The incidence of skin reactivity to insulin in diabetic patients

Arkins, John A.; Engbring, Norman H.; Lennon, Edward J.

doi:10.1016/0021-8707(62)90065-5

Cited by 37 publications

(13 citation statements)

References 3 publications

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“…Antiinsulin IgE levels can be 10-fold to 20-fold higher in patients with allergic disease than in patients without clinical allergies (167,195). However, the demonstration of circulating antiinsulin IgE does not establish the diagnosis of insulin allergy because IgE can be found in patients with no apparent allergy (see Section V.B) (171,196). Patients with antiinsulin IgEs can have concomitant insulinspecific IgG antibodies (88, 167).…”

Section: A Hypersensitivity Reactionsmentioning

confidence: 97%

Immunological Responses to Exogenous Insulin

et al. 2007

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Regardless of purity and origin, therapeutic insulins continue to be immunogenic in humans. However, severe immunological complications occur rarely, and less severe events affect a small minority of patients. Insulin autoantibodies (IAAs) may be detectable in insulin-naive individuals who have a high likelihood of developing type 1 diabetes or in patients who have had viral disorders, have been treated with various drugs, or have autoimmune disorders or paraneoplastic syndromes. This suggests that under certain circumstances, immune tolerance to insulin can be overcome. Factors that can lead to more or less susceptibility to humoral responses to exogenous insulin include the recipient's immune response genes, age, the presence of sufficient circulating autologous insulin, and the site of insulin delivery. Little proof exists, however, that the development of insulin antibodies (IAs) to exogenous insulin therapy affects integrated glucose control, insulin dose requirements, and incidence of hypoglycemia, or contributes to beta-cell failure or to long-term complications of diabetes. Studies in which pregnant women with diabetes were monitored for glycemic control argue against a connection between IAs and fetal risk. Although studies have shown increased levels of immune complexes in patients with diabetic microangiopathic complications, these immune complexes often do not contain insulin or IAs, and insulin administration does not contribute to their formation. The majority of studies have shown no relationship between IAs and diabetic angiopathic complications, including nephropathy, retinopathy, and neuropathy. With the advent of novel insulin formulations and delivery systems, such as insulin pumps and inhaled insulin, examination of these issues is increasingly relevant.

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Section: A Hypersensitivity Reactionsmentioning

confidence: 97%

Immunological Responses to Exogenous Insulin

et al. 2007

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“…In addition, noninsulin components of insulin preparations may also react as allergens, such as various impurities ("dirty insulin"), preservatives (metacresol) or agents to prolong action (zinc, protamine) [8,9]. Primary allergy to recombinant human insulin has also been described, although the prevalence of hypersensitivity reactions (mostly localised to the injection site and more exceptionally generalised) has dramatically decreased from as many as 50-60 % in the 1950-1960s [10,11] to less than 1-3 % in the late 1990s [12][13][14][15]. However, the current prevalence of such insulin allergy reactions is not precisely known among the diabetic population.…”

Section: Introductionmentioning

confidence: 99%

Allergy reactions to insulin: effects of continuous subcutaneous insulin infusion and insulin analogues

Radermecker

Scheen

2007

Diabetes Metabolism Res

113

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SUMMARYThe purification of animal insulin preparations and the use of human recombinant insulin have markedly reduced the incidence but not completely suppressed the occurrence of insulin allergy manifestations. Advances in technologies concerning the mode of delivery of insulin, i.e. continuous subcutaneous insulin infusion (CSII), and the use of insulin analogues, resulting from the alteration in the amino acid sequence of the native insulin molecule, may influence the immunogenicity and antigenicity of native insulin. Instead of increasing allergy reactions, CSII has been reported to represent a successful alternative treatment in diabetic patients presenting local or generalized allergy to insulin or other components (zinc, protamine) of conventional treatment. Most recent reports concern CSII-treated patients using short-acting insulin analogues (essentially insulin lispro), although the precise role of these insulin analogues remains unclear as allergy to 1 them has also been described. Finally, data on antigenicity and immunogenicity of long-acting insulin analogues (glargine, detemir), which may mimic the basal insulin delivery with CSII, remain scarce at present time.

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“…Because of the antigenicity of animal-derived insulin and the additives and contaminants present in insulin preparations, many insulin-treated diabetic patients expe rienced local skin reactions [1]. However, since human insulin has become available, few diabetic patients have experienced allergy against insulin [2].…”

Section: Discussionmentioning

confidence: 99%

“…Insulin allergy is a common finding, manifested by 5-10% of diabetic patients at the initial phase of therapy during the last 20 years [1], However, the recent biosyn thesis of human insulin by recombinant DNA technology, its semisynthesis from porcine insulins, and its purifica tion as a pharmacologic agent have greatly reduced the incidence of this allergic response. We report here a very rare case of newly diagnosed non-insulin-dependent dia betes mellitus (NIDDM) with immediate-type allergy against semisynthetic human insulin at the initial insulin therapy.…”

Section: Introductionmentioning

confidence: 99%

A Case of Newly Diagnosed Non-Insulin-Dependent Diabetes Associated with Immediate-Type Allergy Against Human Insulin

Yamagishi

Abe²,

Sawada³

1995

Horm Res

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A case of newly diagnosed non-insulin-dependent diabetes mellitus with immediate-type allergy against semisynthetic human insulin is reported. She experienced immediate-type allergy 2 months after initial insulin treatment. A skin test showed that she had allergy against the insulin itself but not the additives. The amino acid sequence of the semisynthetic human insulin was identical to that of endogenous native insulin and, moreover, the patient had not been treated with animal-derived insulin previously, so a structural change to the semisynthetic formulation at the injected subcutaneous site might have antigenicity. An H₁histamine blocker markedly diminished the skin reaction to insulin, and her plasma glucose and glycosylated hemoglobin A_Ic became well controlled. In summary, we experienced a diabetic patient with human insulin allergy at the time of initial insulin treatment, emphasizing that the possibility of human insulin allergy should be considered whenever a patient is started on insulin therapy.

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The incidence of skin reactivity to insulin in diabetic patients

Cited by 37 publications

References 3 publications

Immunological Responses to Exogenous Insulin

Immunological Responses to Exogenous Insulin

Allergy reactions to insulin: effects of continuous subcutaneous insulin infusion and insulin analogues

A Case of Newly Diagnosed Non-Insulin-Dependent Diabetes Associated with Immediate-Type Allergy Against Human Insulin

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