IgE‐mediated allergy to recombinant human insulin in a diabetic

Abstract

A 63-year-old nonatopic female suffering from type II diabetes with severe local and systemic immediate-type allergic reactions to injections of different recombinant human insulin products has been reported. Skin testing as well as IgE measurements not only proved immediate-type sensitization to human insulin but also to porcine and bovine insulin which had never been administered and indicated immunological cross-reactivity. Cross-reactivity was proved by an IgE inhibition test. Independent of this reaction, the patient showed IgE-mediated sensitization to protamine.

Insulin allergy: clinical manifestations and management strategies

“…Interestingly, flare reactions can also be elicited at the former injection sites upon insulin injection (11). Furthermore, pruritus of soles and palms, generalized flushing, and itching can occur (12). In rare severe cases, anaphylaxis with dyspnea and hypotension has been observed (2, 13).…”

Low molecular weight protamine/insulin formulation with potential to attenuate protamine-masqueraded insulin allergy

“…It has been proven that the chain-shorten LMWP is deprived of the cross-linking ability of native protamine. 8 It is therefore speculated that the large aggregates that form at a very low protamine/insulin ratio are due to cross-linking of insulin by protamine, rather than the charge-induced aggregation observed at higher ratios. A ratio of 2.0 and 2.4 µg/U was selected for the protamine and LMWP formulations, respectively, for subsequent in vivo studies, because they represented the initial points of reaching the turbidity plateau.…”

“…7 Baur and co-workers further documented that protamine allergy occurred in approximately 50% of NPH insulin treated diabetic patients. 8 Yet, until lately, most of these cases of protamine adverse reactions have been masqueraded as insulin allergy in the diabetic. 9,10 Indeed, protamine has been cited as the major additive responsible for allergic reactions after injection of NPH insulin.…”

Management of Multiple Drug Allergies in Children

“…If the nonirritating concentration for a particular drug is unavailable, skin testing with the highest concentration of intradermal testing not exceeding 1 to 10 mg/mL may be considered. In case of protein allergens such as coagulation factors, insulin, protamine, and heparin, skin testing can be very reliable and helpful [14][15][16][17][18][19]. There are skin test protocols described for a variety of other agents as well, including general anesthetics [20••, 21, 22], chemotherapeutic agents [23][24][25][26], corticosteroids [27,28], and biologic modifiers [20••].…”