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. 2008 Aug 26:2:283.
doi: 10.1186/1752-1947-2-283.

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

Claudia Pföhler  1 , Cornelia Sl Müller, Dirk O Hasselmann, Wolfgang Tilgen
Affiliations

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

Claudia Pföhler et al. J Med Case Rep. .

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.

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Figures

Figure 1
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.
Figure 2
Figure 2
Results of intradermal testing using the Sanofi Aventis Insuman© test kit. Protamine-containing test solutions (6 and 7) showed clear positive results 20 minutes after injections, while other components were negative.
Figure 3
Figure 3
Histologic slide of a skin biopsy obtained from an allergic skin reaction on the injection site: regular epidermis; congestion of different inflammatory cells in blood vessels with emission in the adjacent connective tissue of deeper dermal parts. Hematoxylin/eosin staining, magnification ×200; inset: Giemsa staining, magnification ×200.
See this image and copyright information in PMC

References

    1. Liebermann P, et al. Allergic reactions to insulin. J Am Med Assoc. 1971;215:1106–1112. doi: 10.1001/jama.215.7.1106. - DOI - PubMed
    1. Darmon P, et al. Type III allergy to insulin detemir. Diabetes Care. 2005;28:2980. doi: 10.2337/diacare.28.12.2980. - DOI - PubMed
    1. Kollner A, et al. Delayed hypersensitivity to protamine and immediate hypersensitivity to insulin. Dtsch Med Wochenschr. 1991;116:1234–1238. - PubMed
    1. Porsche R, Brenner ZR. Allergy to protamine sulfate. Heart Lung. 1999;28:418–428. doi: 10.1016/S0147-9563(99)70031-2. - DOI - PubMed
    1. Raap U, et al. Delayed-type hypersensitivity to protamine as a complication of insulin therapy. Contact Dermatitis. 2005;53:57–58. doi: 10.1111/j.0105-1873.2005.00456d.x. - DOI - PubMed