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      Faulty Injection Technique: A Preventable But Often Overlooked Factor in Insulin Allergy

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          Abstract

          Insulin hypersensitivity—a rare occurrence with currently available insulin preparations—may have varied manifestations, ranging from a local injection site allergy to severe generalized anaphylactic reactions. While various additives included in commercial insulin preparations and insulin peptides themselves remain the primary allergens responsible, faulty injection technique may at times potentiate the development of insulin allergy. Management of insulin allergy is complex, potentially dangerous at times, and can be challenging for the treating physician. We report a case of insulin allergy due to intradermal insulin injections which was cured by adopting a proper injection technique.

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          A practical, clinical approach to the assessment and management of suspected insulin allergy.

          Although allergic reactions to insulin are uncommon, they can be difficult to diagnose and management may be very difficult in subjects with Type 1 diabetes with severe allergy. Access to allergists and specialist diagnostic tests is limited and few diabetes specialists are familiar with desensitization as a means of treating allergy. People with diabetes may develop symptoms which mimic insulin allergy but are attributable to other conditions.
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            Epidermal Langerhans cell migration and sensitisation to chemical allergens.

            Epidermal Langerhans cells (LC) form part of the wider family of dendritic cells (DC; professional antigen-processing and antigen-presenting cells). LC are considered to serve in the skin as sentinels of the adaptive immune system, surveying the local environment and transporting foreign antigen for presentation to responsive T lymphocytes in regional lymph nodes. As such, LC play pivotal roles in the initiation of cutaneous immune responses, including immune responses to chemical allergens encountered at skin surfaces. Here we explore two aspects of LC function in the context of sensitisation to chemical allergens. The first is consideration of the cytokine and chemokine signals that regulate and counter-regulate the mobilisation and migration of LC from the epidermis to skin-draining lymph nodes following topical sensitisation. The second is examination of the ways in which LC may influence the polarity of induced T lymphocytes, and thereby the quality of immune responses.
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              Can a faulty injection technique lead to a localized insulin allergy?

              Insulin allergy is a rare occurrence which can present diagnostic and management dilemmas for the clinician. Three types of reaction have been reported: Localized, generalized (systemic), and insulin resistance. All need to be considered in cases of suspected insulin allergy. Adverse reactions to insulin have significantly decreased since the introduction of recombinant human insulin preparations. However, cases with insulin allergy continues to present in the clinic. Symptoms range from local injection site reactions to severe generalized anaphylactic reactions. The case study presented here describes an event of suspected insulin allergy arising out of faulty insulin injection technique.
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                Author and article information

                Contributors
                docparthapc@yahoo.co.in
                Journal
                Diabetes Ther
                Diabetes Ther
                Diabetes Therapy
                Springer Healthcare (Cheshire )
                1869-6953
                1869-6961
                3 February 2016
                3 February 2016
                March 2016
                : 7
                : 1
                : 163-167
                Affiliations
                Department of Medicine, Midnapore Medical College and Hospital, Midnapore, Paschim Medinipur, 721101 West Bengal India
                Article
                151
                10.1007/s13300-016-0151-5
                4801812
                26843018
                d9b0b4dd-36e9-4ecf-b484-1b3885b5ee07
                © The Author(s) 2016
                History
                : 9 December 2015
                Categories
                Case Report
                Custom metadata
                © Springer Healthcare 2016

                Endocrinology & Diabetes
                faulty injection technique,insulin allergy,insulin desensitization therapy

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