Allergic reactions in patients with type 1 diabetes mellitus (literature review and own research)

Abstract

In recent years the drug allergy incidence is on the rise in developed countries. Today, up to 40 % of patients are suffering from pathological reactions caused by drug intolerance. The most problematic ones (taken into account the lack of preventive measures) are those caused by different types of insulin. The allergen can be not only insulin but also protein (protamine) and non-protein (zinc) impurities that are part of the drugs. In most cases, allergies are caused by insulin itself or its polymers, as evidenced by local allergic reactions to human insulin and systemic reactions to highly purified insulins. The literature review considers the features of real and pseudo allergic reactions, a combination of allergic and pseudoallergic mechanisms. Given that the clinical manifestations of real and pseudo allergic reactions are the same, and the possibilities of diagnosis are different, approaches to their treatment are also different, which makes it necessary to conduct a differential diagnosis between them. It is very difficult to make a differential diagnosis based only on the assessment of the clinical picture of the disease, so approaches to diagnosis should be comprehensive. Of particular importance in the differential diagnosis between real and pseudo allergic reactions are history and specific tests with causative allergens. This article presents an overview of features of real and false allergic reactions, results of retrospective patients’ histories analysis (170 diabetic patients with positive allergic anamnesis), as well as the results of the analysis identifying the effectiveness of anti-mediator drugs — quifenadine and sequifenadine. It has been identified that the frequency of allergic reactions in patients with insulin-dependent diabetes is 2.9 times higher than that in a healthy population and is directly linked with the duration and severity of diabetes mellitus. Drugs and food were found to be the most significant allergens in tested patients. The following are the measures to prevent allergic reactions in patients with diabetes mellitus: educating patients about recommended food diet, eliminating sensitizing and provoking factors, taking drugs that have proven effectiveness for a patient and preventing polypharmacy. Quinuclidine derivatives demonstrate great effectiveness when treating allergic dermatosis in diabetic patients, especially those that are hypersensitive to insulin.

Keywords

• diabetes mellitus
• insulin therapy
• allergic response
• review