胰岛素过敏的诊断与处理对策

Diagnosis and Management of Insulin Allergy

胰岛素过敏的诊治在临床上相当棘手,并且随糖尿病发病率的不断增加而日渐成为一个不可忽视的问题。对疑似胰岛素过敏的患者要依据药物过敏诊断原则进行详细的病史询问、结合皮肤试验、血清相关特异性IgE测定和撤药后反应进行准确的诊断和鉴别。对于诊断明确的难治性患者主要采用脱敏疗法进行治疗。胰岛素类似物的发展和持续皮下胰岛素输注技术的不断完善使脱敏治疗的成功率逐渐提高,操作日趋简便。极少数患者脱敏治疗难以奏效时,需要二线、三线治疗。

Diagnosis and management of insulin allergy is a big challenge and an indispensable problem in clinical practice, which becomes more and more severe due to the increasing morbidity of diabetes mellitus. According to the diagnosis criteria of drug allergy, the diagnosis and differential diagnosis of insulin allergy should be based on carefully inquiring medical history, skin test, serum specific insulin IgE detection, and observation of the reaction after ceasing insulin therapy. Desensitization is the main therapeutic method for the refractory diabetes mellitus patients whose insulin allergy diagnosis can be established. The success rate of desensitization increases and operation becomes more convenient due to the usage of insulin analogues and the improvement of continuous subcutaneous insulin infusion. The second and third line treatment will be necessary for a few patients who failed in desensitization therapy.