Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Diabet Med. 2013 Aug;30(8):977-85. doi: 10.1111/dme.12194. Epub 2013 Apr 19.
Although allergic reactions to insulin are uncommon, they can be difficult to diagnose and management may be very difficult in subjects with Type 1 diabetes with severe allergy. Access to allergists and specialist diagnostic tests is limited and few diabetes specialists are familiar with desensitization as a means of treating allergy. People with diabetes may develop symptoms which mimic insulin allergy but are attributable to other conditions.
Here we describe three cases of insulin allergy. One patient presented with severe, albeit localized, urticarial reactions at injection sites. The most severe case was a woman with recent-onset Type 1 diabetes who presented with grade 2 anaphylaxis. The third patient presented with generalized urticaria and angioedema. Insulin allergy was confirmed in all three cases.
Assessment involved measurement of immunoglobulin and anti-insulin antibody levels. Skin testing was performed in two cases. Treatments included desensitization in one case, alternative insulin preparations, antihistamines and continuous subcutaneous insulin infusion. In all three cases of insulin allergy there has been successful resolution of symptoms.
The clinical assessment and investigation in cases of suspected insulin allergy is described, along with detailed algorithms for skin testing and desensitization. This case series demonstrates an approach to challenging cases of suspected insulin allergy which will be helpful for diabetes specialists.
尽管胰岛素过敏反应并不常见，但由于 1 型糖尿病患者过敏严重，其诊断可能较为困难，且治疗也可能极具挑战性。由于过敏专科医生和专科诊断测试的资源有限，且很少有糖尿病专家熟悉脱敏作为治疗过敏的方法，因此患者可能会出现类似于胰岛素过敏的症状，但其实是由其他疾病引起的。
本研究描述了三例胰岛素过敏病例。一例患者在注射部位出现严重（但局限）的荨麻疹反应。最严重的病例是一位近期诊断为 1 型糖尿病的女性，表现为 2 级过敏反应。第三位患者出现全身性荨麻疹和血管性水肿。在所有三例病例中均证实存在胰岛素过敏。
评估包括免疫球蛋白和抗胰岛素抗体水平的测量。在两例病例中进行了皮肤测试。治疗包括脱敏治疗、替代胰岛素制剂、抗组胺药和持续皮下胰岛素输注。在所有三例胰岛素过敏的病例中，症状均得到成功缓解。
本文描述了疑似胰岛素过敏病例的临床评估和调查，以及皮肤测试和脱敏的详细方案。本病例系列展示了一种有挑战性的疑似胰岛素过敏病例的处理方法，这将对糖尿病专家有所帮助。
