Radermecker R P, Scheen A J
Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Sart Tilman, University of Liège, B-4000 Liège, Belgium.
Diabetes Metab Res Rev. 2007 Jul;23(5):348-55. doi: 10.1002/dmrr.714.
The purification of animal insulin preparations and the use of human recombinant insulin have markedly reduced the incidence but not completely suppressed the occurrence of insulin allergy manifestations. Advances in technologies concerning the mode of delivery of insulin, i.e. continuous subcutaneous insulin infusion (CSII), and the use of insulin analogues, resulting from the alteration in the amino acid sequence of the native insulin molecule, may influence the immunogenicity and antigenicity of native insulin. Instead of increasing allergy reactions, CSII has been reported to represent a successful alternative treatment in diabetic patients presenting local or generalized allergy to insulin or other components (zinc, protamine) of conventional treatment. Most recent reports concern CSII-treated patients using short-acting insulin analogues (essentially insulin lispro), although the precise role of these insulin analogues remains unclear as allergy to them has also been described. Finally, data on antigenicity and immunogenicity of long-acting insulin analogues (glargine, detemir), which may mimic the basal insulin delivery with CSII, remain scarce at present.
动物胰岛素制剂的纯化以及人重组胰岛素的使用显著降低了胰岛素过敏表现的发生率，但并未完全抑制其发生。胰岛素给药方式相关技术的进步，即持续皮下胰岛素输注（CSII），以及由于天然胰岛素分子氨基酸序列改变而产生的胰岛素类似物的使用，可能会影响天然胰岛素的免疫原性和抗原性。据报道，CSII并非会增加过敏反应，而是为对胰岛素或传统治疗的其他成分（锌、鱼精蛋白）出现局部或全身性过敏的糖尿病患者提供了一种成功的替代治疗方法。最近的报告涉及使用短效胰岛素类似物（主要是赖脯胰岛素）进行CSII治疗的患者，尽管这些胰岛素类似物的确切作用仍不清楚，因为也有对它们过敏的描述。最后，关于长效胰岛素类似物（甘精胰岛素、地特胰岛素）的抗原性和免疫原性的数据目前仍然很少，长效胰岛素类似物可能模拟CSII的基础胰岛素给药。
