papers by this authorC. Kırmaz, C. Kırmaz Division of Allergy, Department of Internal Medicine, Celal Bayar University, Manisa, TurkeySearch for more papers by this authorA. Comlekci, A. Comlekci Division of Endocrinology and Metabolism, Department of Internal MedicineSearch for more papers by this author F. Bayraktar, F. Bayraktar Division of Endocrinology and Metabolism, Department of Internal MedicineSearch for more papers by this authorB. Akinci, B. Akinci Division of Endocrinology and Metabolism, Department of Internal MedicineSearch for more papers by this authorF. Demirkan, F. Demirkan Division of Haematology, Department of Internal Medicine, Dokuz Eylul University Medical School, IzmirSearch for more papers by this authorS. Yener, S. Yener Division of Endocrinology and Metabolism, Department of Internal MedicineSearch for more papers by this authorS. Yesil, S. Yesil Division of Endocrinology and Metabolism, Department of Internal MedicineSearch for more papers by this authorC. Kırmaz, C. Kırmaz Division of Allergy, Department of Internal Medicine, Celal Bayar University, Manisa, TurkeySearch for more papers by this authorA. Comlekci, A. Comlekci Division of Endocrinology and Metabolism, Department of Internal MedicineSearch for more papers by this author First published: 01 June 2009 https://doi.org/10.1111/j.1464-5491.2009.02733.xCitations: 12Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume26, Issue6June 2009Pages 659-660 RelatedInformation

インスリンアレルギーに引き続き，造影剤，抗生物質に対しても有害薬物反応を呈した2型糖尿病の1例

インスリンアレルギーに引き続き，造影剤，抗生物質に対しても有害薬物反応を呈した2型糖尿病の1例

Successful desensitization by glargine administration in a patient with insulin allergy: A case report

The patient was a 56-year-old man with type 2 diabetes and insulin allergy. He was administered glargine, which did not produce any allergic reactions, except for a small non-pruritic wheal. Thereafter, other insulin preparation could be administered. We consider this the first case of successful insulin desensitization by glargine administration.

Rituximab and Omalizumab in Severe, Refractory Insulin Allergy

To the Editor: We describe the sequential use of two targeted biologic agents to treat a patient with severe systemic insulin allergy accompanied by marked metabolic dysregulation and corticosteroid toxicity. In 1996, a 50-year-old woman received the diagnosis of type 1 diabetes. Shortly after insulin therapy was initiated, a generalized urticarial rash (resulting in excoriation, bleeding, and disrupted sleep) developed. Insulin allergy was diagnosed on the basis of positive skin-prick tests and a level of insulin-specific IgE of 5.75 kU per liter (normal value, <0.70 kU per liter). Until 2000, she was treated with a standard stepwise approach of trying . . .

Severe insulin allergy after percutaneous transluminal coronary angioplasty

Background: Insulin therapy is essential for type 1 and inadequately controlled type 2 diabetic patients. Insulin allergies have become less common since the introduction of highly purified human recombinant insulin. There are rare reports of severe insulin allergic reactions after percutaneous transluminal coronary angioplasty (PTCA) in patients with type 2 diabetes who had no previous allergic reactions. To better understand the causes and presentation of this rare acute reaction, we present the following observed case. Case summary: A 63-year-old Chinese man (height, 172 cm; weight, 68.5 kg) with a 17-year history of type 2 diabetes and hypertension was first admitted to the West China Hospital, Sichuan University, Sichuan, People's Republic of China, for uncontrolled type 2 diabetes. He used regular human insulin, neutral protamine Hagedorn insulin, or premixed insulin without any allergic reactions. Four months later, PTCA was performed because of an acute myocardial infarction. The patient was administered 50 mg of protamine after active abdominal bleeding due to a right external iliac artery rupture. Three months later, recurrent raised, pruritic erythema occurred at the insulin injection site immediately after injection. Four weeks later, he experienced an attack of generalized urticaria at multiple previous injection sites (abdomen, upper arms, thighs) after injecting premixed insulin. It was accompanied by dizziness and palpitations. During the following 3 months, the symptoms recurred 3 times; one time, the patient reported losing consciousness for 2 to 3 minutes. The results of a skin prick test found that he was allergic to human recombinant insulin and insulin lispro. The allergy was resolved by changing his treatment regimen from insulin to oral hypoglycemic agents. A Naranjo score of 10 suggested a definite relationship (score ≥9) between the adverse drug reaction and the insulin administration. Conclusions: We present a definite case of allergy associated with insulin and insulin lispro administration. The patient had not experienced anaphylactic reactions prior to PTCA and protamine administration.

Gallbladder Edema in Type 1 Diabetic Patient due to Delayed-type Insulin Allergy

A 29-year-old woman was diagnosed as having type 1 diabetes mellitus and received insulin aspart and NPH insulin (NovolinN). On day 22, she had leg edema and right abdominal pain. The serum hepatobiliary enzyme levels were markedly elevated. Computed tomography revealed gallbladder edema. After an injection of human regular insulin and NPH insulin (HumacartN), the elevated liver enzyme levels were no longer observed. Challenge testing demonstrated that protamine was the cause of her allergy. Furthermore, tests revealed increased VEGF levels. This is an extremely rare case with a delayed-type protamine allergy caused by NovolinN resulting in gallbladder edema.

Insulin glulisine in the treatment of allergy to rapid acting insulin and its rapid acting analogs

This is a case report of a patient with allergy to the rapid acting insulins and rapid acting analogs. Before trying insulin desensitization the treatment was changed to a basal-bolus regimen with glargine and glulisine with no signs of insulin allergy during the months after the start of the treatment.

Successful desensitization with human insulin in a patient with an insulin allergy and hypersensitivity to protamine: a case report

IntroductionInsulin allergy may occur in patients treated with subcutaneous applications of insulin preparations. Besides additives in the insulin preparation such as protamine, cresol, and phenol, the insulin molecule itself may be the cause of the allergy. In the latter case, therapeutic options are rare.Case presentationA 68-year-old man with poorly controlled type 2 diabetes mellitus received different insulin preparations subcutaneously while on oral medication. Six to eight hours after each subcutaneous application, he developed pruritic plaques with a diameter of >15 cm at the injection sites that persisted for several days. Allergologic testing revealed positive reactions against every insulin preparation and against protamine. Investigation of serum samples demonstrated IgG antibodies against human and porcine insulin. We treated the patient with human insulin using an ultra-rush protocol beginning with 0.004 IU and a rapid augmentation in dose up to 5 IU. Therapy was accompanied by antihistamine therapy. Subsequent conversion to therapy with glargine insulin (6 IE twice daily) was well-tolerated.ConclusionAs reported in this case, desensitization with subcutaneously administered human insulin using an ultra-rush protocol in patients with an insulin allergy may present an easy form of therapy that is successful within a few days.

Insulin allergy desensitization with simultaneous intravenous insulin and continuous subcutaneous insulin infusion

Persistent 'IgE-mediated' insulin allergy (type 1 allergy) (1), unresponsive to changes in insulin type or the use of antihistamines, necessitates desensitization. A number of case reports (2-7) and recent reviews (8, 9) have demonstrated that desensitization can be achieved with continuous subcutaneous insulin infusion (CSII), but in type 1 diabetes mellitus, the need to slowly increase insulin dose from sub-therapeutic levels competes with the need for glycaemic control and suppression of ketogenesis. Tolerance to intravenous (IV) insulin despite persistent life-threatening allergic reactions to subcutaneous human insulin (bolus or CSII) has been recently described (10). We present the cases of two unrelated 9-yr-old boys with persistent generalized urticarial reactions to subcutaneous injections of all available insulin types, despite treatment with oral antihistamines. After failed rapid desensitization to insulin delivered by either subcutaneous injection or CSII, the concurrent use of IV insulin allowed desensitization to CSII over 5-6 d.