Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Feb;9(2):53-65.
doi: 10.1177/2042018817745484. Epub 2017 Dec 26.

Hypersensitivity reactions to human insulin analogs in insulin-naïve patients: a systematic review

Andrew S Bzowyckyj  1 , Amanda M Stahnke  2
Affiliations
Review

Hypersensitivity reactions to human insulin analogs in insulin-naïve patients: a systematic review

Andrew S Bzowyckyj et al. Ther Adv Endocrinol Metab. 2018 Feb.

Abstract

Objective: The objective of this study was to raise awareness of hypersensitivity reactions to human insulin analogs (HIAs) in insulin-naïve patients and encourage consistent and detailed reporting of HIA reactions.

Data sources: A search of PubMed, MEDLINE and International Pharmaceutical Abstracts using the terms 'insulin' and 'hypersensitivity' was completed with English language, humans, and publication date after 1 January 1990 as limits.

Study selection and data extraction: The initial search identified 598 articles. These titles and abstracts were reviewed for relevance (e.g. mention of HIA) resulting in the exclusion of 477 articles. The full texts of the remaining titles were evaluated in addition to each article's references to identify additional reports meeting criteria (n = 14). Upon extensive review, 118 articles were excluded for not meeting prespecified inclusion criteria, resulting in 17 articles.

Data synthesis: Evidence supporting hypersensitivity reactions to HIAs was variable, potentially due to a variety of causes (e.g. difficulty identifying a true case of hypersensitivity reaction to HIAs). Inconsistencies were noted for the identification, confirmatory testing, management, and reporting of these reactions. Management strategies included use of insulin desensitization protocols, antihistamines, steroids, immunosuppressant/immunomodulator therapies, conversion to noninsulin therapies, and pancreas transplantation.

Conclusions: Complete and consistent identification, evaluation, management, and reporting of these reactions is essential. Specific aspects of the patient's history should be reported, including previous insulin exposure, the specific HIAs used, duration of use prior to the reaction, a clear timeline of the reaction, and discussion of precipitating events or confounding factors.

Keywords: adverse drug reaction; diabetes; endocrinology; hypersensitivity; insulin.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Study selection. HIA, human insulin analog.
See this image and copyright information in PMC

References

    1. Ghazavi MK, Johnston GA. Insulin allergy. Clin Dermatol 2011; 29: 300–305. - PubMed
    1. Pföhler C, Müller CSL, Hasselmann DO, et al. Successful desensitization with human insulin in a patient with an insulin allergy and hypersensitivity to protamine: a case report. J Med Case Rep 2008; 2: 283. - PMC - PubMed
    1. Lebovitz HE. Insulin allergy and insulin resistance. In: Barden CW. (ed.) Current therapy in endocrinology and metabolism. 6th ed. Philadelphia: Mosby, 1997, pp.500–504. - PubMed
    1. Akinci B, Yener S, Bayraktar F, et al. Allergic reactions to human insulin: a review of current knowledge and treatment options. Endocrine 2010; 37: 33–39. - PubMed
    1. Imakado S, Hamada K, Atsumi Y. Subcutaneous antihistamine injection is effective to control a local allergic reaction to human insulin [letter to the editor]. Diabetes Res Clin Pract 2009; 85: e42–e43. - PubMed

LinkOut - more resources