Circulating insulin-binding antibodies

Kurtz, A. B.; Nabarro, J. D. N.

doi:10.1007/bf00280515

Cited by 83 publications

(49 citation statements)

References 51 publications

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“…If insulin clearance occurs entirely via free insulin, antibodies in such titres will act as a simple binding protein without influencing insulin requirements in the long run [7].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to their wellrecognized adverse effects, the presence of insulin antibodies has often been considered to have some beneficial effects, at least under certain circumstances [2,3]. Regardless of the clinical significance of circulating insulin antibodies, assessment of their kinetics is of considerable interest [1,[4][5][6][7][8]. Fairly precise data are available concerning the dynamics of the appearance of antibodies in the circulation, but with regard to their disappearance our knowledge is limited.…”

Section: Introductionmentioning

confidence: 99%

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Disappearance rate of insulin antibodies after discontinuing insulin treatment in 42 Type 2 (non-insulin-dependent) diabetic patients

et al. 1984

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Summary.The disappearance rate of insulin antibodies was studied after cessation of insulin treatment which had been given for 3 months to 6 years in 42 Type 2 (non-insulin-dependent) diabetic patients. Insulin antibodies were measured before and 15 days after interruption of insulin treatment, and every 30 days until the disappearance of insulin antibodies. The mean + SD value of insulin binding in the entire group before the interruption of insulin treatment was 32 + 14%. There was no relationship between the antibody level at that time and the duration of insulin treatment. However, the insulin antibody level was significantly higher in 17 diabetic patients on an insulin dose of > 20 U/day (p < 0.02) than in 25 on an insulin dose of < 20 U/day (39 _+ 13% versus 28 _+ 12%). A positive correlation was found between intial insulin binding and the time required for it to fall below 10% (r = 0.74). Antibodies were absent 60 days after discontinuing insulin treatment in eight of ten subjects presenting with initial binding of < 20%. In contrast, in only two of 12 patients with an initial binding of > 40% were insulin antibodies detectable 150 days after discontinuation of insulin therapy. Disappearance of insulin antibodies sometimes took up to 1 year and occasionally even more than 2 years.

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“…If insulin clearance occurs entirely via free insulin, antibodies in such titres will act as a simple binding protein without influencing insulin requirements in the long run [7].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Disappearance rate of insulin antibodies after discontinuing insulin treatment in 42 Type 2 (non-insulin-dependent) diabetic patients

et al. 1984

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“…Anaphylaxis is the most dangerous and dramatic immunlogical side effect of insulin treatment and is now very rare, most probably because currently used insulin preparations are less impure than they used to be. In patients treated with highly purified pork insulin, the induction of insulin binding IgG is much less than in patients treated with conventional beef insulin [15]. Lipoatrophy, which is thought to be an immunological phenomenon, is also less common.…”

Section: Discussionmentioning

confidence: 99%

“…The immunogenicity appears to be related more to the physical characteristics of the insulin than to the species of origin [15]. Anaphylaxis is the most dangerous and dramatic immunlogical side effect of insulin treatment and is now very rare, most probably because currently used insulin preparations are less impure than they used to be.…”

Section: Discussionmentioning

confidence: 99%

“…The discs were then washed once in 200 ml of sodium bicarbonate (0.1 mol/1) and unreacted sites were blocked by incubation in 50 mmol/1 ethanolamine 200 ml diluted in sodium bicarbonate 0.1 tool/1 for 1 h at 4 ~ C. The discs were then washed in sodium bicarbonate 0.l mol/1 and then in PBS and stored at -20 ~ The binding of 1251 labelled insulin by sera was determined using a 15% polyethylene glycol separation [15]. This method determines the binding of insulin by IgG.…”

Section: Patient and Methodsmentioning

confidence: 99%

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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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Is There a Direct Relationship Between Lactic Acidosis and Epinephrine Administration?-Reply

Caruso¹,

Miles²

1988

Arch Intern Med

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Circulating insulin-binding antibodies

Cited by 83 publications

References 51 publications

Disappearance rate of insulin antibodies after discontinuing insulin treatment in 42 Type 2 (non-insulin-dependent) diabetic patients

Disappearance rate of insulin antibodies after discontinuing insulin treatment in 42 Type 2 (non-insulin-dependent) diabetic patients

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

Is There a Direct Relationship Between Lactic Acidosis and Epinephrine Administration?-Reply

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