Immediate-type allergy with marked eosinophilia against human insulin associated in type 2 diabetic patient

We describe a, type 2 diabetic patient who showed immediate-type allergy ag ainst human insulin associated with marked eosinophilia at initial insulin therapy. Three months after initiation of insulin therapy, he noticed itchy skin wheals at the site of the insulin injection. Laboratory data at that time showed marked eosinophilia (2512/mm(3)) and progression of renal dysfu nction. Skin test with semisynthetic human insulin and protamine sulfate re sulted in local immediate skin reactions such as itchy erythema and wheals. Histopathology of the biopsy specimen from skin showed perivascular infilt ration of lymphocytes and numerous eosinophils in the dermis and subcutaneo us fat. Although the titer of total IgE antibody was within normal range, t hat of insulin-specific IgE antibody was high. Insulin administration was d iscontinued to preserve his insulin secretion, and stable control of his hy perglycemia was obtained by initiating nateglinide treatment (360 mg/day). His itchy skin lesions disappeared within two weeks after cessation of the insulin therapy and both eosinophilia and renal dysfunction gradually impro ved. Although the widespread use of human insulin in diabetic patients has greatly reduced the incidence of insulin allergy, the possibility of human insulin allergy should be kept in mind when initiating such therapy.