Insulin allergy and resistance successfully treated by desensitisation with Aspart insulin

Abstract

A 25-year-old, with type I Diabetes Mellitus with a previous diagnosis of Protamine Allergy but not to human Insulin, started to notice anaphylactic reactions inmmediatly after bolus with Insulin. Skin prick and intradermal test were positive to all insulins. Skin tests to other potential allergens resulted negative. Examination after bolus of Human Insulin revealed urticaria. Daily insulin requirement were around 2-2,4 U/Kg/day. Slow desensitisation with Aspart insulin, the insulin with lowest size of skin test, was performed using subcutaneous insulin pump. Six months after the end of desensitisation his daily insulin requirement decreased to 0.8 U/Kg/day and oral corticosteroids are being reduced with no symptoms.

Allergic reactions to human insulin: a review of current knowledge and treatment options

“…Specific immunotherapy has been used successfully to treat insulin allergy [27][28][29]. It has been associated with a decrease in IgE antibodies titers, although the reduction in serum IgE levels does not always prevent from the development of allergic symptoms [17].…”

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

“…In a 25-year-old type 1 diabetic patient, after an initial diagnosis of protamine allergy, an allergy for all kinds of insulin (human, short-and long-acting analogues) was confirmed. A treatment with CSII and insulin aspart associated with oral corticoid therapy was used with success as a desensitisation method [73]. In a 50-year-old type 2 diabetic patient, allergic reactions presented at the local injection site.…”

Successful Modified Desensitization Therapy with Analog Insulin in an Individual with Severe Allergy to Multiple Insulin Preparations: A Case Report

“…These allergens include insulin molecule or excipients such as preservatives (i.e., metacresol), retardants (i.e., protamine sulphate), stabilizers (i.e., zinc), acid and base buffers, and isotonic agents (i.e., glycerol). 1,2 The advent of analog insulin has reduced the incidence of insulin allergy. Allergenicity of insulin has been proposed by chemical changes in terminal B chains which have been modified in analog insulin.…”

“…Allergenicity of insulin has been proposed by chemical changes in terminal B chains which have been modified in analog insulin. 1 It has been reported that the ability of analog insulin to reduce immunogenicity is associated with its rapid absorption rather than changes in the immunogenic epitopes itself. 1 Treatment of insulin allergy includes antihistamine and use of alternative insulin preparation.…”

“…Insulin desensitization can be in the form of micro doses of insulin, subcutaneous continuous insulin infusion (SCII) or low basal rate of intravenous insulin infusion running between 0.1 IU/hour to 0.3 IU/hour. 1 The mechanism for tolerability of intravenous insulin infusion is unclear. Suggested mechanism includes different responses of the immune system to the route of insulin administration.…”