Insulin allergy: clinical manifestations and management strategies

Abstract

Insulin allergy in patients with diabetes mellitus on insulin treatment is a rare condition. It is suspected upon noticing immediate symptoms following insulin injections. The immediate vital implications for the patient call for prompt diagnosis and management of insulin allergy. We review current knowledge and procedures based on four diabetic patients who presented in our clinic. Insulin allergy was suspected as they showed immediate symptoms after insulin injection (urticaria, rash, angioedema, hypotension, dyspnea). A detailed allergologic work‐up was performed and adequate therapy was initiated. In three of the four patients, a specific immunotherapy was started whereas in one patient a switch to oral antidiabetics was possible and consequently initiated. By standard prick testing and measurement of specific IgE antibodies, a type 1 IgE‐mediated allergy was confirmed. After initiation of insulin immunotherapy, the symptoms completely resolved in two out three of patients and significantly improved in the third patient. The fourth patient was successfully switched to oral antidiabetics. Insulin allergy is a rare but severe condition that calls for immediate allergological work‐up. It can be managed well in close cooperation between the diabetologist and the allergologist. Specific immunotherapy is efficient and should be considered.

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

“…10,[35][36][37] Another approach for the management of insulin allergy is the use of specific immunotherapy with escalating insulin doses. 4 This strategy, also known as desensitization, induces tolerance in many patients with type I, IgE-mediated reactions. 4 The exact mechanism of tolerance induction is unknown, but it may be related to the depletion of specific T cells, the induction of Tregulatory cells, and the modulation of antibody production by cytokines.…”

“…4 This strategy, also known as desensitization, induces tolerance in many patients with type I, IgE-mediated reactions. 4 The exact mechanism of tolerance induction is unknown, but it may be related to the depletion of specific T cells, the induction of Tregulatory cells, and the modulation of antibody production by cytokines. 38 In certain cases, immunologic insulin resistance may occur secondary to the formation of insulin antibodies.…”

“…3 Local symptoms typically present immediately after insulin injection and include injection site swelling, erythema, and itching. 3,4 The reaction may become generalized, featuring urticaria, angioedema, and even anaphylaxis. 4,5 In some cases, type I reactions are associated with a late phase, which peaks at 4 to 6 hours but can feature injection site indurations lasting several days.…”

“…3,4 The reaction may become generalized, featuring urticaria, angioedema, and even anaphylaxis. 4,5 In some cases, type I reactions are associated with a late phase, which peaks at 4 to 6 hours but can feature injection site indurations lasting several days. 3 Type III insulin allergy typically manifests as a local Arthus reaction, which is characterized by the development of subdermal, tender nodules at the injection site.…”

“…1,2 However, cases of insulin allergy continue to be reported and range from local injection site reactions to generalized life-threatening anaphylaxis. [3][4][5] Individuals may be allergic to the insulin molecule itself or to pharmaceutical excipients, such as protamine, zinc, or metacresol. [6][7][8] Immediate, immunoglobulin E (IgE)-mediated allergic reactions (type I) are most common, although immune complex (type III) and delayed hypersensitivity (type IV) reactions can also occur.…”