Rituximab and Omalizumab in Severe, Refractory Insulin Allergy

Allergic reactions to human insulin: a review of current knowledge and treatment options

“…Tacrolimus aiming for serum trough levels between 5 and 10 ng/ml was given to a patient with generalized insulin allergy; however no improvement of his symptomatology was observed [65]. In a very recent paper, Yong et al [66] reported a patient with severe generalized insulin allergy who was treated successfully by the sequential use of two targeted biologic agents, rituximab and omalizumab, in a two-step therapeutic approach which also consisted of the use of prednisolone and mycophenolate mofetil. On the other hand, steroids or immunosuppressive agents are usually required to treat immunological insulin resistance.…”

Allergy to Insulin Glargine: A Case Report

“…Management of this condition can be very difficult. Treatment options for insulin allergy are symptomatic therapy with antihistamines, use of an alternative insulin preparation, addition of glucocorticoids to insulin, insulin desensitization using small doses of insulin subcutaneously or through a continuous subcutaneous insulin infusion (CSII) [4], use of monoclonal antibodies (omalizumab) [5], and pancreatic transplantation for severe resistant cases [6].…”

Refractory insulin allergy: pancreas transplantation or immunosuppressive therapy alone?

“…Unbearable symptoms ceased only with omalizumab therapy. Therefore, Yonk et al [1] claimed that although combined therapy is relatively expensive, it was more economical and safer than pancreatic transplantation alone (PTA) which we proposed in one young patient with life-threatening severe insulin allergy.…”

“…Yonk et al [1] claimed the benefit of using omalizumab, an anti-IgE mAb which was approved by the US FDA for persistent allergic asthma. This recombinant humanized mAb is supposed to block free serum IgE and prevents IgE-mediated inflammatory changes.…”

“…Recently, Yonk et al [1] described the sequential use of two targeted biologic agents -rituximab and omalizumab along with corticosteroids to treat a patient with severe systemic insulin allergy accompanied by marked metabolic dysregulation and corticosteroid toxicity.…”