Köllner A, Senff H, Engelmann L, Kalveram K J, Velcovsky H G, Haneke E
Klinik für Dermatologie und Allergologie, St.-Barbara-Hospital Duisburg.
Dtsch Med Wochenschr. 1991 Aug 16;116(33):1234-8. doi: 10.1055/s-2008-1063741.
A 63-year-old female, with type II diabetes mellitus, diagnosed in 1967, was started on combination therapy with sulphonylureas and human depot insulin in May 1989, because of inadequate blood sugar control with sulphonylureas alone. Within 3 months she began to develop nodular skin reactions at the site of injection, 12-24 hours after insulin injections. Intradermal testing demonstrated delayed (Gell and Coombs type IV) hypersensitivity to protamine. No specific IgE or IgG antibodies were demonstrable. She was changed to protamine-free human delayed action insulin. After an initial reaction-free period, red urticarial lesions, attributable to immediate (Gell and Coombs type I) hypersensitivity to human insulin, appeared at the injection sites. There were no other complications with continued insulin therapy, and after about 6 weeks no further local reactions were detectable. When an allergic reaction to an insulin preparation is suspected, careful immunological investigation should be performed, to ensure adequate treatment without risk to the patient.
一名63岁女性，1967年被诊断为II型糖尿病，由于仅使用磺脲类药物血糖控制不佳，于1989年5月开始接受磺脲类药物和人长效胰岛素联合治疗。在3个月内，她开始在胰岛素注射后12 - 24小时在注射部位出现结节性皮肤反应。皮内试验显示对鱼精蛋白有迟发性（盖尔和库姆斯IV型）超敏反应。未检测到特异性IgE或IgG抗体。她改用了不含鱼精蛋白的人延迟作用胰岛素。经过最初的无反应期后，注射部位出现了归因于对人胰岛素速发型（盖尔和库姆斯I型）超敏反应的红色荨麻疹病变。继续胰岛素治疗没有出现其他并发症，大约6周后未检测到进一步的局部反应。当怀疑对胰岛素制剂过敏时，应进行仔细的免疫学检查，以确保在不危及患者的情况下进行充分治疗。
