Allergic Reaction to NPH Insulin?

[pagandeva2000, LPN]

This was a first for me. I had a new patient coming to our clinic, and while reviewing his chart, I saw that he has allergies to Penicillin V and NPH insulin, and then, saw a prescription for Lantus insulin...to take 20 units each evening. Patient does not recall...all he said was that he was told that it "did not agree with him" but seemed unable, with all of the MANY questions I asked what the actual reaction was. I searched my drug book and did not see anything documented on insulin side effects. I went to the doctor (a resident) and asked if this was safe for the patient to take Lantus at home, he says 'yes', went to an attending that agreed. I then reviewed basic allergic reactions to the patient, documented the fact that in researching the drug, informing the resident and attending (by names), that they stated it was safe for patient to self administer and sent him home.

Have any of you heard of this? What reactions can possibly happen? This was a human insulin that was documented. I didn't have a resource to even begin asking, but went into the possibility of rashes, respiratory distress or itching with the patient for starters. Did I do the right thing? Is there any information I can find on line that speaks of reactions to insulin? Thanks!

[santhony44, MSN, RN, NP]

Interesting. My little prescribing guide makes mention of "allergy" with no details.

I suspect that the patient may have reacted to whatever in the preparation prevents it from all being absorbed immediately. It could be anything from a local reaction to a systemic one, just as with any other drug reaction.

Years ago, we used insulin prepared from animal pancreas, and I remember having patients allergic to those, but I haven't run across that in a long time.

I would guess that it's pretty unlikely he'll have a problem with the Lantus. It sounds like you did a thorough teaching and documentation job, too.

[pagandeva2000, LPN]

My nursing career is really short, so, it would be unfair for me to say that this almost never exists, but I never heard of it in school (heard of problems with animal-specifically allergies to pork insulin). It made me think across the board and wonder if the Lantus was safe for him. Thanks, santhony44!

[RedCell]

This was a first for me. I had a new patient coming to our clinic, and while reviewing his chart, I saw that he has allergies to Penicillin V and NPH insulin, and then, saw a prescription for Lantus insulin...to take 20 units each evening. Patient does not recall...all he said was that he was told that it "did not agree with him" but seemed unable, with all of the MANY questions I asked what the actual reaction was. I searched my drug book and did not see anything documented on insulin side effects. I went to the doctor (a resident) and asked if this was safe for the patient to take Lantus at home, he says 'yes', went to an attending that agreed. I then reviewed basic allergic reactions to the patient, documented the fact that in researching the drug, informing the resident and attending (by names), that they stated it was safe for patient to self administer and sent him home.

Have any of you heard of this? What reactions can possibly happen? This was a human insulin that was documented. I didn't have a resource to even begin asking, but went into the possibility of rashes, respiratory distress or itching with the patient for starters. Did I do the right thing? Is there any information I can find on line that speaks of reactions to insulin? Thanks!

Allergies to NPH are usually IgE hypersensitivies. NPH stands for neutral protamine hagedorn. Protamine is basically a polycationic alkaline protein found in salmon sperm. It binds with the insulin to give NPH its intermediate duration of action. Sometimes the unlucky, with enough exposure will develop an allergy. People with fish allergies should be considered at risk for unpleasant reactions to NPH. Also, giving protamine to reverse heparin in a dude with an NPH allergy is not a great idea either. Buku anaphylaxis with this combo.

Giving Lantus, humalog/novolog, humulin/novolin is fine.

[rjflyn, ASN, RN]

COuld quite possible be allergic to a preservative in the preparation as well. Redcell's explanation seems the most logical baring that though.

My favorite is people who are allergic to heparin or refuse pork products , that makes tx interesting to say the least.

RJ