胰岛素过敏患者脱敏治疗文献分析

Literature analysis on desensitization treatment for patients with insulin allergy

目的通过调查分析文献报道中胰岛素脱敏的治疗方法,为临床治疗胰岛素过敏反应的处理提供参考。方法检索PubMed、中国知网、维普、万方数据库中涉及到胰岛素过敏治疗的病例报道,检索时间为2010年1月至2020年12月,分析纳入文献中的患者基本信息、疾病类型、过敏反应、脱敏治疗等相关内容。结果胰岛素过敏临床表现多为注射部位出现风团、红晕、瘙痒等局部皮肤反应,少数病例出现荨麻疹、胸闷、过敏性休克等全身反应。临床上常见的胰岛素脱敏治疗方法有采用多次皮下注射胰岛素以达到耐受效果的传统胰岛素脱敏治疗和持续皮下胰岛素输注(CSⅡ)脱敏治疗,有部分患者在传统的胰岛素脱敏治疗失败后,会选择CSⅡ进行脱敏治疗,最终均脱敏成功。传统的胰岛素脱敏治疗初始剂量多为0.001 U、最终剂量多为4 U时,患者已出现耐受。CSⅡ脱敏治疗的初始基础速率多为0.05 U/h,最终基础速率多为0.8 U/h。部分患者在脱敏后期三餐会追加胰岛素剂量。胰岛素类似物过敏反应相对较轻,常作为脱敏胰岛素进行治疗。结论胰岛素过敏反应依然存在,但胰岛素脱敏治疗仍是临床上重要的治疗手段。

Objective This study was designed to provide reference for clinical treatment of insulin allergic reaction by investigating and analyzing the treatment methods of insulin desensitization in the literature. Methods PubMed,CNKI,VIP,and Wanfang database were searched for case reports related to insulin allergy treatment from January 2010 to December 2020. The analysis was conducted on the basic information of patients,disease types,allergic reactions,and desensitization treatments included in the literature and other related content. Results The clinical manifestations of insulin allergy are mostly local skin reactions such as urticaria,flushing,and itching at the injection site,and systemic reactions such as urticaria,chest tightness,and anaphylactic shock were observed in a few cases. Common clinical methods of insulin desensitization include traditional insulin desensitization,which uses multiple subcutaneous iniections of insulin to ahieve tolerance,and continuous subcutaneous insulin infusion(CSⅡ)desensitization. Some patients will choose CSⅡ after the traditional insulin desensitization treatment failed. After desensitization treatment,all desensitization was successful. The initial dose of traditional insulin desensitization treatment is mostly 0. 001 U,and the patient has already tolerated it when the final dose is mostly 4 U. The initial basal rate of CSⅡ desensitization treatment is mostly 0. 05 U/h,and the final basal rate is mostly 0. 8 U/h. In the later stage of desensitization,some patients will add insulin doses to the three meals. Insulin analogues have relatively mild allergic reactions and are often treated as desensitized insulin. Conclusion Insulin hypersensitivity still exists,and insulin desensitization therapy is still an important clinical treatment.