Successful desensitization with human insulin in a patient with an insulin allergy and hypersensitivity to protamine: a case report.

Journal of Medical Case Reports
Claudia PföhlerWolfgang Tilgen

Abstract

Insulin allergy may occur in patients treated with subcutaneous applications of insulin preparations. Besides additives in the insulin preparation such as protamine, cresol, and phenol, the insulin molecule itself may be the cause of the allergy. In the latter case, therapeutic options are rare. A 68-year-old man with poorly controlled type 2 diabetes mellitus received different insulin preparations subcutaneously while on oral medication. Six to eight hours after each subcutaneous application, he developed pruritic plaques with a diameter of >15 cm at the injection sites that persisted for several days. Allergologic testing revealed positive reactions against every insulin preparation and against protamine. Investigation of serum samples demonstrated IgG antibodies against human and porcine insulin. We treated the patient with human insulin using an ultra-rush protocol beginning with 0.004 IU and a rapid augmentation in dose up to 5 IU. Therapy was accompanied by antihistamine therapy. Subsequent conversion to therapy with glargine insulin (6 IE twice daily) was well-tolerated. As reported in this case, desensitization with subcutaneously administered human insulin using an ultra-rush protocol in patients with an insulin aller...Continue Reading

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Citations

May 23, 2012·Diabetes Research and Clinical Practice·Tatsuya FujikawaHaruko Kitaoka
Mar 22, 2016·The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG·Jennifer BadikTsz-Yin So
Jun 22, 2010·Allergy·M Ben-Shoshan, A E Clarke
Dec 1, 2012·Anais Brasileiros De Dermatologia·Pedro AndradeMargarida Gonçalo
Feb 6, 2017·Drug Delivery·Yaron DekelJacob Pitcovski
Feb 2, 2018·Therapeutic Advances in Endocrinology and Metabolism·Andrew S Bzowyckyj, Amanda M Stahnke

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Methods Mentioned

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