Insulin/insulin detemir/insulin suspension isophane
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Allergy to zinc chloride adjuvant: case report A 61-year-old man developed an allergy to a zinc chloride adjuvant in insulin [Actrapid], insulin detemir [Levimir] and insulin suspension isophane [dosages not stated; some times to reaction onsets not stated]. The man had a history of multiple allergies and diabetes mellitus type 2 since age 27 years. Due to degenerative diabetic complications, his oral antihyperglycaemic therapy was switched to insulin. He received an injection of insulin suspension isophane. About 1 hour later, he developed local symptoms with injection-site induration, swelling, erythema and pruritus, which progressed to generalised urticaria with dyspnoea and face oedema. After a few hours, his symptoms resolved. He subsequently received a second injection of insulin suspension isophane; however, he developed the same symptoms. The man received corticosteroids, and his allergic symptoms resolved. He subsequently received insulin [route not stated]; however, he developed the same allergic manifestations again. Oral antihyperglycaemic treatment was restarted despite diabetic instability. A few years later, his diabetes had worsened, and he received an injection of insulin detemir. He developed the aforementioned allergic symptoms, which resolved after receiving histamine H1-receptor antagonists. The man underwent prick testing to determine the cause of allergy to multiple insulin preparations. He had positive prick tests to 10–40 fold diluted zinc chloride 5 µg/mL after approximately 10 minutes, with immediate wheal and flare local reaction, laryngeal tickling, and subsequent transient urticaria. He then started insulin glulisine, which does not contain zinc chloride. While receiving insulin glulisine, his glucose control improved, and he had not experienced any allergic reactions over about 8 months of treatment. Author comment: "We report a case of an allergy against zinc chloride a major adjuvant component of most insulin preparations". Ben Ammar I, et al. Generalized allergy due to zinc in insulin treated with zincfree insulin. Acta Diabetologica 49: 239-241, No. 3, Jun 2012. Available from: 803076167 URL: http://dx.doi.org/10.1007/s00592-010-0230-4 - Tunisia
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Reactions 1 Sep 2012 No. 1417
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