Dermal Reactions to Insulin Therapy

Paley, Ronald G.; Tunbridge, R. E.

doi:10.2337/diab.1.1.22

Cited by 37 publications

(6 citation statements)

References 10 publications

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“…Local A llergy.-Troublesome local insulin reactions are commonly encountered, as has been pointed out by Paley and Tunbridge (1952). This was a feature in eight of our cases, all of which had been receiving protamine zinc insulin either alone or in a mixture.…”

Section: Resultssupporting

confidence: 64%

The New Insulins--Lente, Ultralente, and Semilente

Murray¹,

Wilson²

1953

BMJ

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Section: Resultssupporting

confidence: 64%

The New Insulins--Lente, Ultralente, and Semilente

Murray¹,

Wilson²

1953

BMJ

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“…Type 4 hypersensitivity. Local, delayed reactions are the most common hypersensitivity reaction and usually occur at the start of insulin therapy (192,198,201,202). They generally begin 8 to 12 h after an insulin injection and peak at 24 to 48 h. Most local delayed reactions are mild and self-limited.…”

Section: Type 3 Hypersensitivitymentioning

confidence: 99%

Immunological Responses to Exogenous Insulin

et al. 2007

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Regardless of purity and origin, therapeutic insulins continue to be immunogenic in humans. However, severe immunological complications occur rarely, and less severe events affect a small minority of patients. Insulin autoantibodies (IAAs) may be detectable in insulin-naive individuals who have a high likelihood of developing type 1 diabetes or in patients who have had viral disorders, have been treated with various drugs, or have autoimmune disorders or paraneoplastic syndromes. This suggests that under certain circumstances, immune tolerance to insulin can be overcome. Factors that can lead to more or less susceptibility to humoral responses to exogenous insulin include the recipient's immune response genes, age, the presence of sufficient circulating autologous insulin, and the site of insulin delivery. Little proof exists, however, that the development of insulin antibodies (IAs) to exogenous insulin therapy affects integrated glucose control, insulin dose requirements, and incidence of hypoglycemia, or contributes to beta-cell failure or to long-term complications of diabetes. Studies in which pregnant women with diabetes were monitored for glycemic control argue against a connection between IAs and fetal risk. Although studies have shown increased levels of immune complexes in patients with diabetic microangiopathic complications, these immune complexes often do not contain insulin or IAs, and insulin administration does not contribute to their formation. The majority of studies have shown no relationship between IAs and diabetic angiopathic complications, including nephropathy, retinopathy, and neuropathy. With the advent of novel insulin formulations and delivery systems, such as insulin pumps and inhaled insulin, examination of these issues is increasingly relevant.

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“…In addition, noninsulin components of insulin preparations may also react as allergens, such as various impurities ("dirty insulin"), preservatives (metacresol) or agents to prolong action (zinc, protamine) [8,9]. Primary allergy to recombinant human insulin has also been described, although the prevalence of hypersensitivity reactions (mostly localised to the injection site and more exceptionally generalised) has dramatically decreased from as many as 50-60 % in the 1950-1960s [10,11] to less than 1-3 % in the late 1990s [12][13][14][15]. However, the current prevalence of such insulin allergy reactions is not precisely known among the diabetic population.…”

Section: Introductionmentioning

confidence: 99%

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

Radermecker

Scheen

2007

Diabetes Metabolism Res

112

113

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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.

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Dermal Reactions to Insulin Therapy

Cited by 37 publications

References 10 publications

The New Insulins--Lente, Ultralente, and Semilente

The New Insulins--Lente, Ultralente, and Semilente

Immunological Responses to Exogenous Insulin

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

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