A case report and systematic literature review: insulin-induced type III hypersensitivity reaction
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...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Allergy |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/falgy.2024.1357901/full |
| _version_ | 1797294911162155008 |
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| author | Rebecca R. Meredith Pooja Patel Polly Huang Chinelo Pamela Onyenekwu Herleen Rai Jody Tversky Santiago Alvarez-Arango Santiago Alvarez-Arango |
| author_facet | Rebecca R. Meredith Pooja Patel Polly Huang Chinelo Pamela Onyenekwu Herleen Rai Jody Tversky Santiago Alvarez-Arango Santiago Alvarez-Arango |
| author_sort | Rebecca R. Meredith |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-07T21:38:58Z |
| format | Article |
| id | doaj.art-e238616cf291438a8befee20a2b52141 |
| institution | Directory Open Access Journal |
| issn | 2673-6101 |
| language | English |
| last_indexed | 2024-03-07T21:38:58Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Allergy |
| spelling | doaj.art-e238616cf291438a8befee20a2b521412024-02-26T10:43:47ZengFrontiers Media S.A.Frontiers in Allergy2673-61012024-02-01510.3389/falgy.2024.13579011357901A case report and systematic literature review: insulin-induced type III hypersensitivity reactionRebecca R. Meredith0Pooja Patel1Polly Huang2Chinelo Pamela Onyenekwu3Herleen Rai4Jody Tversky5Santiago Alvarez-Arango6Santiago Alvarez-Arango7Division of Hospital Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesDivision of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesDivision of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesDivision of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesDivision of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesDivision of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesDivision of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesDivision of Clinical Pharmacology, Department of Medicine and Pharmacology and Molecular Science, Johns Hopkins University School of Medicine, Baltimore, MD, United StatesInsulin-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.https://www.frontiersin.org/articles/10.3389/falgy.2024.1357901/fullinsulin hypersensitivityimmune complex-mediated hypersensitivityinsulin allergyIgG-mediated hypersensitivity reactionstype III hypersensitivity reactioninsulin resistance |
| spellingShingle | Rebecca R. Meredith Pooja Patel Polly Huang Chinelo Pamela Onyenekwu Herleen Rai Jody Tversky Santiago Alvarez-Arango Santiago Alvarez-Arango A case report and systematic literature review: insulin-induced type III hypersensitivity reaction Frontiers in Allergy insulin hypersensitivity immune complex-mediated hypersensitivity insulin allergy IgG-mediated hypersensitivity reactions type III hypersensitivity reaction insulin resistance |
| title | A case report and systematic literature review: insulin-induced type III hypersensitivity reaction |
| title_full | A case report and systematic literature review: insulin-induced type III hypersensitivity reaction |
| title_fullStr | A case report and systematic literature review: insulin-induced type III hypersensitivity reaction |
| title_full_unstemmed | A case report and systematic literature review: insulin-induced type III hypersensitivity reaction |
| title_short | A case report and systematic literature review: insulin-induced type III hypersensitivity reaction |
| title_sort | a case report and systematic literature review insulin induced type iii hypersensitivity reaction |
| topic | insulin hypersensitivity immune complex-mediated hypersensitivity insulin allergy IgG-mediated hypersensitivity reactions type III hypersensitivity reaction insulin resistance |
| url | https://www.frontiersin.org/articles/10.3389/falgy.2024.1357901/full |
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