A case of human insulin allergy induced by short-acting and intermediate-acting insulin but not by long-acting insulin.
A 66-year-old woman suffering from pollinosis developed generalized urticaria after injection of intermediate-acting insulin for diabetes mellitus. She had human insulin-specific IgE, and in skin tests was positive for human recombinant insulin and negative for additives. Uniquely, she reacted to fast-acting and slow-acting insulin but not to long-acting insulin. We further confirmed that human insulin preparations could stimulate her peripheral basophils to release a significant amount of histamine. Genetically generated human insulin analogs, aspart and lispro, induced positive skin tests and histamine release from basophils. She was recommended to use a long-acting insulin preparation and was free from symptoms thereafter.
Adachi
Atsuko
A
Department of Dermatology, Hyogo Prefectural Kakogawa Hospital, Japan. faadachi@dd.iij4u.or.jp
Fukunaga
Atsushi
A
Horikawa
Tatsuya
T
D000368:Aged; D003920:Diabetes Mellitus / Q000188:drug therapy; D003875:Drug Eruptions / Q000209:etiology* / Q000276:immunology; D005260:Female; D006636:Histamine Release / Q000276:immunology; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000276:immunology; D007073:Immunoglobulin E / Q000276:immunology; D007328:Insulin / Q000009:adverse effects* / Q000276:immunology; D049528:Insulin, Long-Acting / Q000627:therapeutic use; D007428:Intradermal Tests; D014581:Urticaria / Q000139:chemically induced / Q000276:immunology
D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D007073:Immunoglobulin E