title: Insulin allergy; desensitization with crystalline zinc-insulin and steroid tapering.
abstract: The insulin analogues, aspart and lispro, have been considered safe alternatives for patients with insulin allergy, because of their decreased immunogenicity. However, recent several reports showed that neither of them was completely free from allergic reactions. We also experienced a patient with insulin allergy not only to human regular insulin but also to both of the insulin analogues. Interestingly, the insulin analogues, which readily dissociate from polymer to monomer, induced the most severe allergic reaction among several types of human insulin reagents in the present case. Allergy to crystalline zinc-insulin, the three-dimensional structure of which results in delayed dissociation and absorption, was negative on intradermal tests. However, its large subcutaneous injection caused local allergic reaction. These results suggested that the allergic reaction might depend on the rapidity of insulin monomerization and absorption, and thus that the immunogenic residue of insulin is concealed when insulin is polymerized. Based on the intradermal tests, we speculated that the antigenic epitope might be B30-Thr in the present case. We also report here the modified method of insulin desensitization using crystalline zinc-insulin with prednisolone tapering. This might be a simple and useful treatment for insulin allergy.
authors.affiliation: Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, 545-8585 Osaka, Japan.
authors.forename: Hisayo
authors.initials: H
authors.lastname: Yokoyama
authors.forename: Shinya
authors.initials: S
authors.lastname: Fukumoto
authors.forename: Hidenori
authors.initials: H
authors.lastname: Koyama
authors.forename: Masanori
authors.initials: M
authors.lastname: Emoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nishizawa
mesh_terms: D000595:Amino Acid Sequence; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000737:chemistry / Q000276:immunology; D007328:Insulin / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000737:chemistry / Q000276:immunology; D061268:Insulin Lispro; D049528:Insulin, Long-Acting / Q000009:adverse effects / Q000737:chemistry / Q000276:immunology; D007428:Intradermal Tests; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D007004:Hypoglycemic Agents; D007328:Insulin; D061268:Insulin Lispro; D049528:Insulin, Long-Acting; D011239:Prednisolone