Immediate-Type Allergy against Human Insulin Associated with Marked Eosinophilia in Type 2 Diabetic Patient

We describe a type 2 diabetic patient who showed immediate-type allergy against human insulin associated with marked eosinophilia at initial insulin therapy. Three months after initiation of insulin therapy, he noticed itchy skin wheals at the site of the insulin injection. Laboratory data at that t...

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Bibliographic Details
Published in:Endocrine Journal 2001, Vol.48(3), pp.311-316
Main Authors: NAGAI, YUKIHIRO, MORI, TOSHIFUMI, ABE, TOSHIO, NOMURA, GAKUJI
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Cyclohexanes - therapeutic use
Diabetes Mellitus, Type 2 - drug therapy
Diabetes Mellitus, Type 2 - immunology
Drug Hypersensitivity
Eosinophilia
Eosinophilia - immunology
Erythema - immunology
Erythema - pathology
Human insulin
Humans
Hypersensitivity, Immediate - chemically induced
Hypoglycemic Agents - therapeutic use
Immunoglobulin E - blood
Insulin - immunology
Insulin - therapeutic use
Insulin allergy
Male
Nateglinide
Phenylalanine - analogs & derivatives
Phenylalanine - therapeutic use
Renal dysfunction
Seasons
Skin Tests
Type 2 diabetes mellitus
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Summary:We describe a type 2 diabetic patient who showed immediate-type allergy against human insulin associated with marked eosinophilia at initial insulin therapy. Three months after initiation of insulin therapy, he noticed itchy skin wheals at the site of the insulin injection. Laboratory data at that time showed marked eosinophilia (2512/mm3) and progression of renal dysfunction. Skin test with semisynthetic human insulin and protamine sulfate resulted in local immediate skin reactions such as itchy erythema and wheals. Histopathology of the biopsy specimen from skin showed perivascular infiltration of lymphocytes and numerous eosinophils in the dermis and subcutaneous fat. Although the titer of total IgE antibody was within normal range, that of insulin-specific IgE antibody was high. Insulin administration was discontinued to preserve his insulin secretion, and stable control of his hyperglycemia was obtained by initiating nateglinide treatment (360mg/day). His itchy skin lesions disappeared within two weeks after cessation of the insulin therapy and both eosinophilia and renal dysfunction gradually improved. Although the widespread use of human insulin in diabetic patients has greatly reduced the incidence of insulin allergy, the possibility of human insulin allergy should be kept in mind when initiating such therapy.
ISSN:0918-8959
1348-4540
DOI:10.1507/endocrj.48.311