Chronic urticaria from isophane insulin therapy; sensitivity associated with noninsulin components in commercial preparations

Shore, R. N.

doi:10.1001/archderm.111.1.94

Cited by 8 publications

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“…Urticaria to an isophane insulin but not to a zinc crystalline insulin of the same species was reported by Shore et al [17]. They speculated that protamine, although not covalently bound to insulin, might render the insulin, as a hapten, antigenic.…”

Section: Discussionmentioning

confidence: 53%

An anaphylactic reaction to highly purified pork insulin. Confirmation by RAST and RAST inhibition

1982

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Summary. We describe a patient who had an anaphylactic reaction to highly purified pork insulin; he was not allergic however to beef insulin. The sensitivity to pork but not to beef insulin was confirmed by skin testing, radioallergosorbent test (RAST) and RAST inhibition. A scheme is suggested for the investigation of such patients. Key words:Anaphylaxis, radioallergosorbent test, highly purified insulin, beef insulin, allergen.There have been reports of anaphylactic reactions to insulin, the first being by Williams [1], who described a patient who was allergic to insulin extracted from pork pancreas but not to a beef extract. At that time insulin was very impure and it is likely that the allergen was not insulin. It has always been difficult to prove the precise nature of the allergen causing such reactions and with increasing purity of insulin preparations allergic reactions have become increasingly rare. Patients have been described who had allergic reactions to conventional insulins [2,4]. There have also been instances of reactions to highly purified insulins [5, 121, but with one doubtful exception all patients had received conventional insulins previously [12]. We describe a patient who became allergic to highly purified pork, but not to beef insulin, in whom we have demonstrated by skin testing and RAST that the insulin is the allergen and that the immunopathological mechanism was IgE mediated. Patient and MethodsThe patient is an Australian male born in 1953. During childhood, he experienced episodes of allergic rhinitis, there being no family history of atopy. Diabetes mellitus was diagnosed in 1968 and treatment with insulin started. Initially he received beef protamine zinc and soluble insulins. After 2 years of treatment, his insulin requirement had increased to more than 200 units daily. Treatment was then changed to Actrapid (pork) and Rapitard (pork 25%/beef 75%) insulins (Novo Industri, Denmark) with a reduction in his insulin requirement. He has been seen regularly in our diabetic clinic since 1977 and his diabetes has been well controlled on an average dose of 90 U insulin/day (weight: 80 kg) and there have been no complications of the disease.In May 1980, a change was made in his insulin regimen. Mixtard insulin (52 U), a highly purified pork insulin (30% neutral / 70% NPH; Nordisk Denmark), was substituted for the Rapitard insulin, of which he had been taking 72 U daily. After I week, wheals started to appear at injection sites and 2 weeks later a generalised reaction occurred. This reaction started within seconds of an insulin injection. The patient experienced difficulty in breathing with chest tightness and laryngeal obstruction and he developed a generalised urticarial eruption i. e. anaphylaxis. While on the Actrapid and Mixtard insulins diabetic control had been good. After the anaphylactic reaction, the patient resumed his previous insulin regimen and has subsequently been entirely free of allergic symptoms.Prick testing was performed using normal saline, insulin vehicle, and pork an...

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Section: Discussionmentioning

confidence: 53%