2006 Volume 49 Issue 3 Pages 215-220
We report a 58-year-old Japanese man who was admitted to our hospital in August 2003 with refractory scleroedema, peripheral eosinophilia and hydrothorax. He was 172 cm tall and weighed 72 kg. Peripheral eosinophils and IgE levels were elevated to 1,716/ml and 348 U/ml, respectively. Since he had a history of allergy to human isophen insulin, we changed insulin lispro to insulin aspart. This resulted in immediate fall in blood eosinophil count and marked improvement of scleroedema and hydrothorax. Drug-induced lymphocyte stimulation tests for human neutral insulin, insulin aspart and insulin lispro showed a positive result for insulin lispro. It was considered that peripheral eosinophilia, scleroedema and hydrothorax were caused by insulin lispro because (1) the symptoms improved rapidly and finally disappeared after changing insulin lispro to insulin aspart, and (2) the above symptoms and signs have never appeared again since treatment with insulin aspart in September 2003. We report here a rare case of severe insulin allergy with scleroedema, peripheral eosinophilia, and hydrothorax probably due to insulin lispro. The allergy to insulin analogue in our case is considered severe since only skin allergic reactions have been reported previously. While insulin analogues are beneficial for patients with insulin allergy, they are certainly not safe with respect to insulin allergy, and thus one must be aware of the potential insulin allergy in patients treated with insulin analogues.
