Background: Insulin allergy is a rare condition that poses a great challenge particularly in diabetics who are insulin dependent. If feasible, switching to different antidiabetic agents or immunotherapy is the common approach, but the universal consensus on insulin allergy management in diabetics is lacking. Here we present a clinical case of a diabetic with allergy to insulin successfully managed with a combination of degludec and liraglutide.

Case Report: A 51-year-old female patient with type 2 diabetes presented with poorly controlled glycaemia (HbA1c 8.6%) on dual oral antidiabetic treatment, metformin and sitagliptin. Due to pronounced fasting hyperglycaemia the NPH insulin before bedtime, but soon began to complain of urticariform skin lesions on insulin injection sites. Despite the adverse reaction the patient continued to up-titrate the insulin, but the effect on glycaemia was negligible. After switching to different NPH insulin manufacturer, to no avail, the insulin analogs detemir and glargin were introduced, respectively, but produced same adverse reaction. The elevated levels of specific IgE immunoglobulins to human insulin (2.58 klU/L) confirmed the allergy to insulin. Conversely, the novel insulin analog degludec yielded no skin reaction. The patient was then titrated to a fixed combination of degludec and GLP-1 receptor agonist liraglutide which provoked no allergic reaction and promptly improved glycemic control (HbA1c 6.7% 4 months after treatment commencement). Understandably, treatment with sitagliptin was stopped, whereas metformin was continued.

Conclusion: The patient with confirmed IgE mediated allergy to insulin exhibited allergic reaction to all types of basal insulin but degludec. It can be assumed that the unique structure of degludec has different epitopes than other insulin analogues and therefore provides safe and combined with GLP-1 receptor agonist effective therapeutic approach to patient with allergy to insulin.


N. Gregoric: Other Relationship; Self; Lilly Diabetes, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S. M. Ravnik Oblak: None. P. Kopac: Speaker's Bureau; Self; AstraZeneca, Novartis Pharmaceuticals Corporation, Shire.

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