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Sola-Gazagnes A, Pecquet C, Berré S, Achenbach P, Pierson LA, Virmoux-Buisson I, M'Bemba J, Elgrably F, Moguelet P, Boitard C, Caillat-Zucman S, Laanani M, Coste J, Larger E, Mallone R. Insulin allergy: a diagnostic and therapeutic strategy based on a retrospective cohort and a case-control study. Diabetologia 2022; 65:1278-1290. [PMID: 35505238 DOI: 10.1007/s00125-022-05710-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS Insulin allergy is a rare but significant clinical challenge. We aimed to develop a management workflow by (1) validating clinical criteria to guide diagnosis, based on a retrospective cohort, and (2) assessing the diagnostic performance of confirmatory tests, based on a case-control study. METHODS In the retrospective cohort, patients with suspected insulin allergy were classified into three likelihood categories according to the presence of all (likely insulin allergy; 26/52, 50%), some (possible insulin allergy; 9/52, 17%) or none (unlikely insulin allergy; 17/52, 33%) of four clinical criteria: (1) recurrent local or systemic immediate or delayed hypersensitivity reactions; (2) reactions elicited by each injection; (3) reactions centred on the injection sites; and (4) reactions observed by the investigator (i.e. in response to an insulin challenge test). All underwent intradermal reaction (IDR) tests. A subsequent case-control study assessed the diagnostic performance of IDR, skin prick and serum anti-insulin IgE tests in ten clinically diagnosed insulin allergy patients, 24 insulin-treated non-allergic patients and 21 insulin-naive patients. RESULTS In the retrospective cohort, an IDR test validated the clinical diagnosis in 24/26 (92%), 3/9 (33%) and 0/14 (0%) likely, possible and unlikely insulin allergy patients, respectively. In the case-control study, an IDR test was 80% sensitive and 100% specific and identified the index insulin(s). The skin prick and IgE tests had a marginal diagnostic value. Patients with IDR-confirmed insulin allergy were treated using a stepwise strategy. CONCLUSIONS/INTERPRETATION Subject to validation, clinical likelihood criteria can effectively guide diabetologists towards an insulin allergy diagnosis before undertaking allergology tests. An IDR test shows the best diagnostic performance. A progressive management strategy can subsequently be implemented. Continuous subcutaneous insulin infusion is ultimately required in most patients. CLINICALTRIALS gov: NCT01407640.
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Affiliation(s)
- Agnès Sola-Gazagnes
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université Paris Cité, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France.
| | - Catherine Pecquet
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service d'Allergologie Dermatologie, Paris, France
| | - Stefano Berré
- Université Paris Cité, CNRS, Inserm, Institut Cochin, Paris, France
| | - Peter Achenbach
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Diabetes Research, Munich-Neuherberg, Germany
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Forschergruppe Diabetes, Munich, Germany
| | - Laure-Anne Pierson
- Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu, Service de Pharmacie, Pharmacologie, Toxicologie, Paris, France
| | - Isabelle Virmoux-Buisson
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université Paris Cité, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France
| | - Jocelyne M'Bemba
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université Paris Cité, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France
| | - Fabienne Elgrably
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université Paris Cité, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France
| | - Philippe Moguelet
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service d'Anatomo-Pathologie, Sorbonne Université, Faculté de Médecine, Paris, France
| | - Christian Boitard
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université Paris Cité, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France
- Université Paris Cité, CNRS, Inserm, Institut Cochin, Paris, France
| | - Sophie Caillat-Zucman
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Laboratoire d'Immunologie, Paris, France
- Université Paris Cité, Inserm UMR976, Institut de Recherche Saint-Louis, Paris, France
| | - Moussa Laanani
- Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Biostatistics and Epidemiology Unit, Paris, France
| | - Joel Coste
- Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Biostatistics and Epidemiology Unit, Paris, France
| | - Etienne Larger
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université Paris Cité, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France
- Université Paris Cité, CNRS, Inserm, Institut Cochin, Paris, France
| | - Roberto Mallone
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université Paris Cité, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France
- Université Paris Cité, CNRS, Inserm, Institut Cochin, Paris, France
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