Latex Allergy in Diabetic Patients: A call for latex-free insulin tops

L atex allergies have recently become more commonly recognized. It was only a matter of time before patients with diabetes would overlap with those of latex allergies. We admitted a 13-year-old boy with new-onset diabetes who was born with extrophy of the bladder requiring many surgical corrections. In many children with spina bifida and in others undergoing multiple urological procedures, latex allergies are well-known. Our patient reported that his lips had become quite swollen on a recent trip to the dentist, presumably secondary to the dentist's latex gloves. He also reported a severe allergy to peanuts. Because of his presumed latex sensitivity, he was given his first few insulin injections in a latex-free fashion using a glass syringe and Humulin insulin withdrawn with the top removed. No local reaction was reported. His first local allergic reaction consisted of itching and a O.5-cm erythematous flare occurring within minutes of an injection of Lilly Iletinll pure pork insulin drawn through the top using a Becton Dickinson (BD) syringe. Subsequently, the same response occurred with Humulin and a BD insulin syringe. This eliminated the possibility of a pork allergy. We developed a systematic approach to limit latex contact during insulin administration. Novo Nordisk informed us that their tops contained latex. Becton Dickinson stated that their insulin syringes contained latex but their TB syringes did not. Our patient had a local reaction to Humulin insulin withdrawn through the top with the BD TB syringe. In August 1995, Towse et al. (1) described a laboratory technician with a 7-year history of diabetes who developed a local allergic reaction at the site of insulin injection. Further investigation ruled out insulin allergy and demonstrated elevated latex-specific IgE antibodies. The patient was able to use Terumo syringes (latex free) and Lilly insulin with no allergic response. With the patient's and parents' consent, we divided the morning insulin into two shots. After using a Terumo syringe (latex free) with 5 U of Humulin R drawn through the Lilly top, the patient again reacted. After using the Terumo syringe with 10 U of Humulin N drawn from a topless vial, he had a small amount of erythema with no wheal or itching. That evening, the dose was again divided and no alcohol was used to prepare the site. One shot was given using a Terumo syringe with Humulin drawn through the top. The second shot differed because the needle was wiped with 70% isopropyl alcohol after removal from the top and just before injection. The second site had much less erythema and itching.