Department of Dermatology, Leicester Royal infirmary, University Hospitals of Leicester, Infirmary Square, Leicester LE1 5WW, UK.
Clin Dermatol. 2011 May-Jun;29(3):300-5. doi: 10.1016/j.clindermatol.2010.11.009.
Insulin reactions occur rarely but are of tremendous clinical importance. The first was reported in 1922 as a callus reaction at the injection site of insufficiently purified bovine insulin. Porcine insulin was subsequently found to be less allergenic than bovine insulin. Increasingly pure insulins have decreased the risk of adverse reactions, and the production of recombinant insulin with the same amino sequence as human insulin saw a large decrease in adverse reactions. Currently, the prevalence of allergic reactions to insulin products appears to be approximately 2%, and less than one-third of these events have been considered related to the insulin itself. Other reactions occur due to the preservatives added to insulin, including zinc, protamine, and meta-cresol. Allergic reactions can be type I or immunoglobulin E-mediated, type III or Arthus, and type IV or delayed-type hypersensitivity reactions. Type I reactions are the most common and can, rarely, cause anaphylaxis. In contrast, type IV reactions can occur after a delay of several days. Investigations include skin prick testing, patch testing, intradermal testing, and occasionally, skin biopsy.
胰岛素反应虽然罕见，但具有重要的临床意义。首例报告于 1922 年，在注射部位出现牛胰岛素纯度不足引起的硬结反应。随后发现猪胰岛素比牛胰岛素的过敏原性更低。越来越纯净的胰岛素降低了不良反应的风险，而与人类胰岛素具有相同氨基酸序列的重组胰岛素的使用则大大降低了不良反应的发生。目前，胰岛素产品过敏反应的发生率约为 2%，其中不到三分之一的事件被认为与胰岛素本身有关。其他反应是由于胰岛素中添加的防腐剂引起的，包括锌、鱼精蛋白和间甲酚。过敏反应可以是 I 型或免疫球蛋白 E 介导的、III 型或 Arthus 型，或 IV 型或迟发型超敏反应。I 型反应最为常见，极少数情况下可引起过敏反应。相比之下，IV 型反应可能在数天后出现。检查包括皮肤点刺试验、斑贴试验、皮内试验，偶尔还包括皮肤活检。
