2012
DOI: 10.1590/s0365-05962012000600018
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Type 1 Ig-E mediated allergy to human insulin, insulin analogues and beta-lactam antibiotics

Abstract: Insulin, a crucial therapeutic agent for diabetes mellitus, has been rarely associated with hypersensitivity events. We present a 69-year-old type-2 diabetic patient with urticariform lesions on the sites of subcutaneous injection of insulin. The patient denied any known allergies, except for an unspecific cutaneous reaction after intramuscular penicillin administration in childhood. Prick tests revealed positive reactions to all tested human insulins and insulin analogues. Serum IgE levels were above normal r… Show more

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Cited by 8 publications
(10 citation statements)
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References 7 publications
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“…The importance of insulin allergy relies on its fundamental role as a lifelong treatment. Several cases have been documented on diabetic patients, allergic to Glargine [ 32 , 33 ], Detemir [ 34 , 35 ], Crystalline [ 14 , 36 ], NPH [ 14 , 37 ], Aspart [ 14 ], Lispro [ 33 ], all available insulins [ 8 , 12 , 15 , 38 ], and even components of such medications such as metacresol [ 24 ] and protamine [ 10 , 19 , 33 ], with or without presence of beta-lactam antibiotic allergy [ 12 ]. Clinical presentation varies, from local cutaneous lesions to anaphylactic shock, either IgE- or IgG-mediated [ 39 ]; see Figure 1 .…”
Section: Discussionmentioning
confidence: 99%
“…The importance of insulin allergy relies on its fundamental role as a lifelong treatment. Several cases have been documented on diabetic patients, allergic to Glargine [ 32 , 33 ], Detemir [ 34 , 35 ], Crystalline [ 14 , 36 ], NPH [ 14 , 37 ], Aspart [ 14 ], Lispro [ 33 ], all available insulins [ 8 , 12 , 15 , 38 ], and even components of such medications such as metacresol [ 24 ] and protamine [ 10 , 19 , 33 ], with or without presence of beta-lactam antibiotic allergy [ 12 ]. Clinical presentation varies, from local cutaneous lesions to anaphylactic shock, either IgE- or IgG-mediated [ 39 ]; see Figure 1 .…”
Section: Discussionmentioning
confidence: 99%
“…At subcutaneous injection sites, urticaria-like lesions, pain, erythema, and desquamation may occur within minutes (11,12). However, these may disappear in a few minutes to a few hours.…”
Section: Diagnosismentioning
confidence: 99%
“…A positive response may be obtained with provocation using a small dose, such as 2 U. Compared to insulins of animal origin, insulins produced by recombinant DNA technology have a lower risk of reaction (11).…”
Section: Diagnosismentioning
confidence: 99%
“…There are various reports in the literature describing reactions that have been attributed to excipients within insulin (i.e. protamine, [14][15][16][17][18][19] meta-cresol 1,14,15,17,[20][21][22][23] and zinc [14][15][16][17][18][19]23,24 ). In addition, the bacteria utilized during the manufacturing process has been speculated to act as a potential antigen.…”
Section: Introductionmentioning
confidence: 99%
“…25 Due to the presence of case reports describing hypersensitivity reactions to specific excipients, clinicians may feel inclined to attribute hypersensitivity reactions from HIAs to these components, rather than considering the possibility that it may be the actual HIA itself. 17,25 Prior insulin exposure warrants consideration when discussing insulin hypersensitivity reactions as this may increase a patient's risk for developing a hypersensitivity reaction to HIAs. 14,28 The higher immunogenicity of older insulins and the potential for the development of higher antibody levels with long-term insulin use may affect tolerability of HIAs.…”
Section: Introductionmentioning
confidence: 99%