Successful Modified Desensitization Therapy with Analog Insulin in an Individual with Severe Allergy to Multiple Insulin Preparations: A Case Report*

12 August 2018

This article is published in the Journal of the ASEAN Federation of Endocrine Societies

Journal Issue: Vol 33, No 1 (2018)

Authors: Wan Juani Wan Seman, Azraai Bahari Nasruddin, Nurain Mohd Noor

 

Institutions: Endocrine Unit, Putrajaya Hospital, Wilayah Persekutuan Putrajaya, Malaysia

*Presented as Poster Presentation in the 18th AFES Congress in Kuala Lumpur, Malaysia from the 10th to 13th of December 2015.
 
Corresponding Author

Dr Wan Juani Wan Seman

Endocrine Unit, Putrajaya Hospital, Pusat Pentadbiran Kerajaan Persekutuan,
Presint 7, 62250 Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia
Tel. No.: +603-83124200
Fax No.: +603-88889169
E-mail: wjuani@yahoo.com/ ppjuani@hpj.gov.my
ORCID iD: https://orcid.org/0000-0002-5303-4189
 

e-ISSN 2308-118x

Printed in the Philippines
Copyright © 2018 by the JAFES
Received January 16, 2018. Accepted March 12, 2018.
Published Online First: May 13, 2018.
 
ABSTRACT
We present a case of a 27-year-old female with T2 DM who developed allergic reactions after commencement of insulin therapy. Trial with different types of insulin resulted in a series of allergic reactions ranging from urticarial rash to development of angioedema, bronchospasm and anaphylactic shock. She was successfully treated with a modified insulin desensitization protocol using rapid-acting insulin.
 
Keywords: insulin allergy, desensitization, excipients, T2 DM, insulin preparations
 
INTRODUCTION
Allergy to insulin has become rare with the advent of human insulin and its analogues. The incidence of insulin allergy is less than 1% in patients with diabetes. The diagnosis is based on clinical presentation and supported by skin or serological testing if available.
 
Insulin preparation requires additives such as protamine or zinc, which may act as a potential allergen. Therefore, allergy to insulin can be precipitated by the insulin molecule itself or carrier proteins.
 

Treatment options for insulin allergy include symptomatic therapy with antihistamines and use of alternative insulin preparation. Other therapeutic actions which have been reported include insulin desensitization using small doses of insulin or through a continuous subcutaneous insulin infusion (CSII), use of monoclonal antibodies (Omalizumab) and even pancreatic transplantation for severe, resistant cases.[1] We report a case of insulin allergy successfully treated using a modified insulin desensitization protocol.

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