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A case report and systematic literature review: insulin-induced type III hypersensitivity reaction

Authors :
Rebecca R. Meredith
Pooja Patel
Polly Huang
Chinelo Pamela Onyenekwu
Herleen Rai
Jody Tversky
Santiago Alvarez-Arango
Source :
Frontiers in Allergy, Vol 5 (2024)
Publication Year :
2024
Publisher :
Frontiers Media S.A., 2024.

Abstract

Insulin-induced type III hypersensitivity reactions (HSRs) are exceedingly rare and pose complex diagnostic and management challenges. We describe a case of a 43-year-old woman with type 1 diabetes mellitus (DM), severe insulin resistance, and subcutaneous nodules at injection sites, accompanied by elevated anti-insulin IgG autoantibodies. Treatment involved therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIg) as bridge therapy, followed by long-term immunosuppression, which reduced autoantibody levels and improved insulin tolerance. Given the limited treatment guidelines, we conducted a comprehensive literature review, identifying 16 similar cases. Most patients were females with a median age of 36.5 years; 63% had type 1 DM, and 44% had concurrent insulin resistance (56% with elevated autoantibodies). Treatment approaches varied, with glucocorticoids used in 67% of cases. Patients with type 1 DM were less responsive to steroids than those with type 2 DM, and had a more severe course. Of those patients with severe disease necessitating immunosuppression, 66% had poor responses or experienced relapses. The underlying mechanism of insulin-induced type III HSRs remains poorly understood. Immunosuppressive therapy reduces anti-insulin IgG autoantibodies, leading to short-term clinical improvement and improved insulin resistance, emphasizing their crucial role in the condition. However, the long-term efficacy of immunosuppression remains uncertain and necessitates continuous evaluation and further research.

Details

Language :
English
ISSN :
26736101
Volume :
5
Database :
Directory of Open Access Journals
Journal :
Frontiers in Allergy
Publication Type :
Academic Journal
Accession number :
edsdoj.238616cf291438a8befee20a2b52141
Document Type :
article
Full Text :
https://doi.org/10.3389/falgy.2024.1357901