Insulin-induced Drug Eruptions and Reliability of Skin Tests

Ai-Young Lee, Won-Young Chey, Joon Choi, Jae-Seok Jeon
2002 Acta Dermato-Venereologica  
Allergic reaction to insulin preparations seemed to have insulin preparations are virtually free of protein contaminants, which has undoubtedly contributed to the decreased since the introduction of contaminant-free , human preparations. The role of protamine sulfate in decreasing prevalence of insulin allergies caused by insulin-related protein and contaminants (2-4). decreasing the prevalence of allergy is unclear. This study examines the causative components of insulin allergy However, puri
more » ... ergy However, puri ed preparations still contain additives, and insulin allergies caused by the additives, especially along with the value of skin tests for diagnosis. Eleven patients with insulin allergy and 53 patients receiving protamine sulfate, still occur. Allergic reactions to insulin preparations are freinsulin but without an insulin allergy were included as controls. Intradermal skin tests were conducted using quently local, and although IgE-mediated anaphylaxi s is uncommon, it is the most serious problem. preparations containing various concentrations of insulin [Neutral protamine Hagedorn (NPH ) insulin, regular Granulomatous (5) and nodular (6) reactions have also been rarely documented. insulin (RI )] and protamine sulfate. Of the 11 patients studied, 3 had anaphylaxis and 8 displayed localized We experienced 3 cases of anaphylaxis and 8 of localized adverse reactions to insulin preparations. reactions. All of the patients reacted positively during skin testing. Five patients showed positive intradermal Although no accurate methods have been described for diagnosis in medical publications, we conducted skin skin test reactions to protamine sulfate, and 4 reacted to insulin. Two patients that were not tested with protamine tests for this purpose. Fifty-three controls were tested to evaluate the value of the skin tests. The clinical sulfate reacted positively to NPH insulin. In the case of protamine sulfate, 4 patients with localized symptoms manifestations, the results of skin tests, and the causes of the insulin allergies are described. displayed positive reactions at concentrations of 10 mg/ml, 3 mg/ml or 0.3 mg/ml. One patient with anaphylaxis reacted positively to a concentration as low as 0.03 ng/ml. MATERIAL AND METHODS In the case of insulin protein, 3 patients reacted positively to a 100-fold dilution (1 UI/ml ). Eight of the 53 controls Subjects experienced pruritus and/or skin lesions. However, none Eleven patients (6 males and 5 females; aged 32-72 years, of the controls reacted at a concentration of NPH insulin average 53 years) with allergy-suspected symptoms after the of less than 10 U/ml or to protamine sulfate at less than injection of insulin preparations were studied ( Table I ) . The 30 mg/ml. Allergic reactions to protamine sulfate are mean duration of diabetes mellitus (DM ) was 11 years. The common and should not be ignored. This study shows a patients had been treated with insulin preparations (continu-
doi:10.1080/00015550252948149 pmid:12125938 fatcat:ndd73mjukzdcrb4heglqi5hhoq