Diabetes Care
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by JiXiong, X.
Right arrow Articles by Huixian, C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by JiXiong, X.
Right arrow Articles by Huixian, C.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
Diabetes Care 27:2084-2085, 2004
© 2004 by the American Diabetes Association, Inc.

Letters: Observations

The Human Insulin Analog Aspart Can Induce Insulin Allergy

Xu JiXiong, MD, Liu Jianying, MD, Chang Yulan, MD and Chen Huixian, MD

Department of Endocrinology, First Affiliated Hospital of JiangXi Medical College, NanChang, Jiangxi, China

Address correspondence to Xu JiXiong, MD, First Affiliated Hospital of JiangXi Medical College, Department of Endocrinology, 17 N. Yongwaizheng St., Nanchang, JiangXi, 330006 China. E-mail: x2jo{at}163.com

The human insulin analog aspart is produced by recombinant technology that replaces the proline at position 28 on the ß-chain of insulin with negatively charged aspartic acid. Insulin aspart exists as hexamers that rapidly dissociate into monomers and dimers after the subcutaneous injection (1); it appears that it has a reduced antigenicity. It has been confirmed to be less immunogenic for development of antibodies than human insulin (2). Several case reports indicated that the human insulin analog aspart does not cause insulin allergy and is a safe alternative in insulin allergy (3,4). But a case report showed that the patient developed cutaneous allergic reactions not only to human insulin but also to the analogs aspart and lispro (5). However, here we report two cases of cutaneous allergic reaction to insulin aspart (Novorapid; Novo Nordisk, Bagsvaerd, Denmark) and no allergic reactions to human insulin (Novolin R and Novolin N; Novo Nordisk).

A 48-year-old woman with type 2 diabetes diagnosed 5 years prior was referred to our hospital in September 2003 for treatment of uncontrolled diabetes. Because of difficult-to-control hyperglycemia, three daily injections of Novorapid were prescribed. After 4 days, she noticed local skin rash and flare at the injection sites 5–15 min after insulin injection. Although she had been treated with antiallergic drugs, her allergic reaction continued and the skin rash spread. She had no previous history of allergy. She had been treated with Novolin R for acute pyelonephritis 2 years before and no local or systemic allergic reactions had occurred. The skin prick test with Novolin R was negative. We changed Novorapid to Novolin R. Subsequently, her skin rash disappeared 3 days later. However, about half a month after the start of Novolin R, the patient injected herself with Novorapid once by mistake, resulting in a systemic allergic reaction appearing immediately thereafter (generalized urticaria). By treatment with antiallergic drugs, this symptom disappeared. The patient was treated with two daily injections of premixed human insulin (Novolin 30R; Novo Nordisk) after discharge from our hospital. During the 3 months after the start of treatment with Novolin 30R, no allergic reactions occurred.

A 52-year-old man with newly diagnosed type 2 diabetes was referred to our hospital in December 2003. Because of hyperglycemia (fasting plasma glucose >14 mmol/l), three daily injections of Novorapid and one injection of Novolin N at bedtime were prescribed. After a few days, he developed local skin rash and itching at the injection sites ~5 min after insulin injection. There was no known history of allergy. The percentage of eosinophils in his peripheral white blood cell count was 8.7% (normal <7%). He showed a high level of total IgE (1,380 IU/ml; normal <360 IU/ml) and human insulin–specific IgE (12.50 IU/ml; normal <0.34) measured by radioallergosorbent test. The skin prick test for Novorapid was positive, whereas the skin prick test with Novolin R, Novolin N, and Novolin 30R was negative. Thus, he was diagnosed with Novorapid allergy. His insulin was changed to Novolin R, and the skin wheal cleared up a few days later. No antiallergic drugs were used.

These two cases demonstrated skin allergic reaction to insulin aspart Novorapid without any evidence of allergic reactions to Novolin R and Novolin N. Our data suggest that the human insulin aspart, as a variety of exogenous insulin, can induce insulin allergy.

References

  1. Setter SM, Corbett CF, Campbell RK, White JR: Insulin aspart: a new rapid-acting insulin analog. Ann Pharmacother 34:1423–1431, 2000[Abstract]
  2. Ottensen JL, Nilsson P, Jami J, Weilguny D, Duhrkop M, Bucchini D, Havelund S, Fogh JM: The potential immunogenicity of human insulin and insulin analogues evaluated in transgenic mouse model. Diabetologia 37:1178–1185, 1994[Medline]
  3. Yasuda H, Nagata M, Moriyama H, Fujihira K, Kotani R, Yamada K, Ueda H, Yokono K: Human insulin analog insulin aspart does not cause insulin allergy (Letter). Diabetes Care 24:2008–2009, 2001[Free Full Text]
  4. Airaghi L, Lorini M, Tedeschi A: The insulin analog aspart: a safe alternative in insulin allergy (Letter). Diabetes Care 24:2000, 2001[Free Full Text]
  5. Takata H, Kumon Y, Osaki F, Kumagai C, Arii K, Ikeda Y, Suehiro T, Hashimoto K: The human insulin analogue aspart is not the almighty solution for insulin allergy (Letter). Diabetes Care 26:253–254, 2003[Free Full Text]

Add to CiteULike CiteULike   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by JiXiong, X.
Right arrow Articles by Huixian, C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by JiXiong, X.
Right arrow Articles by Huixian, C.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Diabetes Diabetes Care Clinical Diabetes Diabetes Spectrum