Insulins allergy

Highly purified (single component) and human Insulins Local insulin allergy, immunologic insulin resistance, injection-site lipodystrophy temporary insulin use (ie, surgery, acute stress type 2 diabetes, gestational diabetes) newly diagnosed diabetic patients. 

The bioavailability of the insulins is identical when given subcutaneously. The human insulins are slightly less antigenic than pork or beef insulins. Human insulin is the insulin of choice for patients with insulin allergy, insulin resistance, all pregnant patients with diabetes, and any patient who uses insulin intermittently. ... 

Insulin allergy occurs in as many as 3% of patients receiving pork or beef insulin but smaller proportion in those using human insulin. However, the immuno-genicity of insulin is determined more by the purity of its preparations and since the use of monocomponent insulin, insulin allergy has become extremely rare. 

The other side effects include insulin allergy which consists of local itching, swelling, redness at the site of injection. Urticaria and anaphylactic reactions are rarely seen. Other rare side effects include insulin... 

Insulin allergy, an immediate type hypersensitivity, is a rare condition in which local or systemic urticaria results from histamine release from tissue mast cells sensitized by anti-insulin IgE antibodies. In severe cases, anaphylaxis results. Because sensitivity is often to noninsulin protein contaminants, the human and analog insulins have markedly reduced the incidence of insulin allergy, especially local reactions. 

Insulin allergy is quite common (SEDA-7, 403 124—126). Allergy has been reported to human insulin and protamine (127) and to human insulin (128,129). 

Kahn CR, Rosenthal AS. Immunologic reactions to insulin insulin allergy, insulin resistance, and the autoimmune insulin syndrome. Diabetes Care 1979 2(3) 283—95. 

Warita E, Shimuzi H, Ubukata T, Mori M. [A case of human insulin allergy.] J Jpn Diabetes Soc 1999 42 1013-5. 

Abraham MR, al-Sharafi BA, Saavedra GA, Khardori R. Lispro in the treatment of insulin allergy. Diabetes Care 1999 22(11) 1916—7. 

Panczel P, Hosszufalusi N, Horvath MM, Horvath A. Advantage of insulin lispro in suspected insulin allergy. Allergy 2000 55(4) 409-10. 

Kumar D. Insulin allergy differences in the binding of porcine, bovine, and human insulins with anti-insulin IgE. Diabetes Care 1981 4(l) 104-7. 

Sola-Gazagnes A, Pecquet C, Radermecker R, Pietri L, Elgrably F, Slama G, Selam J-L. Successful treatment of insulin allergy in a type 1 diabetic patient by means of constant subcutaneous pump infusion of insulin. Diabetes Care 2003 26 2961-2. 

Yokoyama H, Fukumoto S, Koyama H, Emoto M, Kitagawa Y, Nishizawa Y. Insulin allergy desensitization with crystalline zinc-insulin and steroid tapering. Diabetes Res Clin Pract 2003 61 161-6. 

Patterson R, Roberts M, Grammer LC. Insulin allergy re-evaluation after two decades. Ann Allergy 1990 64(5) 459-62. 

Frigerio C, Aubry M, Gomez F, Graf L, Dayer E, de Kalbermatten N, Gaillard RC, Spertini F. Desensitization-resistant insulin allergy. Allergy 1997 52(2) 238-9. 

Pratt EJ, Miles P, Kerr D. Localized insulin allergy treated with continuous subcutaneous insulin. Diabet Med 2001 18(6) 515-6. 

Airaghi L, Lorini M, Tedeschi A. The insulin analogue aspart a safe alternative in insulin allergy. Diabetes Care 2001 24(11) 2000. 

Takata H, Kumon Y, Osaki F, Kumagai C, Arii K, Ikeda Y, Suehiro T, Hashimoto K. The human insulin analogue aspart is not the almighty solution for insulin allergy. Diabetes Care 2003 26(l) 253 t. 

Leukopenia with oral ulceration has been attributed to atorvastatin in a patient with insulin allergy who had received a pancreatic transplant the symptoms resolved on withdrawal (13). 

Insulin antibodies were also found in six of 58 patients treated for chronic viral hepatitis (542) and that was associated with signs of insulin allergy in one patient (SEDA-19, 335). 

Another manifestation of insulin allergy, which is also now rare, is a delayed local reaction to injected insulin. This presents as a tender subcutaneous lump developing at the injection site half an hour or so after injection and lasting for 12-24 h. This is a local Arthus-type reaction, mediated by IgG rather than IgE, and is due to complement activation by insulin-IgG immune complexes. It often responds to addition of hydrocortisone to the injected insulin. 

Note About 25% of patients with insulin allergy have a concomitant history of penicillin allergy... 

Occasional patients have antibodies to injected insulin, but the significance of the antibodies is minimal. Human insulin therapy has not totally eliminated insulin allergies, although most patients have a local reaction that will dissipate over time. If the allergic reaction does not improve or is systemic, insulin desensitization can be carried out. Protocols for desensitization are available from major insulin manufacturers. While more common in the animal insulin era, lipohypertrophy is still seen in some patients with longstanding type 1 DM. Such patients give their insulin injections in the same site to minimize discomfort. Because insulin absorption from an area of lipohypertrophy is unpredictable, avoidance of injections into these areas is mandatory. 

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