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

Abstract

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.

The Subcutis Ultrasound Map of Type 1 Diabetic Children Improves the Diagnosis of Local Dystrophies and Insulin Injection Technique

“…The SC remodelling is a local consequence of some factors such: very frequently injected areas, duration of treatment, inappropriate injecting technique, needle's quality, physicochemical properties of insulins or individual response as suggested by Lo Presti (2012), Hofman (2007Hofman ( , 2010, Bierkebaek (1998), Wallymahmed (2004) and Hildebrandt (1991). Lipodistrophies were noticed when the administration route was either a portable pump or boluses as Rademecker (2007) had found. Thus, the early detection of local dystrophies and the evaluation of the anatomodynamic features during the long lasting insulin treatment are important especially when very young people are involved.…”

First Case Report: Breakage of an Insulin Pen Needle in Subcutaneous Tissue

“…Local cutaneous complications of insulin injection include lipohypertrophy, the most frequent complication, lipoatrophy, hypersensitivity to insulin therapy, scarring of tissue under the skin and abscess formation. Most of these cutaneous complications are significantly reduced with the use of recombinant human insulin analogs [8,9]. Breakage of the needle infusion set of an insulin pump or Insulin syringe needle in children with T1D has been previously reported [10,11].…”

Hypersensitivity Reaction to Insulin Glargine and Insulin Detemir in a Pediatric Patient: A Case Report

“…9 They represent insulin-antibody complexes, which lead to inflammation through complement fixation and leukocyte attraction. 10 In rare cases, type III reactions may be associated with serum sickness, which is mediated by IgG antibodies. 10 Type IV insulin allergy represents a delayed, T-cell-mediated reaction characterized by subcutaneous, inflammatory, non-pruritic nodules at the injection sites.…”

“…10 In rare cases, type III reactions may be associated with serum sickness, which is mediated by IgG antibodies. 10 Type IV insulin allergy represents a delayed, T-cell-mediated reaction characterized by subcutaneous, inflammatory, non-pruritic nodules at the injection sites. 11 Type IV allergic reactions can be differentiated from type III reactions in that they usually present at least 24 hours after injection and can last for 4 to 7 days.…”

“…11 Type IV allergic reactions can be differentiated from type III reactions in that they usually present at least 24 hours after injection and can last for 4 to 7 days. 10 However, in some cases the reactions may manifest as early as 2 to 12 hours after administration.…”