Objective: The use of continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion (CSII) devices adhering to the skin can lead to skin reactions. The objective was to determine the prevalence and consequences of skin reactions at CGM or CSII sites in a large unbiased population. Research Design and Methods: This is a cross-sectional multicenter study. All adult patients with diabetes seen in consultation over a period of 7 months and using or having used a system with skin adhesives (in the last 10 years) were included and filled out a self-assessment questionnaire. Results: Among 851 patients, skin reaction was reported in 28% with CGM and 29% with CSII. Patients reporting reactions were more frequently women using CGM and CSII, and CGM users had type 1 more often than type 2 diabetes (P < 0.001). Manifestations were similar for reactions to CGM and CSII: redness and pruritus in 70%-75% of patients with reactions, pain in 20%-25%, and vesicles and desquamation in 12%-15%. Manifestations occurred within the first 24 h of first use in 22%-24% of patients with reactions to CGM and CSII, but after more than 6 months in 38% and 47% of patients with reactions to CGM and CSII, respectively. Device use was definitively stopped in 12% of patients with reactions to CGM (3.2% of all users) and 7% with reactions to CSII (2.1% of all users). Conclusions: Skin reactions were common, with similar presentations in CGM and CSII users. Manifestations suggested skin irritation rather than allergies. These reactions rarely led to the definitive discontinuation of the use of the device.

L’utilisation d’appareils adhérant à la peau chez les patients vivants avec un diabète ne cesse d’augmenter. Cette étude française, multicentrique transversale, a évalué la prévalence et les conséquences des réactions cutanées chez 851 adultes diabétiques ayant utilisé des capteurs de glucose ou des pompes à insuline au cours des 10 dernières années. Les résultats ont montré que 28 % des utilisateurs de capteurs et 29 % des utilisateurs de pompes ont présenté des réactions cutanées, plus fréquemment chez les femmes et les patients ayant des antécédents d’eczéma. Les symptômes suggèrent une irritation cutanée plutôt qu’une allergie. Les réactions cutanées sont survenues dans les premières 24heures dans 22 à 24 % des cas, et après plus de 6 mois dans 38 et 47 % des cas pour les capteurs et les pompes, respectivement. Enfin, 12 % des patients présentant une réaction au capteur et 7 % des patients présentant une réaction à une pompe ont arrêté d’utiliser le dispositif.

Insulin 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. In 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. In 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. Subject 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.

BACKGROUND:An aqueous antiseptic containing "chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol" (CBB) is widely used in France. The only previous documented study dealing with allergic contact dermatitis (ACD) to this antiseptic is one small case series in children. The French Vigilance Network for Dermatology and Allergy (REVIDAL-GERDA) has collected many cases in the last few years.OBJECTIVES:To evaluate the clinical and sensitization profiles of patients diagnosed with ACD to CBB.METHODS:We performed a retrospective study of patients with contact dermatitis to CBB and positive tests to CBB and/or at least one of its components. All patients had to be tested with all components of CBB.RESULTS:A total of 102 patients (71 adults and 31 children) were included. The lesions were extensive in 63% of patients and 55% had delayed time to diagnosis. CBB patch tests were positive in 93.8% of cases. The allergen was identified in 97% of patients, mainly benzyl alcohol in adults (81.7%) and chlorhexidine digluconate in children (54.8%). About 32.4% of the patients were sensitized to several components.CONCLUSION:CBB is a cause of ACD at all ages. The components of the antiseptic should be tested. The sensitization profile seems to be different between adults and children.

Skin reactions are well described complications of tattooing, usually provoked by red inks. Chemical characterizations of these inks are usually based on limited subjects and techniques. This study aimed to determine the organic and inorganic composition of inks using X-ray fluorescence spectroscopy (XRF), X-ray absorption spectroscopy (XANES) and Raman spectroscopy, in a cohort of patients with cutaneous hypersensitivity reactions to tattoo. A retrospective multicenter study was performed, including 15 patients diagnosed with skin reactions to tattoos. Almost half of these patients developed skin reactions on black inks. XRF identified known allergenic metals - titanium, chromium, manganese, nickel and copper - in almost all cases. XANES spectroscopy distinguished zinc and iron present in ink from these elements in endogenous biomolecules. Raman spectroscopy showed the presence of both reported (azo pigments, quinacridone) and unreported (carbon black, phtalocyanine) putative organic sensitizer compounds, and also defined the phase in which Ti was engaged. To the best of the authors' knowledge, this paper reports the largest cohort of skin hypersensitivity reactions analyzed by multiple complementary techniques. With almost half the patients presenting skin reaction on black tattoo, the study suggests that black modern inks should also be considered to provoke skin reactions, probably because of the common association of carbon black with potential allergenic metals within these inks. Analysis of more skin reactions to tattoos is needed to identify the relevant chemical compounds and help render tattoo ink composition safer.

Histamine H1 antagonist (H1A) is the treatment of urticaria and some allergic symptoms. The cutaneous manifestations due to HA1 is not well-known. The objective was to describe the cutaneous manifestations due to H1A, the most common imputed classes, the interest of the allergologics tests and profil of cross reactions. We realized a systematics analysis of literature of cutaneous adverse effects due to H1A, completed with a monocentric retrospective analysis having included patients explored from 2001 to 2017 for suspicion of allergy to H1A in the dermatology and allergology department of Tenon hospital in Paris. The review of literature included 138 patients with urticaria (n=42), anaphylaxis (n=13), fixed drug eruption (FDE) (n=39), maculopapular type drug eruption (MPDE) (n=11), systemic contact dermatitis (SCD) (n=12), photoallergy (n=4), acute generalized exanthematous pustulosis (AGEP) (n=7), Stevens-Johnson syndrome (n=2), and other non allergics cutaneous reactions (n=12). The retrospective review included 18 patients: urticaria (n=13), anaphylaxis (n=1), MPDE (n=3) and AGEP (n=1). The most frequent responsible H1A was the group of piperazines (n=100), followed by piperidine (n=48). The cutaneous test by intradermoreaction and prick test had a good specificity (Sp) in the urticaria and anaphylaxis but a limited sensibility (Se). The patch tests had a Se of 38% in the MPDE, 77% in affected skin in the FDE and 80% in AGEP. In urticaria, cross reaction between different H1A was noted and between piperazine and piperidine in the case of anaphylaxis, MPDE and SCD. We call “paradoxical urticaria” (UP) these urticaria appear or exacerbate under H1A, reproductible with oral provocation test (OPT). The UP was confirmed by OPT in 36 patients. The H1A can be responsible of allergic manifestations and UP. These imputations must be suspected in case of occurrence or exacerbation of urticaria and in cases of allergic manifestations.

The classification of radiocontrast media (RCM) into 3 groups (A, B or C) based on the frequency of cross-reactions between RCM belonging to the same group isn’t robust for immediate hypersensitivity reactions (IHSR).[1] In case of IHSR, the allergic mechanism can be rarely highlighted by prick or intradermal skin test (ST). In other cases, osmolarity may be involved by a direct membrane effect on mast cells causing tryptase release. Six cases were published about the good tolerance of Iodixanol, an isosmolar RCM.[2] We want to evaluate the tolerance of Iodixanol in case of IHSR to RCM. We did a monocentric retrospective study of all patients who presented a possible IHSR to a RCM, who had a drug provocation test (DPT) with Iodixanol, from 2013 to 2018. Symptoms presented during the IHSR/grade of anaphylaxis, name of the nontolerated RCM, results of prick and intradermal test, results of the Iodixanol DPT, were analysed in an EXCEL database. Among 76 patients who had a Iodixanol DPT: 20 had positive ST with an other RCM than Iodixanol, and 56 had negative ST. All patients who had positive ST had tolerated the Iodixanol, including 3 anaphylactic shock. All patients with negative ST had grade 1 anaphylaxis. Fifty three of 56 negative ST tolerated the Iodixanol: 28 of 30 patients whose RCM name was unknown, and 25 of 26 patients whose RCM name was known (Iodixanol(12/13), Iomeprol(4), Iopromide(2), Ioversol(3), Iobitridol(2) and Ioxaglate(2)). In case of slight IHSR to RCM, when ST are negative, it’s possibly an osmolarity problem and not an allergic reaction. In this study, Iodixanol was tolerated in 95% of cases of IHSR to RCM with negative ST. One of 13 patients who had an IHSR with Iodixanol didn’t tolerated the Iodixanol DPT, even if previous ST was negative for this RCM. It's possibly a false negative ST. The other 12 patients tolerated the Iodixanol even if they reported a grade 1 reaction with the same RCM. It may be due to a difference in concentration and/or in speed injection. The Iodixanol, an isosmolar RCM, is well tolerated in case of IHSR to RCM even in the group A to which it belongs.

AP-HP, Dermatology and Allergology Department, Hôpital Tenon, Paris, France Dermatology Department, Hôpital le Bocage, Dijon, France Faculty of Medicine, Sorbonne Université, Paris, France Immunology and Infectious Diseases Department (Cimi-Paris), Inserm 1135, Paris, France Correspondence Dr. Tullia de Risi-Pugliese, Service de Dermatologie et Allergologie, Hôpital Tenon 4 rue de la Chine, 75020 Paris, France. Email: tullia.derisi@gmail.com

Airborne allergic contact dermatitis caused by paints containing isothiazolinones has been recognized as a health hazard.

Nadia Raison-Peyron1 , Emmanuelle Amsler2 , Catherine Pecquet2, Aurélie Du-Thanh1, Tania Naessens3, Sandra Apers3,† and Olivier Aerts4 1Department of Dermatology, Hôpital Saint-Eloi, CHU de Montpellier, 34295 Montpellier, France, 2Dermatology and Allergology Department, Tenon Hospital (AP-HP), Sorbonne Universities, UPMC University Paris 06, 75020 Paris, France, 3Research Group Natural Products and Food – Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp (UA), 2610 Antwerp, Belgium, and 4Department of Dermatology, University Hospital Antwerp (UZA) and University of Antwerp (UA), 2650 Antwerp, Belgium

Allergic contact dermatitis to plants is common, especially with the Compositae family and caused by sesquiterpene lactones (SL), which are present in the oleoresin fraction of leaf, stem, flower and possibly pollen (1). Allergic contact dermatitis caused by Geranium robertianum has only been reported once from Denmark (2). We report a new case of contact dermatitis to G. robertianum causing an erythema multiforme-like eruption.

BACKGROUND:The diagnosis of HSR to iodinated contrast media (ICM) is challenging based on clinical history and skin tests.OBJECTIVE:This study evaluates the negative predictive value (NPV) of skin tests and intravenous provocation test (IPT) with low-dose ICM in patients with suspected immediate hypersensitivity reaction (HSR) to ICM.METHODS:Thirty-seven patients with suspected immediate hypersensitivity reaction to ICM were included retrospectively. Skin tests and a single-blind placebo-controlled intravenous provocation test (IPT) with low-dose iodinated contrast media (ICM) were performed.RESULTS:Skin tests with ICM were positive in five cases (one skin prick test and five intradermal test). Thirty-six patients were challenged successfully by IPT, and only one patient had a positive challenge result, with a grade I reaction by the Ring and Messmer classification. Ten of 23 patients followed up by telephone were re-exposed to a negative tested ICM during radiologic examination; two experienced a grade I immediate reaction.CONCLUSIONS & CLINICAL RELEVANCE:For immediate hypersensitivity reaction to ICM, the NPV for skin tests and IPT with low dose was 80% (95% CI 44-97%).

Delayed onset of non-ischemic cerebral enhancing (NICE) lesions is a rare complication of intracranial aneurysms’ endovascular therapy (EVT). The purpose of this study is to report this rare complication and its potential pathophysiology in a single-center case series and review the relevant literature.

La survenue retardée de lésions cérébrales non ischémiques prenant le contraste (non-ischemic cerebral enhancing [NICE]) est une complication rare après embolisation d'anévrysmes intracrâniens. Cette complication a été attribuée soit à une réaction granulomateuse à corps étrangers ou à une allergie au nickel. L'objectif de notre étude est d'évaluer la fréquence de cette complication et de rechercher les causes de cette entité rare. Analyse rétrospective des patients traités par voie endovasculaire pour des anévrysmes intracrâniens entre le 1er janvier 2012 et le 31 décembre 2014 dans notre institution. Les complications de type lésions NICE (confirmées en IRM) ont été systématiquement relevées. Les signes cliniques et aspects en imagerie ont systématiquement été évalués. Des tests épicutanés ont été réalisés avec tous les outils endovasculaires utilisés chez les patients atteints ainsi qu'avec la batterie standard européenne (comprenant le nickel). Une biopsie neuro-méningée a été réalisée à 21 mois de l'embolisation chez un des deux patients identifiés. Deux patients sur 374 (0,5 %) ont présenté des lésions NICE. Le premier patient a développé des lésions cérébrales prenant le contraste 1 mois après coiling d'un anévrysme rompu de l'artère communicante antérieure. Le second patient a développé des lésions 12 mois (le plus long délai rapporté à ce jour) après traitement d'un anévrysme carotido-ophtalmique droit par coiling et stent flow-diverter. Le test épicutané au nickel était positif chez le second patient. Tous les tests avec les outils endovasculaires étaient négatifs. L'analyse anatomopathologique de la pièce de biopsie réalisée chez le second patient a trouvé une infiltration inflammatoire lymphocytaire non spécifique, une réaction astrocytaire et une minime vascularite éosinophile leucocytoclasique, sans corps étranger ou cellule géante. Sur la base des 2 cas rapportés et de la revue de la littérature, les lésions NICE sont plus vraisemblablement en rapport avec une réaction à corps étranger qu'une allergie au nickel.

Contact DermatitisVolume 72, Issue 6 p. 407-409 Contact Points An outbreak of contact allergy to cocamide diethanolamide? Antoine Badaoui, Corresponding Author Antoine Badaoui Dermatologie-Allergologie, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris, FranceCorrespondence: Dr Antoine Badaoui, Service de Dermatologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris et Université Paris VI, 4 rue de la Chine, 75020 Paris, France. Tel: +33156017227; Fax: +33156017235. E-mail: abadaoui92@hotmail.comSearch for more papers by this authorEmmanuelle Amsler, Emmanuelle Amsler Dermatologie-Allergologie, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris, FranceSearch for more papers by this authorNathalie Raison-Peyron, Nathalie Raison-Peyron Dermatologie, Hôpital Saint Eloi, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, FranceSearch for more papers by this authorMartine Vigan, Martine Vigan EF Allergology Department of Dermatology, Jean Minjoz Hospital, 3 Boulevard Fleming, 25030 Besançon Cedex, FranceSearch for more papers by this authorCatherine Pecquet, Catherine Pecquet Dermatologie-Allergologie, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris, FranceSearch for more papers by this authorCamille Frances, Camille Frances Dermatologie-Allergologie, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris, FranceSearch for more papers by this authorAngele Soria, Angele Soria Dermatologie-Allergologie, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris, France Sorbonne Universités, UPMC Univ Paris 06, Unité Mixte de Recherche de Santé (UMR S) CR7, Centre d'Immunologie et des Maladies Infectieuses – Paris (CIMI-Paris), F-75013 Paris, France Institut National de Santé et de Recherche Médicale (INSERM) U1135, CIMI-Paris, F-75013 Paris, FranceSearch for more papers by this author Antoine Badaoui, Corresponding Author Antoine Badaoui Dermatologie-Allergologie, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris, FranceCorrespondence: Dr Antoine Badaoui, Service de Dermatologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris et Université Paris VI, 4 rue de la Chine, 75020 Paris, France. Tel: +33156017227; Fax: +33156017235. E-mail: abadaoui92@hotmail.comSearch for more papers by this authorEmmanuelle Amsler, Emmanuelle Amsler Dermatologie-Allergologie, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris, FranceSearch for more papers by this authorNathalie Raison-Peyron, Nathalie Raison-Peyron Dermatologie, Hôpital Saint Eloi, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, FranceSearch for more papers by this authorMartine Vigan, Martine Vigan EF Allergology Department of Dermatology, Jean Minjoz Hospital, 3 Boulevard Fleming, 25030 Besançon Cedex, FranceSearch for more papers by this authorCatherine Pecquet, Catherine Pecquet Dermatologie-Allergologie, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris, FranceSearch for more papers by this authorCamille Frances, Camille Frances Dermatologie-Allergologie, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris, FranceSearch for more papers by this authorAngele Soria, Angele Soria Dermatologie-Allergologie, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris, France Sorbonne Universités, UPMC Univ Paris 06, Unité Mixte de Recherche de Santé (UMR S) CR7, Centre d'Immunologie et des Maladies Infectieuses – Paris (CIMI-Paris), F-75013 Paris, France Institut National de Santé et de Recherche Médicale (INSERM) U1135, CIMI-Paris, F-75013 Paris, FranceSearch for more papers by this author First published: 24 February 2015 https://doi.org/10.1111/cod.12332Citations: 5 Conflict of interest: The authors declare no conflict of interests. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume72, Issue6June 2015Pages 407-409 RelatedInformation

Introduction: Over the past few years, allergic contact dermatitis to MI has reached an 24 epidemic level in Europe. We report a series of 4 patients presenting allergic contact

International Journal of DermatologyVolume 53, Issue 3 p. e196-e197 Correspondence Chronic contact eczema on the hand related to PlayStation® controller use Nicolas Kluger MD, Nicolas Kluger MD Department of Dermatology, Allergology and Venereology, Institute of Clinical Medicine, University of Helsinki, Skin and Allergies Hospital, Helsinki University Central Hospital, Helsinki, FinlandSearch for more papers by this authorCatherine Pecquet MD, Catherine Pecquet MD [email protected] Department of Dermatology and Allergology, Hospital Tenon, Paris, FranceSearch for more papers by this author Nicolas Kluger MD, Nicolas Kluger MD Department of Dermatology, Allergology and Venereology, Institute of Clinical Medicine, University of Helsinki, Skin and Allergies Hospital, Helsinki University Central Hospital, Helsinki, FinlandSearch for more papers by this authorCatherine Pecquet MD, Catherine Pecquet MD [email protected] Department of Dermatology and Allergology, Hospital Tenon, Paris, FranceSearch for more papers by this author First published: 15 May 2013 https://doi.org/10.1111/ijd.12018Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Kluger N, Pecquet C. Dermatoses associated with high technology (cell phones, computers and video games). Ann Dermatol Venereol 2012; 139: 230–238. 2Bernabeu-Wittel J, Domínguez-Cruz J, Zulueta T, et al. Hemorrhagic parallel-ridge pattern on dermoscopy in "PlayStation fingertip". J Am Acad Dermatol 2011; 65: 238–239. 3Kasraee B, Masouyé I, Piguet V. PlayStation palmar hidradenitis. Br J Dermatol 2009; 160: 892–894. 4Giordano-Labadie F, Mariut I, Paul C. Addiction aux jeux vidéo et dermite des mains. Ann Dermatol Venereol 2011; 138(Suppl.): 127. 5 Sony Computer Entertainment, Inc. PlayStation One Manual. 2000. http://www.playstation.com/manual/pdf/SCPH-110U.pdf. [Accessed January 5, 2012.] 6Kanerva L, Kanervo K, Jolanki R, et al. Cobalt – a possible sensitizer in personal computer (PC) mouse and polyester resins. Contact Dermatitis 2001; 45: 126–127. 7Cahill JL, Andersen KE. Occupational cobalt-allergic contact dermatitis resulting from polyester resin. Contact Dermatitis 2010; 63: 292–294. 8 SCPH. http://maru-chang.com/hard/scph/index.php/english. [Accessed January 5, 2012.] 9Thyssen JP, Johansen JD, Zachariae C, et al. The outcome of dimethylglyoxime testing in a sample of cell phones in Denmark. Contact Dermatitis 2008; 59: 38–42. Citing Literature Volume53, Issue3March 2014Pages e196-e197 ReferencesRelatedInformation

L'allergie à l'insuline (AI) est toujours observée avec l'insuline humaine et les analogues de l'insuline. Nous rapportons une série de 42 patients consécutifs vus dans un centre unique pour suspicion d'AI avec hypersensibilité immédiate. Nous présentons une procédure systématique de diagnostic et une stratégie thérapeutique. 42 patients diabétiques de type 2 (n = 27) ou 1 (n = 15) adressés pour possible AI. Constitution selon des critères cliniques précis, de 3 groupes : « AI évidente », « AI douteuse », « pas d'AI ». Les patients ont été explorés par prick-tests et tests intradermiques (IDR) à différentes insulines, dosage d'IgE anti-insuline et anti-protamine et un traitement a été proposé aux patients allergiques. Le groupe « AI évidente » comptait 19 patients âgés de 52 ans (17–72), durée d'insulinothérapie 13 ans (0,5 à 41), HbA1c 8,7 % (6-14). Cinq étaient diabétiques de type 1 et 6 avaient une réaction généralisée. Seuls 3/15 pricks tests étaient positifs vs. 19/19 IDR. Les IgE anti insulines étaient positives chez 4/16, IgE antiprotamine toujours négatives (16/16). Trois patients ont stoppé l'insuline, 5 l'ont poursuivi avec ou sans antihistaminiques. Une perfusion continue sous-cutanée d'insuline (CSII), a été utilisée chez dix autres patients. Trois des 9 patients classés « AI douteuse » avaient des IDR positives, et 5/5 des prick tests négatifs. Seul un patient du groupe jugé « pas AI » (n = 14) avait un test IDR partiellement positif et 4/4 prick tests étaient négatifs. Les tests intradermiques sont utiles pour confirmer ou infirmer le diagnostic de l'AI, les pricks tests semblent moins sensibles. La détermination de leur sensibilité/ spécificité nécessite cependant une étude complémentaire. Tous les cas peuvent être contrôlés par des mesures simples ou CSII.

Aim. - Insulin allergy is a rare but serious and challenging condition in patients with type 1 diabetes (T1D). This is a case report of an 8-year-old boy with T1D and an allergy to insulin.Case report. - Three months after being diagnosed with T1D, the patient developed progressive skin reactions to insulin, characterized by small 1.5-cm pruritic wheals at injection sites that persisted for several days. Seven months after diagnosis, he experienced two episodes of generalized urticaria with systemic symptoms that were seen within a few seconds of insulin injection. Examination revealed lipoatrophy of the thighs. Intradermal skin tests were positive for protamine, glargine and lispro. The patient was started on a continuous subcutaneous insulin infusion (CSII) tolerance induction protocol, consisting of a very low basal rate that was progressively increased, with the first bolus given under medical supervision, and was well tolerated for 4 months. After this period of time, the skin wheals reappeared, localized to the infusion sites, but without urticaria or any other generalized reactions. Intradermal skin tests were repeated and were again positive. Serum insulin-specific IgE measured 30 months after the first allergic reactions were positive. After 3 years, pump therapy is ongoing and blood glucose control has remained relatively good (HbA(1c) 7.6%).Conclusion. - In T1D children with insulin allergy, CSII can successfully be used to both induce insulin tolerance and allow diabetes insulin therapy, although insulin desensitization cannot always be fully achieved. The induction protocol was easily manageable partly due to the "honeymoon" period that the patient was still in, but it should nonetheless be used even when the patient has higher insulin requirements. (C) 2012 Elsevier Masson SAS. All rights reserved.

Some products derived from insects can induce allergic reactions. The main characteristics of some products from honeybees, cochineal and silkworms are summarised here. We review allergic reactions from honey-derived products (propolis, wax, royal jelly), from cochineal products (shellac and carmine) and from silk : clinical features, allergological investigations and allergens if they are known.