Lispro analog for treatment of generalized allergy to human insulin.
OBJECTIVE
To evaluate the clinical usefulness of the human insulin analog lispro in a patient with generalized allergy to human insulin.


METHODS
A 34-year-old obese female patient developed systemic allergic reactions to human insulin but tolerated insulin lispro. Sequential analyses of the anti-insulin IgE and IgG immunoglobulins were performed.


RESULTS
On intradermal test, the lispro insulin produced a 50% less intense wheal-flare response, compared with human insulin, which was presumed to be due to lispro's molecular form. The intradermal reactivity to both human and lispro insulins decreased with time and disappeared by week 25. 125I-labeled lispro and human insulin binding antibody titers of both the IgE and IgG immunoglobulins were high initially, but decreased progressively, becoming very low by the end of 1 year. In in vitro immunoassay, the lispro and human insulins show a complete cross-reactivity.


CONCLUSIONS
Lispro may be useful for the management of allergy to human insulin. This analog of human insulin appears to have a reduced immunogenic potency.
Kumar
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Department of Medicine, University of Southern California School of Medicine, Los Angeles County Medical Center, USA.
D000328:Adult; D000818:Animals; D003429:Cross Reactions / Q000276:immunology; D003888:Desensitization, Immunologic; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D004342:Drug Hypersensitivity / Q000150:complications / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000276:immunology / Q000627:therapeutic use*; D007073:Immunoglobulin E / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007328:Insulin / Q000031:analogs & derivatives* / Q000276:immunology* / Q000627:therapeutic use; D007330:Insulin Antibodies / Q000032:analysis*; D061268:Insulin Lispro; D007428:Intradermal Tests; D007457:Iodine Radioisotopes; D013552:Swine; D013997:Time Factors
D007004:Hypoglycemic Agents; D007074:Immunoglobulin G; D007328:Insulin; D007330:Insulin Antibodies; D061268:Insulin Lispro; D007457:Iodine Radioisotopes; D007073:Immunoglobulin E