A case of hypersensitivity to soluble and isophane insulins but not to insulin glargine

Abstract

Insulin is an important agent for the treatment of diabetes mellitus (DM). Allergic reactions to insulin therapy, although rare, have been evident since animal insulin became available for the treatment of DM in 1922. Hypersensitivity to insulin has considerably been reduced with the introduction of human insulin produced by recombinant deoxyribonucleic acid technology. Here, we present a case of Type 2 DM who demonstrated immediate (Type 1) hypersensitivity reaction on the sites of subcutaneous injection of soluble and isophane insulin but insulin glargine was tolerated well and provided good glycemic control.

Faulty Injection Technique: A Preventable But Often Overlooked Factor in Insulin Allergy

“…A common occurrence during the era of animal insulins because of altered peptide structures, presence of contaminants, highly immunogenic components such as C-peptide and proinsulin and the resulting greater antigenic potential, hypersensitivity reactions are now usually due to the presence of various pharmaceutical formula additives (protamine, meta -cresol, phenol, sodium phosphate, zinc, etc.) [ 2 ]. However, human insulin and insulin analogs can also act as potential allergens at times, and this has been observed with almost all currently available insulins.…”