[Immediate type allergy to insulin (author's transl)]

Area of Science:

• Immunology
• Endocrinology
• Allergy

Background:

• Allergic reactions to insulin have been documented since its therapeutic use for diabetes mellitus.
• While chromatographically purified insulins have reduced incidence, immediate-type insulin allergy remains a clinical concern.
• The co-occurrence of insulin allergy and insulin resistance is frequently observed in patients.

Observation:

• Immediate-type insulin allergy is primarily triggered by immunoglobulin E (IgE) antibodies.
• The Arthus phenomenon, mediated by immunoglobulin G (IgG) antibodies, represents another significant allergic reaction.
• Diagnosis involves intradermal skin tests with various insulin preparations and radioimmunological measurement of specific IgE antibodies.

Findings:

• A strong correlation exists between the severity of allergic reactions and specific IgE antibody levels.
• Diabetics treated with highly purified insulin but showing no allergic reactions exhibit low specific IgE levels.
• These findings suggest that highly purified insulin itself acts as the antigen, eliciting allergic responses.

Implications:

• Understanding the immunologic mechanisms, including IgE and IgG antibody roles, is crucial for managing insulin allergy.
• Diagnostic tools like skin testing and specific IgE measurement aid in identifying and characterizing these reactions.
• Further research into non-immunologic exogenic factors contributing to insulin allergy is warranted for comprehensive patient care.