Case Report: Insulin hypersensitivity in youth with type 1 diabetes

Frontiers in Endocrinology

Endocrinology

Joel P. Brooks¹  Brynn E. Marks²  Thea L. Pfeifer³  Einas H. Alkhatib⁴  Jody B. Grundman⁴  Kyle P. McNerney⁵  Erin M. Janssen⁶  Anna M. Adamusiak⁷  Melena D. Bellin⁸  Kevin S. Buckley⁹  Maleewan Kitcharoensakkul^1,10  Brooke I. Polk^1,10 

[1] Department of Allergy and Immunology, Columbia University/New York-Presbyterian, New York, NY, United States;Department of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, PA, United States;Department of Pediatric Endocrinology, Atrium Health Levine Children’s Hospital, Concord, NC, United States;Department of Pediatric Endocrinology, Children’s National Hospital, Washington, DC, United States;Department of Pediatric Endocrinology, Washington University School of Medicine, St. Louis, MO, United States;Department of Rheumatology, Mott Children’s Hospital/University of Michigan, Ann Arbor, MI, United States;Department of Surgery, University of Minnesota, Minneapolis, MN, United States;Department of Surgery, University of Minnesota, Minneapolis, MN, United States;Department of Pediatrics, Division of Endocrinology, University of Minnesota, Minneapolis, MN, United States;Departments of Hematology/Oncology and Infectious Disease, Atrium Health Levine Children’s Hospital, Concord, NC, United States;Departments of Pediatric Allergy and Pulmonary Medicine, Washington University School of Medicine, St. Louis, MO, United States;

关键词: insulin hypersensitivity;    type 1 diabetes;    pediatrics;    pancreas transplant;    insulin allergy;   

DOI  :  10.3389/fendo.2023.1226231

 received in 2023-05-21, accepted in 2023-10-02,  发布年份 2023

来源: Frontiers

【 摘 要 】

ObjectiveImmediate type I, type III, and delayed type IV hypersensitivity reactions to insulin are rare, but potentially serious complications of exogenous insulin administration required for the treatment of type 1 diabetes (T1D).MethodsWe present four cases of insulin hypersensitivity reactions occurring in youth with T1D and a literature review of this topic.ResultsInsulin hypersensitivity reactions included types I, III, and IV with presentations ranging from localized urticaria, erythematous nodules, and eczematous plaques to anaphylaxis with respiratory distress. Reactions occurred in youth with newly diagnosed T1D and in those with long-standing T1D who were using both injection and insulin pump therapy. Multidisciplinary care involving pediatric endocrinology and allergy/immunology utilizing trials of many adjunct therapies yielded minimal improvement. Despite the use of various treatments, including antihistamines, topical therapies, immunosuppressant medications, desensitization trials, and intravenous immune globulin, cutaneous reactions, elevated hemoglobin A1c levels, and negative effects on quality of life remain persistent challenges. One patient became one of the youngest pancreas transplant recipients in the world at age 12 years due to uncontrollable symptoms and intolerable adverse effects of attempted therapies.ConclusionAlthough rare, insulin hypersensitivity reactions negatively affect glycemic control and quality of life. These cases demonstrate the varying severity and presentation of insulin hypersensitivity reactions along with the limited success of various treatment approaches. Given the life-sustaining nature of insulin therapy, further studies are needed to better understand the underlying pathophysiology of insulin hypersensitivity and to develop targeted treatment approaches.

【 授权许可】

Unknown   
Copyright © 2023 Alkhatib, Grundman, Adamusiak, Bellin, Brooks, Buckley, Janssen, Kitcharoensakkul, McNerney, Pfeifer, Polk and Marks