Successful Treatment of Insulin Allergy with Desensitization Therapy: A Case Report and Literature Review
-
Hamza Elfekih
,
Faten Hadjkacem
,
Mouna Elleuch
,
Dorra Ghorbel
,
Nadia Charfi
,
Fatma Mnif
,
Nabila Rekik
,
Mouna Mnif
,
Mohamed Abid
Abstract
Insulin therapy is an essential treatment for type 1 and uncontrolled type 2 diabetes mellitus (DM). Hypersensitivity reactions have been described since the first administration of insulin, the same as any other therapy. Despite being a rare situation nowadays, it requires careful intra-hospital monitoring and multidisciplinary management. Here, we present a case of a 57-year-old patient with type 2 DM, an average glycemic control, and both penicillin and insulin allergy. Heunderwent a desensitization protocol which allowed successfully dismiss him with intermediate-acting insulin.
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2. Ghazavi M, Johnston GA. Insulin allergy. Clin Dermatol 2011; 29(3):300-5.
3. Waton J. L’allergie à l’insuline : mise au point. Revue Française d'Allergologie 2011; 51(3):336-42.
4. Wheeler B, Taylor B. Successful management of allergy to the insulin excipient metacresol in a child with type 1 diabetes: a case report. J Med Case Rep 2012; 6:263.
5. Hasani-Ranjbar S, Fazlollahi M, Mehri A, Larijani B. Allergy to human insulin and specific immunotherapy with glargine; case report with review of literature. Acta Diabetol 2011; 49(1):69-73.
6. Feinglos M, Jegasothy B. "Insulin" allergy due to zinc. Lancet1979; 313(8108):122-4.
7. Ben Ammar I, Ksouri H, Trabelsi N, Mellouli F, Ben Mami F, Dakhli S, et al. Generalized allergy due to zinc in insulin treated with zinc-free insulin. Acta Diabetol 2010; 49(3):239-41.
8. Kim D, Baraniuk J. Delayed-type hypersensitivity reaction to the meta-cresol component of insulin. Ann Allergy Asthma Immunol 2007; 99(2):194-5.
9. Clerx V, Van Den Keybus C, Kochuyt A, Goossens A. Drug intolerance reaction to insulin therapy caused by metacresol. Contact Dermatitis 2003; 48(3):162-3.
10. Rojas J, Villalobos M, Martínez M, Chávez-Castillo M, Torres W, Mejías J, et al. Successful Management of Insulin Allergy and Autoimmune Polyendocrine Syndrome Type 4 with Desensitization Therapy and Glucocorticoid Treatment: A Case Report and Review of the Literature. Case Reports Immunol 2014; 2014:394754.
11. Bodtger U, Wittrup M. A rational clinical approach to suspected insulin allergy: status after five years and 22 cases. Diabet Med 2005; 22(1):102-6.
12. Mollar-Puchades M, Villanueva I. Insulin glulisine in the treatment of allergy to rapid acting insulin and its rapid acting analogs. Diabetes Res Clin Pract 2009; 83(1):e21-e22.
13. Sola-Gazagnes A, Larger E, Pecquet C, Boitard C. Allergie à l’insuline à l’ère des analogues de l’insuline. Sang Thrombose Vaisseaux 2007; 19(8):418-24.
14. Yokoyama H, Fukumoto S, Koyama H, Emoto M, Kitagawa Y, Nishizawa Y. Insulin allergy; desensitization with crystalline zinc-insulin and steroid tapering. Diabetes Res Clin Pract 2003; 61(3):161-6.
15. Munshi R, Varthakavi P, Belhekar M, Pai S, Tayade P, Dalwadi P. A case of hypersensitivity to soluble and isophane insulins but not to insulin glargine. Indian J Pharmacol 2015;47(2):227-9.
16. Pitrola D, MacIver C, Mallipedhi A, Udiawar M, Price D, Stephens J. Cutaneous allergy to insulin: Could statins and ACE inhibitors play a role? A case report. Diabetes Res Clin Pract 2014; 104(1):e20-2.
17. Jacquier J, Chik C, Senior P. A practical, clinical approach to the assessment and management of suspected insulin allergy. Diabet Med 2013; 30(8):977-85.
18. Hasselmann C, Pecquet C, Bismuth E, Raverdy C, Sola-Gazagnes A, Lobut J, et al. Continuous subcutaneous insulin infusion allows tolerance induction and diabetes treatment in a type 1 diabetic child with insulin allergy. Diabetes Metab 2013; 39(2):174-7.
19. Yoshida N, Okubo M, Ishiguro K, Mori Y. Development of insulin allergy after bone marrow transplantation. Diabet Med 2012; 29(10):1339-41.
20. Luyasu S, Hougardy N, Hasdenteufel F, Jacquenet S, Weber E, Moneret-Vautrin A et al. Choc anaphylactique à l’insuline humaine recombinante : suivi d’un protocole d’accoutumance par tests d’activation des basophiles. Rev Med Interne 2011; 32(1):39-42.
21. Tuboi M, Tsuchiya T, Taguchi R, Tanaka Y, Iwasaki Y, Hashimoto K, et al. Insulin allergy whose local/systemic reactions were reduced by desensitization with long-acting Insulin analog, Glargine. Nihon Naika Gakkai Zasshi 2010; 9(1):133-5.
22. Wang C, Ding Z, Shu S, Liu Y, Chen Y, Ran X, et al. Severe insulin allergy after percutaneous transluminal coronary angioplasty. Clin Ther 2009;31(3):569-74.
23. Hara M, Izumida Y, Sato N, Ohashi K, Osuga J, Tobe K et al. Successful desensitization by glargine administration in a patient with insulin allergy: A case report. Diabetes Res Clin Pract 2009; 84(3):e48-9.
24. Caruso C, Alonzi C, Gaeta F, Viola M, Romano A. Same-patient allergy to ampicillin and human insulin. Allergy 2009; 64(7):1105-7.
25. Pérez E, González R, Martínez J, Iglesias J, Matheu V. detemir insulin–induced anaphylaxis. Ann Allergy Asthma Immunol 2009; 102(2):174-5.
26. Pföhler C, Müller C, Hasselmann D, Tilgen W. Successful desensitization with human insulin in a patient with an insulin allergy and hypersensitivity to protamine: a case report. J Med Case Reports 2008; 2:283.
27. Neville K, Verge C, Wainstein B, Woodhead H, Ziegler J, Walker J. Insulin allergy desensitization with simultaneous intravenous insulin and continuous subcutaneous insulin infusion. Pediatr Diabetes 2008; 9(4pt2):420-2.
28. Kaya A, Gungor K, Karakose S. Severe anaphylactic reaction to human insulin in a diabetic patient. J Diabetes Complications 2007; 21(2):124-7.
29. Madero M, Sastre J, Carnes J, Quirce S, Herrera-Pombo J. IgG4-mediated allergic reaction to glargine insulin. Allergy 2006; 61(8):1022-3.
30. Moyes V, Driver R, Croom A, Mirakian R, Chowdhury T. Insulin allergy in a patient with Type 2 diabetes successfully treated with continuous subcutaneous insulin infusion. Diabet Med 2006; 23(2):204-6.
31. Katahira M, Hara I, Nishizaki T. Insulin allergy decreased by Humulin S (Humulin R) and not by insulin aspart or Actrapid Penfill (Penfill R). Diabet Med 2005; 22(10):1455-7.
32. Matheu V, Perez E, Hernández M, Díaz E, Darias R, González A, et al. Insulin allergy and resistance successfully treated by desensitisation with Aspart insulin. Clin Mol Allergy 2005; 3(1):16.
33. Kara C, Kutlu A, Evliyaoglu O, Bilgili H, Yildirim N. Successful Treatment of Insulin Allergy in a 1-Year-Old Infant With Neonatal Diabetes by Lispro and Glargine Insulin. Diabetes Care 2005; 28(4):983-4.
34. Adachi A, Fukunaga A, Horikawa T. A case of human insulin allergy induced by short-acting and intermediate-acting insulin but not by long-acting insulin. Int J Dermatol 2004; 43(8):597-9.
35. Raubenheimer P, Levitt N. A case of generalised allergic reaction to human insulin. J Endocrinol Metab Diabetes S Afr 2004; 9(1):18-20.
36. Baur X, Bossert J, Koops F. IgE-mediated allergy to recombinant human insulin in a diabetic. Allergy 2003; 58(7):676-8.
37. Barranco R, Herrero T, Tornero P, Barrio M, Frutos C, Rodriguez A, et al. Systemic allergic reaction by a human insulin analog. Allergy 2003; 58(6):536-7.
38. Rosas Vargas M, Alvarez Amador M, Alvarez Amador L, del Río Navarro B, Avila Castanón L, Sienra Monge J. Desensitization to human recombinant DNA insulin in an adolescent with insulin-dependent diabetes mellitus. Rev Alerg Mex 2001; 48(5):129-32.
39. Nagai Y, Mori T, Abe T, Nomura G. Immediate-Type allergy against human insulin associated with marked eosinophilia in type 2 diabetic patient. Endocr J 2001; 48(3):311-6.
40. Sackey A. Drug points: Recurrent generalised urticaria at insulin injection sites. BMJ 2000; 321(7274):1449.
41. Pánczél P, Hosszúfalusi N, Horváth M, Horváth A. Advantage of insulin lispro in suspected insulin allergy. Allergy2000; 55(4):409-10.
42. Bollinger M, Hamilton R, Wood R. Protamine allergy as a complication of insulin hypersensitivity: A case report. J Allergy Clin Immunol 1999; 104(2):462-5.
43. Gonzalo M, Argila D, Revenga F, Garcia J, Diaz J, Morales F. Cutaneous allergy to human (recombinant DNA) insulin. Allergy 1998; 53(1):106-7.
44. Nagai T, Nagai Y, Tomizawa T, Mori M. Immediate-type human insulin allergy successfully treated by continuous subcutaneous insulin infusion. Intern Med 1997; 36(8):575-8.
45. Akinci B, Yener S, Bayraktar F, Yesil S. Allergic reactions to human insulin: a review of current knowledge and treatment options. Endocrine 2009; 37(1):33-9.
2. Ghazavi M, Johnston GA. Insulin allergy. Clin Dermatol 2011; 29(3):300-5.
3. Waton J. L’allergie à l’insuline : mise au point. Revue Française d'Allergologie 2011; 51(3):336-42.
4. Wheeler B, Taylor B. Successful management of allergy to the insulin excipient metacresol in a child with type 1 diabetes: a case report. J Med Case Rep 2012; 6:263.
5. Hasani-Ranjbar S, Fazlollahi M, Mehri A, Larijani B. Allergy to human insulin and specific immunotherapy with glargine; case report with review of literature. Acta Diabetol 2011; 49(1):69-73.
6. Feinglos M, Jegasothy B. "Insulin" allergy due to zinc. Lancet1979; 313(8108):122-4.
7. Ben Ammar I, Ksouri H, Trabelsi N, Mellouli F, Ben Mami F, Dakhli S, et al. Generalized allergy due to zinc in insulin treated with zinc-free insulin. Acta Diabetol 2010; 49(3):239-41.
8. Kim D, Baraniuk J. Delayed-type hypersensitivity reaction to the meta-cresol component of insulin. Ann Allergy Asthma Immunol 2007; 99(2):194-5.
9. Clerx V, Van Den Keybus C, Kochuyt A, Goossens A. Drug intolerance reaction to insulin therapy caused by metacresol. Contact Dermatitis 2003; 48(3):162-3.
10. Rojas J, Villalobos M, Martínez M, Chávez-Castillo M, Torres W, Mejías J, et al. Successful Management of Insulin Allergy and Autoimmune Polyendocrine Syndrome Type 4 with Desensitization Therapy and Glucocorticoid Treatment: A Case Report and Review of the Literature. Case Reports Immunol 2014; 2014:394754.
11. Bodtger U, Wittrup M. A rational clinical approach to suspected insulin allergy: status after five years and 22 cases. Diabet Med 2005; 22(1):102-6.
12. Mollar-Puchades M, Villanueva I. Insulin glulisine in the treatment of allergy to rapid acting insulin and its rapid acting analogs. Diabetes Res Clin Pract 2009; 83(1):e21-e22.
13. Sola-Gazagnes A, Larger E, Pecquet C, Boitard C. Allergie à l’insuline à l’ère des analogues de l’insuline. Sang Thrombose Vaisseaux 2007; 19(8):418-24.
14. Yokoyama H, Fukumoto S, Koyama H, Emoto M, Kitagawa Y, Nishizawa Y. Insulin allergy; desensitization with crystalline zinc-insulin and steroid tapering. Diabetes Res Clin Pract 2003; 61(3):161-6.
15. Munshi R, Varthakavi P, Belhekar M, Pai S, Tayade P, Dalwadi P. A case of hypersensitivity to soluble and isophane insulins but not to insulin glargine. Indian J Pharmacol 2015;47(2):227-9.
16. Pitrola D, MacIver C, Mallipedhi A, Udiawar M, Price D, Stephens J. Cutaneous allergy to insulin: Could statins and ACE inhibitors play a role? A case report. Diabetes Res Clin Pract 2014; 104(1):e20-2.
17. Jacquier J, Chik C, Senior P. A practical, clinical approach to the assessment and management of suspected insulin allergy. Diabet Med 2013; 30(8):977-85.
18. Hasselmann C, Pecquet C, Bismuth E, Raverdy C, Sola-Gazagnes A, Lobut J, et al. Continuous subcutaneous insulin infusion allows tolerance induction and diabetes treatment in a type 1 diabetic child with insulin allergy. Diabetes Metab 2013; 39(2):174-7.
19. Yoshida N, Okubo M, Ishiguro K, Mori Y. Development of insulin allergy after bone marrow transplantation. Diabet Med 2012; 29(10):1339-41.
20. Luyasu S, Hougardy N, Hasdenteufel F, Jacquenet S, Weber E, Moneret-Vautrin A et al. Choc anaphylactique à l’insuline humaine recombinante : suivi d’un protocole d’accoutumance par tests d’activation des basophiles. Rev Med Interne 2011; 32(1):39-42.
21. Tuboi M, Tsuchiya T, Taguchi R, Tanaka Y, Iwasaki Y, Hashimoto K, et al. Insulin allergy whose local/systemic reactions were reduced by desensitization with long-acting Insulin analog, Glargine. Nihon Naika Gakkai Zasshi 2010; 9(1):133-5.
22. Wang C, Ding Z, Shu S, Liu Y, Chen Y, Ran X, et al. Severe insulin allergy after percutaneous transluminal coronary angioplasty. Clin Ther 2009;31(3):569-74.
23. Hara M, Izumida Y, Sato N, Ohashi K, Osuga J, Tobe K et al. Successful desensitization by glargine administration in a patient with insulin allergy: A case report. Diabetes Res Clin Pract 2009; 84(3):e48-9.
24. Caruso C, Alonzi C, Gaeta F, Viola M, Romano A. Same-patient allergy to ampicillin and human insulin. Allergy 2009; 64(7):1105-7.
25. Pérez E, González R, Martínez J, Iglesias J, Matheu V. detemir insulin–induced anaphylaxis. Ann Allergy Asthma Immunol 2009; 102(2):174-5.
26. Pföhler C, Müller C, Hasselmann D, Tilgen W. Successful desensitization with human insulin in a patient with an insulin allergy and hypersensitivity to protamine: a case report. J Med Case Reports 2008; 2:283.
27. Neville K, Verge C, Wainstein B, Woodhead H, Ziegler J, Walker J. Insulin allergy desensitization with simultaneous intravenous insulin and continuous subcutaneous insulin infusion. Pediatr Diabetes 2008; 9(4pt2):420-2.
28. Kaya A, Gungor K, Karakose S. Severe anaphylactic reaction to human insulin in a diabetic patient. J Diabetes Complications 2007; 21(2):124-7.
29. Madero M, Sastre J, Carnes J, Quirce S, Herrera-Pombo J. IgG4-mediated allergic reaction to glargine insulin. Allergy 2006; 61(8):1022-3.
30. Moyes V, Driver R, Croom A, Mirakian R, Chowdhury T. Insulin allergy in a patient with Type 2 diabetes successfully treated with continuous subcutaneous insulin infusion. Diabet Med 2006; 23(2):204-6.
31. Katahira M, Hara I, Nishizaki T. Insulin allergy decreased by Humulin S (Humulin R) and not by insulin aspart or Actrapid Penfill (Penfill R). Diabet Med 2005; 22(10):1455-7.
32. Matheu V, Perez E, Hernández M, Díaz E, Darias R, González A, et al. Insulin allergy and resistance successfully treated by desensitisation with Aspart insulin. Clin Mol Allergy 2005; 3(1):16.
33. Kara C, Kutlu A, Evliyaoglu O, Bilgili H, Yildirim N. Successful Treatment of Insulin Allergy in a 1-Year-Old Infant With Neonatal Diabetes by Lispro and Glargine Insulin. Diabetes Care 2005; 28(4):983-4.
34. Adachi A, Fukunaga A, Horikawa T. A case of human insulin allergy induced by short-acting and intermediate-acting insulin but not by long-acting insulin. Int J Dermatol 2004; 43(8):597-9.
35. Raubenheimer P, Levitt N. A case of generalised allergic reaction to human insulin. J Endocrinol Metab Diabetes S Afr 2004; 9(1):18-20.
36. Baur X, Bossert J, Koops F. IgE-mediated allergy to recombinant human insulin in a diabetic. Allergy 2003; 58(7):676-8.
37. Barranco R, Herrero T, Tornero P, Barrio M, Frutos C, Rodriguez A, et al. Systemic allergic reaction by a human insulin analog. Allergy 2003; 58(6):536-7.
38. Rosas Vargas M, Alvarez Amador M, Alvarez Amador L, del Río Navarro B, Avila Castanón L, Sienra Monge J. Desensitization to human recombinant DNA insulin in an adolescent with insulin-dependent diabetes mellitus. Rev Alerg Mex 2001; 48(5):129-32.
39. Nagai Y, Mori T, Abe T, Nomura G. Immediate-Type allergy against human insulin associated with marked eosinophilia in type 2 diabetic patient. Endocr J 2001; 48(3):311-6.
40. Sackey A. Drug points: Recurrent generalised urticaria at insulin injection sites. BMJ 2000; 321(7274):1449.
41. Pánczél P, Hosszúfalusi N, Horváth M, Horváth A. Advantage of insulin lispro in suspected insulin allergy. Allergy2000; 55(4):409-10.
42. Bollinger M, Hamilton R, Wood R. Protamine allergy as a complication of insulin hypersensitivity: A case report. J Allergy Clin Immunol 1999; 104(2):462-5.
43. Gonzalo M, Argila D, Revenga F, Garcia J, Diaz J, Morales F. Cutaneous allergy to human (recombinant DNA) insulin. Allergy 1998; 53(1):106-7.
44. Nagai T, Nagai Y, Tomizawa T, Mori M. Immediate-type human insulin allergy successfully treated by continuous subcutaneous insulin infusion. Intern Med 1997; 36(8):575-8.
45. Akinci B, Yener S, Bayraktar F, Yesil S. Allergic reactions to human insulin: a review of current knowledge and treatment options. Endocrine 2009; 37(1):33-9.
| Files | ||
| Issue | Vol 18, No 5 (2019) | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/ijaai.v18i5.1927 | |
| PMID | 32245301 | |
| Keywords | ||
| Desensitization Immunologic Diabetes mellitus Hypersensitivity Insulin | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Elfekih H, Hadjkacem F, Elleuch M, Ghorbel D, Charfi N, Mnif F, Rekik N, Mnif M, Abid M. Successful Treatment of Insulin Allergy with Desensitization Therapy: A Case Report and Literature Review. Iran J Allergy Asthma Immunol. 2019;18(5):572-583.
