Successful Use of Omalizumab in an Inadequately Controlled Type 2 Diabetic Patient With Severe Insulin Allergy

A 62-year-old male patient with type 2 diabetes for 16 years developed a severe anaphylactic shock upon administration of intravenous, short-acting regular insulin. The patient’s medical history comprised allergic reactions to an unknown agent as a child as well as injection site reactions, urticaria, and dyspnea to subcutaneous NPH-insulin injections. The diagnostic work-up revealed a type 1 IgE-mediated insulin allergy by positive skin prick tests and elevated specific IgE levels against insulins of human, porcine, and bovine origin by ImmunoCAP-Assay. The insulins used were free of proinsulin. Skin prick tests with all solvents and additives of the insulin solutions were negative. Genetic sequencing of the patient’s insulin molecule revealed a normal insulin gene. Because of unsatisfactory glycemic control, specific desensitization (1) and maintenance therapy with insulin detemir was performed, but improvement of urticaria and …