Haastrup Maija Bruun, Henriksen Jan Erik, Mortz Charlotte Gotthard, Bindslev-Jensen Carsten
1Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
2Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.
Clin Transl Allergy. 2018 Sep 25;8:35. doi: 10.1186/s13601-018-0223-x. eCollection 2018.
Type I insulin allergy can be a challenging condition, and there is no international consensus on how to establish the diagnosis. Measurement of specific IgE and skin testing have been cornerstones in the diagnostic work-up. However, these tests have limitations, mainly lack of correlation between test results and clinical findings. At the Allergy Centre, Odense University Hospital, patients with suspected insulin allergy have been evaluated since 2003. The aim of this study was to establish a systematic approach to diagnose and treat patients with insulin allergy.
The study was conducted retrospectively by retrieving data from the Allergy Centre database on patients with suspected insulin allergy evaluated from 2003 to 2017. The examination comprised a comprehensive medical history, specific IgE against insulin and intracutaneous tests (ICT) with different insulins.
A total of 144 patients were examined on suspicion of insulin allergy of which 110 had negative specific IgE in serum. Of the remaining 34 patients, 33 had ICT performed; 2 had negative ICTs, while 31 had one or more positive ICT. All 34 patients had mild symptoms, and 4 could obtain symptom relief with antihistamines or local steroids, 9 could be managed with oral antidiabetics, and 7 were switched to other insulins. The final 14 patients were offered an insulin pump because of reactions to many different insulins, many positive ICTs, unmanageable diabetes, young age and compliance, or convenience.
Insulin allergy can be managed by a systematic approach, and symptom relief is obtainable in most patients.
I型胰岛素过敏可能是一种具有挑战性的病症，关于如何确立诊断尚无国际共识。特异性IgE检测和皮肤试验一直是诊断检查的基石。然而，这些检测存在局限性，主要是检测结果与临床发现之间缺乏相关性。自2003年以来，欧登塞大学医院过敏中心一直在对疑似胰岛素过敏的患者进行评估。本研究的目的是建立一种系统的方法来诊断和治疗胰岛素过敏患者。
本研究通过检索过敏中心数据库中2003年至2017年接受评估的疑似胰岛素过敏患者的数据进行回顾性研究。检查包括全面的病史、针对胰岛素的特异性IgE以及使用不同胰岛素进行的皮内试验（ICT）。
共有144例患者因疑似胰岛素过敏接受检查，其中110例血清特异性IgE为阴性。在其余34例患者中，33例进行了ICT；2例ICT结果为阴性，而31例有一项或多项ICT结果为阳性。所有34例患者症状均较轻，4例可通过抗组胺药或局部类固醇缓解症状，9例可通过口服降糖药治疗，7例改用其他胰岛素。最后14例患者因对多种不同胰岛素有反应、多项ICT结果为阳性、糖尿病难以控制、年龄小且依从性好或出于便利性考虑而接受胰岛素泵治疗。
胰岛素过敏可通过系统的方法进行管理，大多数患者的症状可得到缓解。
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