Evidence map›Paper›PMID 35505238›Full record

Trial reportDiabetologia2022

Insulin allergy: a diagnostic and therapeutic strategy based on a retrospective cohort and a case-control study.

Agnès Sola-Gazagnes, Catherine Pecquet, Stefano Berré, Peter Achenbach, Laure-Anne Pierson, Isabelle Virmoux-Buisson, Jocelyne M'Bemba, Fabienne Elgrably, Philippe Moguelet, Christian Boitard and 5 more

Registry-linked trialOpen access · bronzeAbstract readClinical Trial
PubMed Publisher
In one paragraph

Trial report in Diabetologia, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01407640 (Diagnosis and Physiopathology of Insulin Allergy), which is not on this map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
2.1field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01407640 nacompletednot on this map

Diagnosis and Physiopathology of Insulin Allergy (IA)

TypeinterventionalSponsorAssistance Publique - Hôpitaux de ParisRan2012 to 2016Enrolled55ConditionsDiabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Hypersensitivity, Immediate HypersensitivityArmsAllergy tests
3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 10 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
  4. Review
  5. Review
  6. Article
  7. Review
  8. Tools for Etiologic Diagnosis of Drug-Induced Allergic Conditions.International journal of molecular sciences · 2023
    Review
  9. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 6 institutions in 2 countries.

Agnès Sola-GazagnesAssistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université Paris Cité, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France. agnes.sola@aphp.fr.
Catherine PecquetAssistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service d'Allergologie Dermatologie, Paris, France.
Stefano BerréUniversité Paris Cité, CNRS, Inserm, Institut Cochin, Paris, France.ORCID https://orcid.org/0000-0001-8427-759X
Peter AchenbachHelmholtz Zentrum München, German Research Center for Environmental Health, Institute of Diabetes Research, Munich-Neuherberg, Germany.ORCID https://orcid.org/0000-0001-6720-2684
Laure-Anne PiersonAssistance Publique-Hôpitaux de Paris, Hôtel-Dieu, Service de Pharmacie, Pharmacologie, Toxicologie, Paris, France.
Isabelle Virmoux-BuissonAssistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université Paris Cité, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France.
Jocelyne M'BembaAssistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université Paris Cité, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France.
Fabienne ElgrablyAssistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université Paris Cité, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France.
Philippe MogueletAssistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service d'Anatomo-Pathologie, Sorbonne Université, Faculté de Médecine, Paris, France.ORCID https://orcid.org/0000-0003-1996-6406
Christian BoitardAssistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université Paris Cité, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France.ORCID https://orcid.org/0000-0003-3985-9405
Sophie Caillat-ZucmanAssistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Laboratoire d'Immunologie, Paris, France.ORCID https://orcid.org/0000-0002-4535-3550
Moussa LaananiUniversité Paris Cité, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Biostatistics and Epidemiology Unit, Paris, France.ORCID https://orcid.org/0000-0002-7200-1315
Joel CosteUniversité Paris Cité, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Biostatistics and Epidemiology Unit, Paris, France.ORCID https://orcid.org/0000-0001-7674-7192
Etienne LargerAssistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université Paris Cité, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France.ORCID https://orcid.org/0000-0002-1017-1845
Roberto MalloneAssistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université Paris Cité, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France.ORCID https://orcid.org/0000-0002-9846-8861
Université Paris Cité · FRCentre National de la Recherche Scientifique · FRSorbonne Université · FRAssistance Publique – Hôpitaux de Paris · FRInserm · FRTUM Klinikum · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aims/hypothesisInsulin allergy is a rare but significant clinical challenge. We aimed to develop a management workflow by (1) validating clinical criteria to guide diagnosis, based on a retrospective cohort, and (2) assessing the diagnostic performance of confirmatory tests, based on a case-control study.

methodsIn the retrospective cohort, patients with suspected insulin allergy were classified into three likelihood categories according to the presence of all (likely insulin allergy; 26/52, 50%), some (possible insulin allergy; 9/52, 17%) or none (unlikely insulin allergy; 17/52, 33%) of four clinical criteria: (1) recurrent local or systemic immediate or delayed hypersensitivity reactions; (2) reactions elicited by each injection; (3) reactions centred on the injection sites; and (4) reactions observed by the investigator (i.e. in response to an insulin challenge test). All underwent intradermal reaction (IDR) tests. A subsequent case-control study assessed the diagnostic performance of IDR, skin prick and serum anti-insulin IgE tests in ten clinically diagnosed insulin allergy patients, 24 insulin-treated non-allergic patients and 21 insulin-naive patients.

resultsIn the retrospective cohort, an IDR test validated the clinical diagnosis in 24/26 (92%), 3/9 (33%) and 0/14 (0%) likely, possible and unlikely insulin allergy patients, respectively. In the case-control study, an IDR test was 80% sensitive and 100% specific and identified the index insulin(s). The skin prick and IgE tests had a marginal diagnostic value. Patients with IDR-confirmed insulin allergy were treated using a stepwise strategy. CONCLUSIONS/

interpretationSubject to validation, clinical likelihood criteria can effectively guide diabetologists towards an insulin allergy diagnosis before undertaking allergology tests. An IDR test shows the best diagnostic performance. A progressive management strategy can subsequently be implemented. Continuous subcutaneous insulin infusion is ultimately required in most patients. CLINICALTRIALS: gov: NCT01407640.

Indexed as

Drug HypersensitivityCase-Control StudiesHumansImmunoglobulin EInsulinIntradermal TestsRetrospective StudiesImmunoglobulin EInsulinAnaphylaxisIgEImmune toleranceIntradermal reactionPrick testSkin test

Identifiers

PMID35505238
OpenAlexW4225418887

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.