Insulin human

Code: c73
Source material: Human insulin
Injection of protein drugs can cause an IgE-sensitization even in individuals without obvious atopic constitution.

Allergen Exposure

Subcutaneous injection.

Potential Cross-Reactivity

Crossreactivity between human insulin and pancreatic insulin of animal origin has been reported (9-14).

Clinical Experience

Local and acute systemic reactions to exogenous human insulin have occasionally been reported (6-7). Patients treated exclusively with human insulins sometimes develop anti-insulin antibodies of the IgG and IgE class, however in very low titers (8). Allergic symptoms to human insulin have been found in <1% of de novo-treated patients (8).
 
Review
Human insulin is a small protein produced by the beta cells in the Islets of Langerhans. Immunological complications of insulin therapy have been evident since animal insulins became available for the treatment of diabetes mellitus in 1922 (1). In view of the wide spectrum of immune-mediated complications of insulin therapy, much attention has been directed at the reduced immunogenicity and allergenicity of highly purified porcine insulins and the more recently available recombinant and semisynthetic human insulin preparations. However, human insulin preparations are not totally non-immunogenic (2-5). Local and acute systemic reactions to exogenous human insulin have occasionally been reported (6-7). Patients treated exclusively with human insulins sometimes develop anti-insulin antibodies of the IgG and IgE class, however in very low titers (8). Allergic symptoms to human insulin have been found in <1% of de novo-treated patients (8). Crossreactivity between human insulin and pancreatic insulin of animal origin has been reported (9-14).
 

References

  1. Williams JR. A clinical study of the effects of insulin in severe diabetes. J Metab Res 1922;2:729-51.
  2. Fineberg SE, Galloway JA, Fineberg NS, Rathbun MJ, Hufferd S. Immunogenicity of recombinant DNA human insulin. Diabetologia 1983;25(6):465-9.
  3. Fireman P, Fineberg SE, Galloway JA. Development of IgE antibodies to human (recombinant DNA), porcine, and bovine insulins in diabetic subjects. Diabetes Care 1982;5(Suppl 2):119-25.
  4. Schernthaner G, Borkenstein M, Fink M, Mayr WR, Menzel J, Schober E. Immunogenicity of human insulin (Novo) or pork monocomponent insulin in HLA-DR-typed insulin-dependent diabetic individuals. Diabetes Care 1983;6(Suppl 1):43-8.
  5. Velcovsky HG, Federlin KF. Insulin-specific IgG and IgE antibody response in type I diabetic subjects exclusively treated with human insulin (recombinant DNA). Diabetes Care 1982;5(Suppl 2):126-8.
  6. Schernthaner G, Ludwig H, Jarisch R, Bruneder H. Immediate-type allergy against insulin itself: clinical and immunologic studies on a diabetic patient with insulin intolerance. Diabetes Care 1981;4(2):196-201.
  7. Grammer LC, Roberts M, Patterson R. IgE and IgG antibody against human (recombinant DNA) insulin in patients with systemic insulin allergy. J Lab Clin Med 1985;105(1):108-13.
  8. Schernthaner G. Immunogenicity and allergenic potential of animal and human insulins. Diabetes Care 1993;16(Suppl 3):155-65.
  9. Brogden RN, Heel RC. Human insulin. A review of its biological activity, pharmacokinetics and therapeutic use. Drugs 1987;34(3):350-71.
  10. Gossain VV, Rovner DR, Mohan K. Systemic allergy to human (recombinant DNA) insulin. Ann Allergy 1985;55(2):116-8.
  11. Grammer LC, Metzger BE, Patterson R. Cutaneous allergy to human (recombinant DNA) insulin. Jama 1984;251(11):1459-60.
  12. Wiles PG, Guy R, Watkins SM, Reeves WG. Allergy to purified bovine, porcine, and human insulins. Br Med J (Clin Res Ed) 1983;287(6391):531.
  13. Waldhausl WK, Kastner G, Komjati M, Bratusch-Marrain P. Studies on the biologic actions of biosynthetic human insulin in vitro and in diabetic man. Diabetes Care 1981;4(2):205-8.
  14. Small P, Lerman S. Human insulin allergy. Annals of Allergy 1984;53(1):39-41.

 

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.