Hypersensitivity Reaction to Insulin Glargine and Insulin Detemir in a Pediatric Patient: A Case Report

Abstract

Allergy to human insulin or its analogs is rare, but it is still a significant issue in current diabetes care. Allergic reactions can range from localized injection site reactions to generalized anaphylaxis, and they can be caused by excipients or the insulin molecules themselves. We presented a case of a 14-year-old male patient with generalized allergic reactions to insulin glargine and insulin detemir. The patient was successfully managed by being switched to a continuous subcutaneous insulin infusion with insulin aspart. Allergic reactions to insulin detemir and insulin glargine have both been well described, with insulin detemir allergy appearing to be more common. There are several potential mechanisms for insulin allergy, and immunologic characteristics vary among different insulin analogs. After confirming insulin allergy in practice, management involves treating symptoms and switching insulin preparations. This is the first documented case of allergies to both insulin glargine and insulin detemir in a pediatric patient. Exact mechanism of insulin allergy is unknown, and management strategies must be individualized for each patient.

Severe allergic reaction to human insulin in the patient with diabetic ketoacidosis

“…However life-threatening angioedema and anaphylaxis were also reported. 2 , 4 The patient's past medical history did not indicate any allergies, and this allergic reaction developed after the first contact with human insulin.…”

“…Densensitization treatment/immunotherapy is efficient for diabetic patients with allergies to insulin, however, these treatments are not appropriate for DKA patients. 2 , 3 , 4 , 5 , 6 On the other hand, these treatment options are not useful in emergency situations. Repeated hemodialysis is another treatment choice for correction of resistant metabolic acidosis and removal of ketone bodies, but it is inadequate overall.…”

Clinical challenges with excipients in insulin formulations and role of concentrated insulin

“…Hypersensitivity reactions are also reported with insulin analogs like glargine and detemir. 27 Excipients used along with the insulin act as antimicrobial preservative and insulin stabilizer. 4,28 Probably the first reported case of protamine allergy was a 26-year old patient of insulin-dependent diabetes receiving insulin zinc protamine 20IU per day.…”

Clinical Safety of Selected Ayurvedic Formulations in Diabetes Mellitus–A Pharmaco-epidemiological Perspective

“…Drug resistance, hypersensitivity with insulin, drug intolerance, and fear to hypo and hyperglycemic episode with drugs are certain setbacks of anti-diabetic modern medicines. [8][9][10][11] Pramehaghna Ayurveda drugs have Rasayana (rejuvinative), Tridosha Shamaka, Lekhana properties by which Ayurvedic drugs are efficacious and most importantly safe so as to maintain overall health in people with diabetes. Ayurvedic drugs hence may suffice in the long-term management of DM.…”