Debora Nakatani Lopes, Wilson Carlos Tartuce Aun, Joao Ferreira de Mello and Adriana Teixeira Rodrigues
Introduction: Insulin has been used for the treatment of diabetes mellitus (DM) since 1920. At first, the animal insulins were available for human use having frequent allergic reactions due to the differences in amino acid sequences with human insulin. Currently, with the use of human insulin, the prevalence of these reactions is around 2% and less than a third of these events were associated with insulin itself. These cases are associated with their additives or preservatives. The most commonly hypersensitivity reaction found is type I. In these cases, the use of a rapid-acting insulin is the best therapeutic alternative. We report the case of a multi-sensibilizated patient to insulin presenting tolerance to the ultralong-acting: Degludec insulin. Case report: Female patient, 74, referring use of NPH (Neutral Protamine Hagedorn) human insulin for 5 years, with papule at the site of application of the insulin minutes after application. She visited the Allergy and Immunology Clinic of the State Public Servant Hospital of Sao Paulo referring anaphylaxis few minutes after application of human insulin (NPH). Also reported extensive local reaction due the use of detemir, and local reaction to lispro insulin. We conducted immediate skin test reading with insulins: Regular, Lispro, NPH, Detemir and Degludeca at a concentration of 1:1; addition of the additive (Protamine 10 mg/ml) and latex. Presented positive test for all insulins, except Degludeca and presented negative test for protamine and latex. Conclusion: we found no common additive to all insulins, which is not present in degludeca insulin (Tresiba ®), enhancing insulin allergy hypothesis. Patient currently tolerates the use of long-acting insulin (Degludeca) and has adequate control of their blood sugar. In this case the patient had no insulin reaction prolonged action and this may be a new therapeutic option to be tested in patients with allergic reactions to insulin.