Registered Nurses´ Association of Ontario
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Allergic Reactions to Insulin
TYPES:
Local
- Occurs in 2-3% of clients
- Develops within the first 2 weeks of therapy
- Approximately 90% of people with local allergy have
spontaneous resolution within 2 months while on the same
therapy. An additional 5% will improve within 6-12 months
- May be associated with lipoatrophy if injection sites are not rotated
Isolated wheal & flare
- Develops within 30 minutes
Biphasic
- Resolves within an hour
- The late phase of a biphasic reaction is painful and erythematous. This peaks in 4-6 hours and lasts for 24 hours.
Arthus reactions
- Are uncommon
- They are localized small-vessel injuries with neutrophilic infiltrates
- Develops over 4-6 hours and peaks in 12 hours
Delayed (tuberculinlike)
- A nodule or “deep hive” develops in 8-12 hours and peaks in 24 hours
Treatment
- Oral or topical antihistamines
- Switch insulin brand or type
Systemic
- Very rare, but are more common in people with histories of atopy and/or intermittent insulin therapy
Urticaria to anaphylaxis
- Anti-insulin IgG and IgE levels are significantly elevated
- Occurs immediately
Treatment
- Anaphylaxis protocol
- Insulin desensitization program
Insulin–antibody mediated Insulin Resistance
- Extremely rare
- Insulin molecule induces immunologic complications
- Use of beef-containing insulins before the initiation resistance is usually always noted
- Presence of these antibodies may increase insulin dose or alter insulin absorption
Treatment
- Use of steroid therapy
- Use of U-500 insulin
