Desensitization of allergy to human insulin and its analogs by administering insulin aspart and insulin glargine

Wu, Ping; Cheng, Ji; Wang, Mingli; Zou, Shengquan; Ge, Weihong

doi:10.1016/j.ando.2012.11.005

Cited by 7 publications

(9 citation statements)

References 9 publications

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“…Many protocols for insulin desensitization have been described in the literature, most commonly using small, increasing doses of SC insulin (6)(7)(8) or CSII (9)(10)(11), and less commonly IV insulin (12). These protocols have also included pretreatment regimens including antihistamines and corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical presentation can range from local injection site reactions to severe anaphylaxis (5). Allergies due to the development of insulin-specific antibodies necessitate insulin desensitization, and several case reports have demonstrated successful desensitization protocols using a series of gradually increasing subcutaneous (SC) doses of a rapid-acting insulin analogue (6)(7)(8), or continuous subcutaneous insulin infusion (CSII) delivered through an insulin pump (9-11). There have only been a few case reports demonstrating successful desensitization with IV insulin alone (12), or in combination with SC insulin delivered by CSII (13,14).…”

Section: Introductionmentioning

confidence: 99%

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Rapid Desensitization with Intravenous Insulin in a Patient with Diabetic Ketoacidosis and Insulin Allergy

Shuster¹,

Borici-Mazi

Awad

et al. 2020

AACE Clinical Case Reports

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Objective: We report a case of insulin desensitization in a patient with known allergy to multiple insulin preparations who presented with diabetic ketoacidosis (DKA). Methods: Clinical and laboratory data, and desensitization protocols are presented. Results: A 65-year-old woman with type 2 diabetes and a documented insulin allergy presented with severe DKA. She was managed initially with intravenous (IV) fluids, sodium bicarbonate, and hemodialysis. An intradermal skin test was positive for 0.01 units/mL of human regular insulin. A rapid desensitization protocol for IV human regular insulin was initiated after pretreatment with methylprednisolone, ranitidine, montelukast, and cetirizine. An initial dilution of 1 unit of insulin in 100,000 mL of 0.9% sodium chloride was started at 5 mL/hour IV. The dilution was increased at 60-minute intervals to 1 unit/10,000 mL, 1 unit/1,000 mL, 1 unit/100 mL, 1 unit/10 mL, then 1 unit/1 mL. The dose was then increased from 1 to 7 units/hour (0.1 units/kg body weight/hour). The anion gap closed after 24 hours, and overlapping desensitization was started for subcutaneous (SC) human regular insulin starting with 0.00001 units with a gradual increase to 7 units before meals and 6 units at bedtime over 5 days. There were no anaphylactic reactions to IV or SC insulin. She was discharged with human regular insulin SC 4 times daily, oral montelukast, cetirizine, diphenhydramine as needed, and an epinephrine pen. No allergic reactions were reported at follow-up visits. Conclusion: Rapid insulin desensitization is possible to allow treatment of DKA with human regular insulin IV in patients with known insulin allergy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rapid Desensitization with Intravenous Insulin in a Patient with Diabetic Ketoacidosis and Insulin Allergy

Shuster¹,

Borici-Mazi

Awad

et al. 2020

AACE Clinical Case Reports

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“…To the best of our knowledge, allergy to insulin analogs is also rare, with no more than a few case reports in the scientific literature . In fact, some desensitization strategies have been proposed by using insulin analogs like glargine in cases of allergy to recombinant regular insulin …”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4] In fact, some desensitization strategies have been proposed by using insulin analogs like glargine in cases of allergy to recombinant regular insulin. [4][5][6] Biopharmaceuticals are drugs containing biotechnology substances (proteins or polysaccharides) as their active ingredients, most of them developed with recombinant DNA techniques, and therefore, are produced in living systems. 7 Patents of several biopharmaceuticals have recently expired, or are due to expire.…”

Section: Introductionmentioning

confidence: 99%

Hypersensitivity reaction to a biosimilar insulin glargine 对甘精胰岛素生物仿制品的过敏反应

García-Nares

Leyva-Carmona

Pérez-Xochipa

et al. 2015

Journal of Diabetes

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“…Numerous strategies for managing HIA hypersensitivity reactions have been utilized in the literature. One of the most common strategies is the use of insulin desensitization protocols, including regular, 28,46 glargine, 47–50 aspart 25,50 and lispro 51 via subcutaneous injections 25,28,46–48,50 or CSII. 49,51 The selection of the ideal HIA for desensitization may be assisted by using the least reactive insulin for the patient (identified via confirmatory testing) when implementing the protocol 14 .…”

Section: Data Synthesismentioning

confidence: 99%

Hypersensitivity reactions to human insulin analogs in insulin-naïve patients: a systematic review

Bzowyckyj

Stahnke

2017

Therapeutic Advances in Endocrinology

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Objective: The objective of this study was to raise awareness of hypersensitivity reactions to human insulin analogs (HIAs) in insulin-naïve patients and encourage consistent and detailed reporting of HIA reactions. Data sources: A search of PubMed, MEDLINE and International Pharmaceutical Abstracts using the terms 'insulin' and 'hypersensitivity' was completed with English language, humans, and publication date after 1 January 1990 as limits. Study selection and data extraction: The initial search identified 598 articles. These titles and abstracts were reviewed for relevance (e.g. mention of HIA) resulting in the exclusion of 477 articles. The full texts of the remaining titles were evaluated in addition to each article's references to identify additional reports meeting criteria (n = 14). Upon extensive review, 118 articles were excluded for not meeting prespecified inclusion criteria, resulting in 17 articles. Data synthesis: Evidence supporting hypersensitivity reactions to HIAs was variable, potentially due to a variety of causes (e.g. difficulty identifying a true case of hypersensitivity reaction to HIAs). Inconsistencies were noted for the identification, confirmatory testing, management, and reporting of these reactions. Management strategies included use of insulin desensitization protocols, antihistamines, steroids, immunosuppressant/immunomodulator therapies, conversion to noninsulin therapies, and pancreas transplantation. Conclusions: Complete and consistent identification, evaluation, management, and reporting of these reactions is essential. Specific aspects of the patient's history should be reported, including previous insulin exposure, the specific HIAs used, duration of use prior to the reaction, a clear timeline of the reaction, and discussion of precipitating events or confounding factors.

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Desensitization of allergy to human insulin and its analogs by administering insulin aspart and insulin glargine

Cited by 7 publications

References 9 publications

Rapid Desensitization with Intravenous Insulin in a Patient with Diabetic Ketoacidosis and Insulin Allergy

Rapid Desensitization with Intravenous Insulin in a Patient with Diabetic Ketoacidosis and Insulin Allergy

Hypersensitivity reaction to a biosimilar insulin glargine 对甘精胰岛素生物仿制品的过敏反应

Hypersensitivity reactions to human insulin analogs in insulin-naïve patients: a systematic review

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