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Successful desensitization with human insulin in a patient with an insulin allergy and hypersensitivity to protamine: a case report.

Pföhler C, Müller CS, Hasselmann DO, Tilgen W - J Med Case Rep (2008)

Bottom Line: We treated the patient with human insulin using an ultra-rush protocol beginning with 0.004 IU and a rapid augmentation in dose up to 5 IU.Therapy was accompanied by antihistamine therapy.Subsequent conversion to therapy with glargine insulin (6 IE twice daily) was well-tolerated.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Saarland University Hospital, Department of Dermatology, Homburg/Saar, Germany. hacpfo@uniklinik-saarland.de

ABSTRACT

Introduction: Insulin allergy may occur in patients treated with subcutaneous applications of insulin preparations. Besides additives in the insulin preparation such as protamine, cresol, and phenol, the insulin molecule itself may be the cause of the allergy. In the latter case, therapeutic options are rare.

Case presentation: A 68-year-old man with poorly controlled type 2 diabetes mellitus received different insulin preparations subcutaneously while on oral medication. Six to eight hours after each subcutaneous application, he developed pruritic plaques with a diameter of >15 cm at the injection sites that persisted for several days. Allergologic testing revealed positive reactions against every insulin preparation and against protamine. Investigation of serum samples demonstrated IgG antibodies against human and porcine insulin. We treated the patient with human insulin using an ultra-rush protocol beginning with 0.004 IU and a rapid augmentation in dose up to 5 IU. Therapy was accompanied by antihistamine therapy. Subsequent conversion to therapy with glargine insulin (6 IE twice daily) was well-tolerated.

Conclusion: As reported in this case, desensitization with subcutaneously administered human insulin using an ultra-rush protocol in patients with an insulin allergy may present an easy form of therapy that is successful within a few days.

No MeSH data available.


Related in: MedlinePlus

Intradermal testing showing positive reactions against Levemir© (1), Huminsulin basal© (2), Humalog© (3), and Lantus© (4) 20 minutes after injection. Histamine (H) served as a positive, aqua dest. (Ø) as a negative control.
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Figure 1: Intradermal testing showing positive reactions against Levemir© (1), Huminsulin basal© (2), Humalog© (3), and Lantus© (4) 20 minutes after injection. Histamine (H) served as a positive, aqua dest. (Ø) as a negative control.

Mentions: Intradermal tests were performed with 0.05 ml of different standard insulins and with a Lantus© test kit from Sanofi Aventis (Frankfurt/Main, Germany) on the volar forearm. Physiological saline and histamine (0.01% histamine solution; Bencard, Munich, Germany) served as controls. Table 1 shows the results of intradermal testing in detail. Figures 1 and 2 show positive intradermal testing with Levemir©, Huminsulin basal© Humalog©, and Lantus© (Fig. 1) and positive reactions against protamine-containing test solutions (Fig. 2).


Successful desensitization with human insulin in a patient with an insulin allergy and hypersensitivity to protamine: a case report.

Pföhler C, Müller CS, Hasselmann DO, Tilgen W - J Med Case Rep (2008)

Intradermal testing showing positive reactions against Levemir© (1), Huminsulin basal© (2), Humalog© (3), and Lantus© (4) 20 minutes after injection. Histamine (H) served as a positive, aqua dest. (Ø) as a negative control.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2538533&req=5

Figure 1: Intradermal testing showing positive reactions against Levemir© (1), Huminsulin basal© (2), Humalog© (3), and Lantus© (4) 20 minutes after injection. Histamine (H) served as a positive, aqua dest. (Ø) as a negative control.
Mentions: Intradermal tests were performed with 0.05 ml of different standard insulins and with a Lantus© test kit from Sanofi Aventis (Frankfurt/Main, Germany) on the volar forearm. Physiological saline and histamine (0.01% histamine solution; Bencard, Munich, Germany) served as controls. Table 1 shows the results of intradermal testing in detail. Figures 1 and 2 show positive intradermal testing with Levemir©, Huminsulin basal© Humalog©, and Lantus© (Fig. 1) and positive reactions against protamine-containing test solutions (Fig. 2).

Bottom Line: We treated the patient with human insulin using an ultra-rush protocol beginning with 0.004 IU and a rapid augmentation in dose up to 5 IU.Therapy was accompanied by antihistamine therapy.Subsequent conversion to therapy with glargine insulin (6 IE twice daily) was well-tolerated.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Saarland University Hospital, Department of Dermatology, Homburg/Saar, Germany. hacpfo@uniklinik-saarland.de

ABSTRACT

Introduction: Insulin allergy may occur in patients treated with subcutaneous applications of insulin preparations. Besides additives in the insulin preparation such as protamine, cresol, and phenol, the insulin molecule itself may be the cause of the allergy. In the latter case, therapeutic options are rare.

Case presentation: A 68-year-old man with poorly controlled type 2 diabetes mellitus received different insulin preparations subcutaneously while on oral medication. Six to eight hours after each subcutaneous application, he developed pruritic plaques with a diameter of >15 cm at the injection sites that persisted for several days. Allergologic testing revealed positive reactions against every insulin preparation and against protamine. Investigation of serum samples demonstrated IgG antibodies against human and porcine insulin. We treated the patient with human insulin using an ultra-rush protocol beginning with 0.004 IU and a rapid augmentation in dose up to 5 IU. Therapy was accompanied by antihistamine therapy. Subsequent conversion to therapy with glargine insulin (6 IE twice daily) was well-tolerated.

Conclusion: As reported in this case, desensitization with subcutaneously administered human insulin using an ultra-rush protocol in patients with an insulin allergy may present an easy form of therapy that is successful within a few days.

No MeSH data available.


Related in: MedlinePlus