Insulin porcine

Code: c70
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 insulin of animal origin has been reported (3, 10-15). A major problem is the cross-reactivity that occurs between anti-insulin antibodies and the various animal and human insulin preparations in patients presenting with allergy to animal insulin (3).

Clinical Experience

Immunological complications of insulin therapy have been evident since animal insulin became available for the treatment of diabetes mellitus in 1922 (1). In insulin-allergic patients treated with conventional insulin preparations, the insulin-specific IgE values are often 10- to 20-fold higher than in patients without allergy (2). It has been shown that human insulin is less immunogenic than animal insulin. Porcine insulin is most similar to human insulin.
 
Review
Insulin is a small protein hormone produced by the beta cells in the Islets of Langerhans. Immunological complications of insulin therapy have been evident since animal insulin became available for the treatment of diabetes mellitus in 1922 (1).

In insulin-allergic patients treated with conventional insulin preparations, the insulin-specific IgE values are often 10- to 20-fold higher than in patients without allergy (2). It has been shown that human insulin is less immunogenic than animal insulin. Porcine insulin is most similar to human insulin. The primary amino acid sequences of bovine and porcine insulin differ from that of human insulin by three and one amino acid, respectively. This greater dissimilarity between human and bovine insulin has been postulated to be the explanation for the greater antigenicity of bovine insulin as compared with porcine insulin (3).

In view of the wide spectrum of immune-mediated complications of insulin therapy, much attention has been directed to the reduced immunogenicity and allergenicity of highly purified porcine insulin and the more recently available recombinant and semi-synthetic human insulin preparations. However, human insulin preparations are not totally non-immunogenic (4-7). Local and acute systemic reactions to exogenous human insulin have occasionally been reported (8,9).

Cross-reactivity between human insulin and insulin of animal origin has been reported (3, 10-15). A major problem is the cross-reactivity that occurs between anti-insulin antibodies and the various animal and human insulin preparations in patients presenting with allergy to animal insulin (3).
 
 

References

  1. Williams JR. A clinical study of the effects of insulin in severe diabetes. J Metab Res 1922;2:729-51.
  2. Heding LG, Falholt K, Kristensen JS. IgE specific for insulin - Formation and clinical significance. In Immunology in Diabetes. Andreani D, Di Mario U, Federlin K, Heding L, Eds. Kimpton 1984:235-44.
  3. Schernthaner G. Immunogenicity and allergenic potential of animal and human insulins. Diabetes Care 1993;16(Suppl 3):155-65.
  4. Fineberg SE, Galloway JA, Fineberg NS, Rathbun MJ, Hufferd S. Immunogenicity of recombinant DNA human insulin. Diabetologia 1983;25(6):465-9.
  5. 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
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. Brogden RN, Heel RC. Human insulin. A review of its biological activity, pharmacokinetics and therapeutic use. Drugs 1987;34(3):350-71.
  11. Gossain VV, Rovner DR, Mohan K. Systemic allergy to human (recombinant DNA) insulin. Ann Allergy 1985;55(2):116-8.
  12. Grammer LC, Metzger BE, Patterson R. Cutaneous allergy to human (recombinant DNA) insulin. Jama 1984;251(11):1459-60.
  13. 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.
  14. 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.
  15. 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.