Insulin therapy in patients with systemic insulin allergy

Insulin was administered to 12 of 15 patients with systemic insulin hypersensitivity. Eight patients with a history of a systemic reaction to insulin but not receiving current therapy were skin-tested and desensitized. Four receiving insulin had temporary dose reduction followed by slow increase to therapeutic levels. No noticeable reactions recurred in any of them. Levels of IgE antibodies against insulin were determined in 12. Substantial elevations were found in eight. These levels declined rapidly in three desensitized patients who were studied in contrast to the slower decline in three patients who were not desensitized. Insulin can be cautiously administered if necessary to patients with prior systemic insulin hypersensitivity. Evidence that IgE antibodies are against the insulin molecule in at least some patients indicates the need for a desensitization regimen.