Insulin Allergy: Case report

Abstract

Background: Insulin allergy is not very common form of drug allergy, but it’s differentiation may be problematic: very often the cause of allergy is not insulin itself, but such additives as zinc, protamine, cresol, trometamol and fenol. Introduction of recombinant human insulin resulted in decrease of allergy rate, which now is between 0.3% and 3%. According to the literature the most common forms are: urticaria, angioedema, general malaise with palpitations, paresthesia (hands and mouth), induration at injection site, macular exanthema, insulin resistance and other. Insulin allergy may be diagnosed using skin prick test and intracutaneus test with insulin preparations, insulin additives, and clinical laboratory methods for the assessment of specific IgG, IgE antibodies to insulin and protamine. Case report: 73 old female was diagnosed with 2nd type of diabetes, which was treated with hypoglycaemic therapy: gliclazide - 120mg per day, metformine - 500mg 3 times per day. However, sufficient control of glycaemia was not achieved therefore insulin therapy was started with ins. lisprum (Humalog®) and ins. lispro and ins. lispro protamine (Humalog Mix®). After 24 hours redness a positive reaction developed in the prick place: the patient suffered from urticaria, pruritus, diplopic images, general malaise with palpations, confusion, induration at injection site, maculous macular exanthema. Skin prick and intracutaneous tests demonstrated positive reactions for the following drugs: ins. glarginum (Lantus®), ins. humanum solubile (Apidra®), ins. lispro (Humalog-Basal®), ins. detemirum (Levemir®), ins. aspartum (NovoMix 30®), ins. aspartum (Novorapid®), ins. lispro mix (Humalog Mix 25®), ins. lisprum (Humalog®), ins. isophan (Protaphan®). Delayed allergy developed after injection of mentioned drugs with the following symptoms: induration at injection site, macular exanthema, urticaria, pruritus, diplopic imag... [...].