Allergy Asthma Respir Dis.  2015 Jul;3(4):302-306. 10.4168/aard.2015.3.4.302.

Allergic reaction to recombinant human insulin

• Choi SJ
• Kwon MK
• Park M
• Bae SY
• Oh HH
• Lee JH
• Moon JI
• Park CS
• Won JC
• Ko KS
• Rhee BD
• Kim JM

• KMID: 2218662
• DOI: http://doi.org/10.4168/aard.2015.3.4.302

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.

Keyword

Insulin; Hypersensitivity; Skin tests; Insulin antibodies; Immunoglobulin E

MeSH Terms

Aged
Anaphylaxis
Drug-Related Side Effects and Adverse Reactions
Female
Glucose
Humans*
Hypersensitivity*
Immunoglobulin E
Insulin Antibodies
Insulin*
Pruritus
Skin
Skin Tests
Urticaria
Zinc
Glucose
Immunoglobulin E
Insulin
Insulin Antibodies
Zinc

Figure

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  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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