Islets of Hope disorders associated with diabetes

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Wikipedia.org (reprinted with permission and edited for content by Lahle Wolfe)

Chart created by Lahle Wolfe


Fast Links to Disorders Often Associated with
Diabetes

Addison's Disease
Asthma and Allergies
Celiac Disease (Sprue)
Cyclic Vomiting Syndrome
Cystic Fibrosis 
Eating Disorders
Fibromyalgia Syndrome
Frozen Shoulder
Hashimoto's Thyroiditis
Hemochromatosis
  (Iron Overload)
Infertility
Irritable Bowel Syndrome
Polycystic Ovarian 
    
Syndrome 
Weight Gain
Weight Loss


Fast Click to Problems Associated with
Diabetes

Acanthosis Nigricans (AN)
Acne
Alopecia Areata (AA)
Gum Disease
Hirsutism
Honeymooning
Skin Tags
Yeast Infections


Is it allergies or asthma?

Symptoms of Allergies

  • rashes
  • vomiting
  • cramps
  • swelling
  • itching
  • tightness in throat
  • diarrhea
  • anaphylaxis
  • difficulty breathing

Symptoms of Asthma

  • shortness of breath
  • coughing
  • anxiety
  • increased heart rate
  • wheezing
  • sweating
  • chest tightness

What is an EpiPen?

Adrenaline (epinephrine) is a natural hormone released in response to stress.  This hormone acts as an antidote to chemicals released during severe allergic reactions including those triggered by drugs, food, or insects.

Because this hormone is destroyed by enzymes in the stomach, it cannot be taken orally and needs to be injected.

When injected, epinephrine rapidly reverses the effects of a severe allergic reaction by reducing throat swelling, opening the airways, and maintaining blood pressure.

Anyone with a severe allergy should always carry an EpiPen with them at all times.

Pictoral guide to administering an EpiPen



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Sheri L. Sanderson is the mother of three children, including one with gluten sensitivities. Her cookbook is the result of personal need---wanting to offer her family gluten-free meals that look and taste just as good as those she made before the change in diet. In addition to many years of... Read more


Are asthma, allergies and diabetes related?

According to Dr. Greene, no.

..."Children with type 1 diabetes are less likely to get asthma, eczema, or hay fever. And the reverse is true, that those with asthma, eczema, or hay fever are less likely to get type 1 diabetes..."

Read the article


Did you know?

... that people with asthma are often allergic to dust mites?

.... that autoimmune disorders are more common in women than in men?


A child with diabetes has a reaction to injections a year into therapy...

Delayed Latex 
hypersensitivity ins a
child with diabetes
.

 


Important Medical Disclaimer

Material on this site is intended for general  informational purposes only and should not be used for self- diagnosis or self-treatment.

IOH recommends you seek the advice of a competent medical professional for diagnosis and treatment options, or before making any changes to your diabetes care plan.

Diabetes Medical Library                       main "Disorders" page
Disorders Associated with Diabetes

Asthma and Allergies
Section 2 - Allergies


Mini Site Index
What is an allergy?
Diabetes and Allergies
Types of Hypersensitivity (chart)
Signs and Symptoms
Diagnosing Allergies
Treatment
Basis of an Allergic Reaction
What is anaphylactic shock?
Common Allergens
 

Go to Section 1: Asthma

What is an allergy?

Allergies are a type I hypersensitive immune response to an "allergen" (anything that causes an allergic reaction).  Some hypersensitivities cause reactions like sneezing, itching, and rashes, while others can cause damage to the body's tissues and cause autoimmune disorders like thyroid problems, Grave's disease, rheumatoid arthritis, and even type 1 diabetes.

There are four types of hypersensitivities but a fifth type is sometimes classified. Type I hypersensitivity, what most people think of when they hear the word "allergy," is characterized by excessive activation of mast cells by immunoglobulin E resulting in an inflammatory response.  Type I allergy symptoms can range from annoying (i.e. a runny nose) to life-threatening anaphylactic shock and even death.  


Diabetes and Allergies

Type 1 diabetes may onset when there is a genetic predisposition to diabetes and an environmental exposure to a trigger that causes a type II antibody-dependent cytotoxic hypersensitivity (see chart below) response.  Diabetes is an autoimmune disorder that can result from several things including a type II hypersensitivity (see chart below).  

Although the rate of common type 1 allergies is not necessarily more common in persons with diabetes other autoimmune disorders which can result from hypersensitivity are more commonly seen in persons with diabetes.

People who take insulin are more likely to be allergic to the older, less-frequently used animal insulins.  However, there are rare cases where a person can be allergic to the new, synthetic insulins.  It is more likely that a person may be allergic to a buffering agent added to intermediate or longer acting insulins that to the insulin itself.  

Sometimes, a person may appear to have an allergic reaction to insulin when it may in fact be an allergy to latex.  Latex is found in many syringes, the rubber stoppers on most insulin vials, and even in some adhesive strips.

For those that may have an allergy to buffering agents, insulin pump therapy may be advisable.  Rapid acting insulin like Novolog needs to be taken every few hours and is best administered via an insulin pump.  

Note:  IOH founder's daughter, Elizabeth,  has an allergy to insulin buffering agents but is now doing fine on rapid insulin and an insulin pump.

To learn more about insulin reactions and allergies, see "Insulin Reactions" and "Insulin Shock."


Types of Hypersensitivity Reactions

Type of Reaction

Response/Onset

Examples

Type I 
Immediate Hypersensitivity
(IgE-mediated hypersensitivity)

Within seconds or minutes - The reaction may be either local or systemic. Symptoms vary from mild irritation to sudden death from anaphylactic shock.

Reactions to molds, insect bites, Allergic asthma , allergic conjunctivitis, allergic rhinitis (hay fever) eczema, anaphylaxis, angioedema. urticaria (hives).

Treatment usually involves epinephrine, antihistamines, and corticosteroids.

Type II(1)
Antibody-Dependent Cytotoxic Hypersensitivity

There are three basic mechanisms  involved with Type II:

  • Type II reactions between members of the same species.
  • Autoimmune type II hypersensitivity
  • Type II drug reactions

Usually within 5-8 hours; sometimes days. This type is typically associated with acute inflammation (as in Hashimoto's thyroiditis where the thyroid gland becomes inflamed).

Type II occurs when antibody binds to either self antigen or foreign antigen on cells, and leads to phagocytosis, killer cell activity or complement-mediated lysis.

Caused by isoimmunization, reactions between  members of the same species include transfusion reactions after transfusion of blood incompatible in the AB0 system, haemolytic disease of the newborn due to rhesus incompatibility and/or transplantation reaction provoked by antibodies in the recipient directed against surface transplantation antigens on the graft.

Autoimmune reactions include autoimmune haemolytic anaemia,  Hashimoto's thyroiditis, idiopathic thrombocytopenic purpura, Goodpasture's syndrome, type 1 diabetes, myasthenia gravis, rheumatic fever, and multiple sclerosis.

Drug reactions are very complicated. In some cases either type III or type IV hypersensitivity may by induced,.

Type III(1)
Immune Complex Hypersensitivity
(1)

Typically 2-8 hours; sometimes days. In this form of hypersensitivity, damage is caused by the deposit in the tissues of complexes of antigen and their antibodies.

Immune complex glomerulonephritis , rheumatoid arthritis, serum sickness, subacute bacterial endocarditis, symptoms of malaria, systemic lupus erythematosus (SLE), arthus reaction

Type IV(2)
Delayed or Cell-Mediated Hyper- 
sensitivity, or Delayed Type Hypersensitivity (DTH)
(2)

Contact Hypersensitivity
Characterized by a reaction at the site of contact with the allergen (contact dermatitis ).

Tuberculin Hypersensitivity
This response was first observed when soluble antigens from organisms such as mycrobacteria were administered under the skin.

Granulomatous Hypersensitivity
This type of reaction is characterized by persistence of the antigen within macrophages as well as of the lesion

Typically, reaction occurs within 72 hours in contact and tuberculin hypersensitivities.

Granulomatous hypersensitivity may take days or weeks to develop.

 Unlike the other types, reaction is not antibody mediated but rather is a type of cell-mediated response.

Contact dermatitis (i.e., poison ivy rash), allergic sensitivities to dust mites, cosmetics and detergents,  symptoms of leprosy, symptoms of tuberculin lesions, spirochete diseases (especially treponema pallidum), crohn's disease, granulomatous Disease

Type V
Stimulatory Hypersensitivity
This is an additional type that is sometimes (often in Britain) used as a distinction from Type II.

Usually within 5-8 hours; sometimes days.

Instead of binding to cell surface components so the cells are destroyed, the antibodies recognize and bind to the cell surface receptors, which either prevents the intended ligand binding with the receptor or mimics the effects of the ligand, thus impairing cell signaling.  Examples are Graves' disease (thyrotoxicosis) and myasthenia gravis.

Chart by Lahle Wolfe, for permission to reuse this information contact Editor@isletsofhope.com

Chart Notes

(1) Both type II and type III hypersensitivity are caused by IgG and IgM antibodies

(2) Type IV hypersensitivity is often called "delayed type." An example of this delayed type of reaction is the rash that follows  exposure to poison ivy.  Because it takes a day or two for the T cells to mobilize following exposure to the antigen, these responses are called delayed-type hypersensitivities (DTH). Those, like poison ivy, that are caused by skin contact with the antigen are also known as contact sensitivities or contact dermatitis.  Often, an initial exposure causes no visible reaction but after the second exposure a reaction occurs.


  • Signs and Symptoms

    Allergy is characterised by a local or systemic inflammatory response to allergens. Local symptoms are:

    • Nose - swelling of the nasal mucosa (allergic rhinitis)
    • Eyes -  redness and itching of the conjunctiva (allergic conjunctivitis)
    • Airways -  bronchoconstriction, wheezing and dyspnoea, difficult breathing, asthma attacks
    • Skin -  various rashes, such as eczema, hives (urticaria) and contact dermatitis; itching
    • Gastrointestinal - vomiting, cramps, diarrhea
    • Bloating
    • Swelling in hands, face, mouth
    • Tightness in throat
    • Anaphylaxis (a systemic response).  Depending of the rate of severity, it can cause skin reactions, bronchoconstriction, edema (water retention), hypotension (high blood pressure), shock, coma, and even death.  


    Diagnosing Allergies

    There are several methods for the diagnosis and assessment of allergies.

    Skin Test

    The typical and most simple method of diagnosis and monitoring of Type I Hypersensitivity is by skin testing, also known as prick testing, due to the series of pricks made into the patient's skin. Small amounts of suspected allergens and/or their extracts (pollen, grass, mite proteins, peanut extract, etc.) are introduced to sites on the skin marked with pen or dye (the ink/dye should be carefully selected, lest it cause an allergic response itself). The allergens are either injected intradermally or into small scratchings made into the patient's skin, often with a lancet. Common areas for testing include the inside forearm and back. If the patient is allergic to the substance, then a visible inflammatory reaction will usually occur within 30 minutes. This response will range from slight reddening of the skin to full-blown hives in extremely sensitive patients.

    After performing the skin test and receiving results, the doctor may apply a steroid cream to the test area to reduce discomfort (such as itching and inflammation).

    While the skin test is probably the most preferred means of testing because of its simplicity and economics, it is not without complications. Some people may display a delayed-type hypersensitivity (DTH) reaction which can occur as far as 6 hours after application of the allergen and last up to 24 hours. This can also cause serious long-lasting tissue damage to the affected area. Fortunately, these type of serious reactions are quite rare.  Also, the application of previously unencountered allergens can actually sensitize certain individuals to the allergen; that is, cause the inception of a new allergy in susceptible individuals.

    Skins tests also are not always able to pinpoint a patient's specific allergies if the patient has an allergy but does not react to the skin test allergen.

    Total IgE count

    Another method used to qualify type I hypersensitivity is measuring the amount of serum IgE contained within the patient's serum (a clear, yellowish fluid obtained after separating whole blood into its solid and liquid components).


    Treatment

    Immunotherapy - So far, the most effective preventive for IgE-mediated allergies is to inject the patient with gradually-increasing doses of the allergen itself. The goal is to shift the response of the immune system away from Th2 cells in favor of Th1 cells. Unfortunately, this therapy takes a long time and the results are too often disappointing.  During this type of therapy it is important that the patient always carry an EpiPen (see side bar).

    Desensitization (hyposensitization) is a form of immunotherapy where the patient is gradually vaccinated against progressively larger doses of the allergen in question. This can sometimes reduce the severity of a reaction or eliminate hypersensitivity altogether.

    In the 1960s, Dr. Len McEwen in the United Kingdom developed a treatment for allergies known as enzyme potentiated desensitization, or EPD.  This form of treatment uses much lower doses of antigens than conventional treatment, with the addition of an enzyme. EPD is available in the United Kingdom and Canada, and was available in the United States until 2001, when the Food and Drug Administration revoked its approval for an investigative study being performed. Since that time, an American counterpart to EPD, known as Low Dose Antigens (LDA), has been formulated from components approved by the FDA, and is available for treatment from a small number of doctors in the United States.

    Both EPD and LDA is still considered experimental by many mainstream doctors and medical insurance companies.

    Another form of immunotherapy involves the intravenous injection of monoclonal anti-IgE antibodies. These bind to free and B-cell IgE signaling such sources for destruction. They do not bind to IgE already bound to the Fc receptor on basophils and mast cells as this would stimulate the allergic inflammatory response.

    Chemotherapy - Several antagonistic drugs are used to block the action of allergic mediators, preventing activation of cells and degranulation processes. They include antihistamines, cortisone, adrenalin (epinephrine), theophylline and Cromolyn sodium. These drugs help alleviate the symptoms of allergy but play little role in chronic alleviation of the disorder. They can play an imperative role in the acute recovery of someone suffering from anaphylaxis (which is why those allergic to bee stings, peanuts, nuts, and shellfish often carry an adrenalin needle with them at all times).

    Alternative therapies - In alternative medicine, a number of treatment modalities are considered effective by its practitioners in the treatment of allergies, particularly traditional Chinese medicine and kinesiology. However, none of these have been backed up by good quality evidence. On the contrary, they are generally criticised by mainstream medical researchers to be supported only by anecdotes, which makes them effective only as placebos. Yet there are case studies involving animals and babies, which makes it difficult to categorise all such successful treatment as being the result of placebos. Dr. Andrew Weil, among others, believes that some allergies can be treated as though they were a psychosomatic illness.


    Basis of the allergic response

    There are two phases in the generation of an immune response a primary response (after first exposure) and a secondary response.

    Primary Response occurs when the allergen (Ag) is first encountered.  This response is slow because, at first, there are only a few B cells that react with the Ag.  This weak response allows the invader enough time to cause illness and a type of antibody (IgM) and memory B cells are produced.

    Secondary Response.  The next time the antigen (any substance that causes your immune system to produce antibodies)  is encountered, the response is quicker and stronger each time.  Memory B cells recognize the antigen and begin to divide quickly.  This results in reproduction of plasma cells which makes a different type of antibody called IgG.  


    What is anaphylactic shock?

    Anaphylaxis is a severe and rapid systemic allergic reaction.  Anaphylaxis occurs when a person is exposed to a trigger substance, called an allergen, to which she/he has become sensitized through a previous exposure. The most severe type of anaphylaxis—anaphylactic shock—will usually lead to death in minutes if left untreated. 

    Even minute amounts of allergens can cause a life-threatening anaphylactic reaction. Anaphylaxis may occur after ingestion, inhalation, skin contact, or injection of an allergen.

    Symptoms of anaphylaxis can include the following:

    • respiratory distress including constriction of the airways making breathing difficult or impossible
    • hypotension (low blood pressure)
    • fainting
    • unconsciousness,
    • urticaria (hives)
    • flushed appearance
    • angioedema (swelling of the face, neck and throat or tongue)
    • tears (due to angioedema and stress)
    • vomiting
    • itching, and
    • anxiety, including a sense of impending doom

    The time between ingestion of the allergen and anaphylaxis symptoms varies among people, depending on the amount of allergen ingested, and level of sensitivity. Symptoms can appear immediately, or may be delayed by half an hour to several hours after ingestion.  However, symptoms of anaphylaxis usually occur rapidly once they do begin.

    Since constriction of the airways is involved, brain damage can result due to a lack of oxygen to the brain.  Treatment involves immediate injection of epinephrine (see EpiPen information, left side bar) and a call to 911 is usually advisable.

    Exercise Anaphylaxis - In some cases, individuals experience anaphylaxis only after combination exposure to a triggering agent (through ingestion) and increased physical activity. For some, neither the exercise nor ingestion (eating) of the triggering allergen alone causes anaphylaxis but there are some people that can experience anaphylaxis with exercise and no other triggering agent.  Triggers include foods (commonly celery, wheat, soy protein, cheese, and shellfish) and medication (i.e., antibiotics, aspirin,  and NSAIDs).


    Common allergens

    In addition to foreign proteins for example, found in blood transfusions, and vaccines, common allergens include:

    • Plant pollens (Hay fever)
    • ragweed
    • timothy grass
    • birch trees
    • Mould spores
    • Drugs
      • penicillins
      • sulfonamides
      • salicylates (also found naturally in numerous fruits)
      • local anaesthetics
    • Foods (food allergy)
      • nuts
      • seafood
      • egg (typically albumen, the white)
      • peas, beans, peanuts, soybeans, and other legumes
      • soy
      • wheat
      • maize (corn)
    • Insect stings
      • bee sting venom
      • wasp sting venom
    • Animal products (animal allergy)
      • Animal hair and dander
      • cockroach calyx
      • dust mite excretion
    • Other
      • Exercise
      • Cold

       

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    Page Updated 03/30/2006