Endocrinol Metab.  2015 Sep;30(3):402-407. 10.3803/EnM.2015.30.3.402.

Two Cases of Allergy to Insulin in Gestational Diabetes

• Kim GJ
• Kim SB
• Jo SI
• Shin JK
• Kwon HS
• Jeong H
• Son JW
• Lee SS
• Kim SR
• Kim BK
• Yoo SJ

• KMID: 2407093
• DOI: http://doi.org/10.3803/EnM.2015.30.3.402

Abstract

Allergic reaction to insulin is uncommon since the introduction of human recombinant insulin preparations and is more rare in pregnant than non-pregnant females due to altered immune reaction during pregnancy. Herein, we report two cases of allergic reaction to insulin in gestational diabetes that were successfully managed. One case was a 33-year-old female using isophane-neutral protamine Hagedorn human insulin and insulin lispro. She experienced dyspnea, cough, urticaria and itching sensation at the sites of insulin injection immediately after insulin administration. We discontinued insulin therapy and started oral hypoglycemic agents with metformin and glibenclamide. The other case was a 32-year-old female using insulin lispro and insulin detemer. She experienced pruritus and burning sensation and multiple nodules at the sites of insulin injection. We changed the insulin from insulin lispro to insulin aspart. Assessments including immunoglobulin E (IgE), IgG, eosinophil, insulin antibody level and skin biopsy were performed. In the two cases, the symptoms were resolved after changing the insulin to oral agents or other insulin preparations. We report two cases of allergic reaction to human insulin in gestational diabetes due to its rarity.

Keyword

Insulin allergy; Diabetes, gestational; Hypersensitivity, immediate

MeSH Terms

Adult
Biopsy
Burns
Cough
Diabetes, Gestational*
Dyspnea
Eosinophils
Female
Glyburide
Humans
Hypersensitivity*
Hypersensitivity, Immediate
Hypoglycemic Agents
Immunoglobulin E
Immunoglobulin G
Immunoglobulins
Insulin Aspart
Insulin Lispro
Insulin*
Metformin
Pregnancy
Pruritus
Sensation
Skin
Urticaria
Glyburide
Hypoglycemic Agents
Immunoglobulin E
Immunoglobulin G
Immunoglobulins
Insulin
Insulin Aspart
Insulin Lispro
Metformin

Figure

• 

  Fig. 1 Grayish and reddish hyperpigmented patches at the site of insulin injection. (A) Right proximal arm. (B) Left proximal arm.

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  Fig. 2 Histopathology of skin lesions of both proximal arms. Perivascular lymphohistiocytic and eosinophilic infiltration (A) around fat tissue in deep dermis (H&E stain, ×400) and (B) around capillaries in subcutis (H&E stain, ×400) was observed.

• 

  Fig. 3 Multiple erythematous nodules at the site of insulin injection. (A) Right thigh. (B) Left thigh.

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  Fig. 4 Histopathology of skin lesions of both thighs. (A) Spongiosis of epidermis (H&E stain, ×400). (B) Perivascular mononuclear cell infiltration around endothelial cells at the dermis level (H&E stain, ×400). (C) Eosinophilic infiltration around capillaries at the subcutis level (H&E stain, ×400).

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