How to deal with an Omnipod allergy

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How do you deal with an allergic reaction to an OmniPod when you want to wear a tubeless pump?

Many Omnipod users suffer from allergic reactions, which make it difficult for them to withstand a Pod for 3 days. These allergies sometimes come and go, or suddenly show up after years of use with no trouble. There is a large online literature of forums posts and blogs that discuss issues and potential solutions. The present series of posts summarizes some of these online reports.

Caveat: it should be clear to everyone that allergies are highly personal issues. So what works for someone certainly may not work for another – it is everyone’s responsibility to do thorough investigation and testing of any option presented here or anywhere else before using it as a remedy. As always, this post (or any other on the forum) does not constitute medical advice.

Allergy to what?

There are two particular sources of allergies in the Omnipod. The most often seen is the adhesive pad. The second is the canula itself. Dexcom has mentioned the presence of a small quantity of nickel, a common allergen.

How to figure out if you are reacting to the canula or the adhesive

Conduct a simple experiment: wear a Pod for a few days without inserting the canula. If you still react to it, you are allergic to the adhesive.

Note: there is a very small likelihood that you may be allergic to both.

CGM and pump allergies: similarities and differences

There are great similarities between CGM and pump allergies. For both types of medical equipment, the PWD may be allergic to the sensor probe or the canula, and the adhesive pad. So the general strategies are the same. But, for every PWD, because the materials in pumps and CGMs and the adhesives are not the same, the actual remedy will likely be different for your pump and for your CGM. In fact, you may react to one and not the other (or, hopefully, to neither).

The Omnipod does have a small different with other, non-tubeless pumps. There is no choice of canula for the pods, whereas non-tubeless pumps do have a choice of infusion sets. What this means is that, among the pumps, the Omipod is closest to a CGM when looking at allergy mitigation strategies.

Because pump and CGM allergies are so similar, do note that this wiki by its nature, is very similar to, and often identical with the Dexcom allergy wiki.

Symptoms

As always, the symptoms vary. Some of them may be:

  • red rash under the adhesive patch location, sometimes nicknamed “Omnipod rash” online.
    This aggressive-looking rash should not be confused with the little red marks you get after lifting a pod a bit too fast. The red rash can look quite angry, as it does on little Caleb’s skin. Such a rash takes multiple weeks to heal, and makes it very difficult to find enough sites to rotate a pod through.

  • systemic reaction
    The localized reaction to spread to the whole body, involving a puffy face, wheezing, skin breakouts in multiple locations, and, worst of all, the risk of anaphylactic shock. Little Henry suffered such a systemic reaction :frowning: . A systemic reaction can quickly turn deadly: you should seek medical attention immediately.

  • Infection
    Localized rashes easily get infected. Such infections can be very serious for diabetics: PWDs are susceptible to infections because sugar is a great medium to grow bacteria. They are also more vulnerable to the consequences of infection because of the out-of-balance BG resulting from medical stress. With PWDs, such infections can quickly become deadly. Isabella suffered from such an infection.

First thoughts

It should be clear to all that, for anything but the mildest symptoms, consulting a dermatologist could be really helpful, and may well be necessary (although, unfortunately, possibly not sufficient). If you are normally subject to allergies, before starting on CGM, it may be a good idea to ask the rep about your known allergies, and to sample a couple of pods. At our diabetes clinic, in an early pump preparation class PWDs have access to all pump reps, and can try out wearing a pod for a few days.

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Omnipod canula allergy

Allergy to the canula itself appears to be less common than allergy to the pad adhesive – a good thing, since it is much harder to deal with. There is simply no way to avoid contact with the probe. So possible remedies can only mitigate rather than suppress. Three primary strategies are mentioned:

  • never using a skin area that has not fully recovered from a previous Pod application: using unblemished, fully recovered skin is critical

  • more frequent site changes: once the skin starts reacting, it takes a long time to get it to heal, and to avoid it reacting faster the next time around in this (or possibly other) location. One strategy is to change site the moment an allergic reaction is detected. This may result in changes more frequently than the usual 3 days. You may be able to discuss the issue with your prescribing physician and obtain a prescription and insurance agreement for more frequent Pod changes.

  • use of a topical anti-allergy medication (unlikely to meet great success since the probe is under the skin), or of a systemic anti-allergy medication such as cetirizine (Zyrtec/Reactine). A prescription allergy medication may be required.

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Adhesive allergy: simple steps

In mild cases, which are the most common, taking a few simple steps is enough to solve the problem. Some possible solutions are (use only those steps you need):

  • never apply a Pod to a skin area that has not fully recovered from a previous Pod application

  • do not use alcohol to clean the skin but antibacterial soap and water

  • use an adhesive barrier such as SkinTac, IV Prep (caution: it has alcohol), Skin Prep, Bard’s Barrier Wipe, Cavilon film or Cavilon cream, before applying the Pod. If you do so, make sure to (a) apply the SkinTac in multiple layers, letting the previous layer dry to tacky to the touch before applying the next one, and (b) leave a small area free of SkinTac where the canula will pierce the skin. Depending upon circumstances, we use either SkinTac bottle or SkinTac wipes. To make sure we don’t apply the barrier where the canula will come through the skin, we typically draw a circle with a pen on the skin once it has been washed and dried.

  • use a squirt of OTC fluticasone such as Flonase (a hydrocortisone spray) after cleaning the skin and before applying an adhesive barrier or the Pod itself. Others have reported success asking for an asthma inhaler prescription and using it as a skin spray, or using a Benadryl spray.

  • use a systemic anti-allergy medication such as cetirizine (Zyrtec/Reactine). A prescription allergy medication may be required.

  • don’t forget to thoroughly clean the skin after taking out a Pod

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Adhesive allergy: additional adhesive layer

If simple steps don’t work, the next step is to place an alternative adhesive layer underneath the Pod, so as to only subject the skin to the alternative adhesive. The key is to find the right adhesive, which will not generate a similar allergic reaction. These adhesives are discussed in an upcoming wiki on Dexcom and pump adhesives. Popular adhesive layers include:

In this case, the application sequence might be:

  • pick an area of skin fully recovered from previous Pod insertions

  • clean quickly with alcohol to remove oil from skin (those whose skin reacts to alcohol should skip that step)

  • clean skin with warm water and mild antibacterial soap.

  • dry thoroughly. Do not use a used towel (only a clean cloth towel, a clean paper towel, or air).

  • apply multiple layers of adhesive barrier (see above).

  • apply alternative adhesive layer, cutting out a small window where the canula will insert through skin (depending upon the actual alternative layer, some users do insert the canula straight through the adhesive layer without cutting an opening).

  • apply Pod on top of alternative adhesive layer. it may be useful to apply SkinTac or equivalent prior to applying the Pod, or to drench the Pod adhesive layer with SkinTac (or both), to improve adhesion.

  • don’t forget to clean the skin well and remove adhesives on skin after getting rid of Pod.

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In the case of a serious allergic reaction that has not been contained by more prosaic precautions, we enter a domain where experimentation and substitution of multiple possible steps is likely necessary. Many sufferers have posted reports of their own trials. The following steps have seen success in the past.

Cut down the Pod adhesive area

Decreasing the total adhesive area of the Pod will decrease the potential allergy risk. By cutting down on the adhesive area, you also decrease the adhesive power, so it will be important to do everything possible to boost adhesive capabilities of the final assembly. One particular difficulty is dealing with water (shower, or, worse, swimming): drying the assembly with a hair dryer after every exposure to water may be necessary.

Two layers of alternative adhesive

Some people have reported success by using two successive layers of the same alternative adhesive. In that case, it may be useful to use SkinTac or an equivalent adhesive under the second layer as well, and under the Pod. As for a single layer, make sure to cut out an opening for the canula through both layers.

Hydrocolloid dressing instead of alternative adhesive

Many people report success with the use of a hydrocolloid dressing such as J&J Tough Pads to isolate the skin from the Pod adhesive. Again, it may be a good idea to apply SkinTac to the top of the hydrocolloid dressing, in multiple layers, prior to applying the Pod, or to drench the Pod with Skintac once it is on. Some people cut out a small window for the canula to come through, while others insert the canula through the Tough Pad.

At the moment (9/2017), J&J Tough Pads, the most popular and cost-effective of hydrocolloid dressings, appear to be unavailable for some unclear reason. Many alternative hydrocolloid dressings are available, typically for a higher cost :frowning: . Some of them include Tegaderm hydrocolloid dressing #90001, Tegaderm thin hydrocolloid dressing #90021, or CVS Hydrocolloid Bandages. It is possible to cut these dressings to size. It is sometimes necessary to trim the Pod adhesive pad in order to fit the thick part of the dressing.

Layer of alternative adhesive below a hydrocolloid dressing

If lesser options are unsuccessful, it is possible to use a first layer of alternative adhesive, chosen among those that do not generate an allergic reaction, followed by a hydrocolloid dressing below the Pod. As usual, judicious use of SkinTac or another adhesive barrier is recommended between layers.

Adhesive remover

Once the Pod is done, an adhesive remover makes removal easier, causes less damage to the skin, and leaves less residue on the skin afterwards. Adhesive removers that people have used with success in the past include SkinTac Tacaway remover, Uni-Solve, Smith & Nephew Remove (for fragile skin, with aloe), J&J baby oil, Neosporin ointment (I can’t imagine this is a good idea but several people seem to swear by it), and Goo-Gone (true!). Several of these come in convenient wipes, and can also be used to remove the adhesive residue on the skin once the Pod has been removed. Rachel Morgan uses calendula oil for little Henry to clean up residue after a Pod is off.

After completing residue removal, don’t forget to thoroughly wash the area with warm water and a mild soap.

Post-removal skin treatment

To improve skin healing and regeneration and prevent future reactions, some report using different substances on the Pod site once it has been removed. One popular option is prescription hydrocortisone cream or spray.

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Good adhesion: keeping the Pod on for 3 days or more

Many of the practices required to mitigate or suppress allergic reactions to the adhesive pad result in lessened adherence for the Pod: after all, the function of the adhesive is to hold the Pod on the skin! So it is particularly important to look at what can be done to improve adhesion. Three practices are often mentioned by allergy sufferers:

  • extensive use of adhesive barriers such as SkinTac at multiple parts of the cycle (to increase adhesive strength), but in particular on the skin and under/on the Pod itself. Drenching Pod itself, particularly when it has been trimmed, is often mentioned.

  • use of an additional adhesive layer on top of the Pod adhesive (but not the Pod itself), extending out all the way to the skin outside the substrate.

  • it is possible that sealing the full substrate with an adhesive like SkinTac once it is fully assembled may help keep the dissolving power of water at bay

Because insulin is sensitive to high temperatures, it is risky to hairdry a Pod substrate that has been exposed to water (whereas the same procedure with a CGM sensor is not a problem).

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Example: serious allergic reaction to adhesive

There probably are as many routines to deal with Omnipod allergies as there are allergy sufferers. The right routine to a specific allergic condition is often reached after many failed attempts. As an example, the following routine could be the routine of a specific PWD suffering from a significant Pod allergy (your own routine WILL be different):

  • thoroughly clean the site with alcohol to destroy germs and remove oils

  • immediately wash thoroughly with warm water and mild soap, to prep skin and decrease chance of alcohol reaction

  • dry thoroughly with air

  • spray a couple of squirts of Flonase over site area

  • lay out a large SkinTac layer; let dry till tacky to the touch; redo two more times

  • cut out a canula opening in a Tegaderm dressing; apply to site; spend 30 seconds brushing fingers over Tegaderm to improve adhesion

  • apply one layer of SkinTac as previously

  • apply a hydrocolloid dressing to site, cutting out a Canula opening; spend 30 seconds brushing fingers over Tegaderm to improve adhesion

  • apply one layer of SkinTac as previously

  • trim Pod to minimal area, to decrease allergy potential.

  • soak Pod’s adhesive layer with SkinTac (using bottle applicator, not wipe).

  • apply Pod to site on top of hydrocolloid dressing; brush and tap Pod adhesive for one to two minutes with fingers to apply it securely; quickly apply Tacaway adhesive remover to fingers to get rid of SkinTac, then wash fingers in lukewarm water and soap to avoid reaction to alcohol

  • apply a wide layer of SkinTac as previously, on top of all adhesive layers and of the bordering skin

  • apply large sports Grif Grip dressing (they are pre-punched for the Pod) on top of Pod and surrounding skin to improve adhesion

When removing Pod:

  • apply Tacaway adhesive remover to area; wait 5 minutes

  • gently and slowly peel all layers at once

  • wash with lukewarm water and mild soap; dry well

  • apply calendula oil to remove adhesive residue

  • wash with lukewarm water and mild soap; dry well

  • apply antiallergenic moisturizer

When Pod has been soaked in water:

  • when possible, quickly dry with hairdryer

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Sources and Resources

There are hundreds of threads discussing allergic reactions to Omnipod (or to Dexcom sensors, a similar process as we discussed) on the DOC. I have found the following links to be particularly helpful:

Arden’s Day: http://www.ardensday.com/blog/gp/morganrash

This is Caleb (Lorraine): https://thisiscaleb.com/2011/02/24/dexcom-adhesive-irritation-allergy/

Inspired by Isabella: http://inspiredbyisabella.com/trial-error-and-flonase/

Arceneaux Family: http://arceneauxfamily.blogspot.com/2013/11/the-dreaded-dexcom-rash.html

Kerri Sparling at SixUntilMe: http://sixuntilme.com/wp/2014/06/25/dexcom-rash/

Insulet product guide p.15: http://insulet-prod-myomnipod-com-v2.azurewebsites.net/patient_guide/PatientResourceGuide.pdf#page=16

tuDiabetes – Best method for removing Dexcom adhesives: http://www.tudiabetes.org/forum/t/best-method-for-removing-dexcom-adhesive/9137

tuDiabetes – Omnipod Rash: http://www.tudiabetes.org/forum/t/omnipod-rash/54540

tuDiabetes – G4 adhesive issues: http://www.tudiabetes.org/forum/t/g4-adhesive-issues/13626/

Children with Diabetes – successful use of Dexcom w adhesive allergy: https://forums.childrenwithdiabetes.com/showthread.php?73114-Successful-use-of-Dexcom-w-adhesive-allergy

End of wiki ---------- comments start here

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Hi, thanks for all your research on allergies to dexcom and pumps. I developed an allergy to both when I was 7 months pregnant (at that point had been Type 1 for 2 years and used Tslim for 1 year with no allergies and dexcoms for 2 months with no problems). The pump is more of a problem than the dexcom and it seems like it’s the actual insertion that is the most irritated although it itches all around too. When I take the set off it is crusty and I even think the crustyness (sorry, gross) interferes with absorption heading into day 3 of the set infusion. Have you heard of people being allergic to insulin as well? It seems I may be allergic to the insulin and both adhesives (dexcom and Tslim). Fun! :stuck_out_tongue_winking_eye: Any words of wisdom from your experience? Thanks, Kellee

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I’ve heard that Sure-T infusion sets (these may be compatible with Mini-Med only) or other infusion sets with a metal canula/needle can be helpful when you’re having an allergic reaction. I personally haven’t used them, so hopefully any members who have can comment on them.

I don’t know if these types of infusion sets are possible on the omnipod, but they might be for the Tslim.

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@Kelleebeth, so sorry you are experiencing these reactions :frowning:

If you experience such strong reactions, then it is likely it is interfering with day 3 absorption. The first thing you can do about it is get a day-day change prescription for your pump, so that you can change after day 2.

it could be that it is because it is at the center. One way to find out is to take out a canula (with pliers or…), and to wear the set or pod for a few days with no insulin or insertion. Have you tried that out yet?

Yes. It happens, but it is quite rare. Here is an NIH reference:

But, based on your symptoms, it does not seem to me that this would be a problem to you? I could be totally wrong. What do you think?

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Thank you so much for responding! I just realized you had responded. I didn’t know how the FU diabetes emails worked. Since then I’ve tried 1) Benadryl cream under tape, recommended by endo (makes tape not stick AT ALL) 2) Putting a hole in an IV 3000 cut in half and putting Benadryl in the hole where the skin is exposed and on the needle/cannula before it goes in. 3) Humalog instead of Novalog

The second one worked well I think but sometimes things work and then stop working. Let’s hope it continues to work. The Humalog I tried without any other methods so that I would know it was really what made the difference or not. Humalog might have worked or maybe Benadryl had already soothed the issue somehow even though I didn’t use it with the Humalog but used it in the weeks before.

Sorry, long post but wanted to be thorough in explaining.

Thanks again for all your research!

Kellee

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Thanks for letting us know what is working and not. It really helps others in the similar situations.

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So glad you found something that works! It is really good of you to let all know of your results. I hope you will keep on updating us!

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Do you mean that you put Benadryl cream on the needle before inserting it? If so, how do you keep it sterile?

I’m allergic to the plastic and metal cannulas, as well as to the tape. I’ve found good success with a combination of daily antihistamines (essential for me), Cavilon cream under the set/sensor, and putting Hypafix tape on top of the set and Opsite Flexifix tape on top of the sensor (I wear the sensor for about a month), and putting Benadryl on the site several times after removal helps. But I do still find myself having to change infusion sets often, sometimes every 12-24 hours, and with at times unbearably itchy sensor sites (but I don’t change that). I have been meaning to try adding Flonase sprayed on sites to my routine, but I keep forgetting to pick some up.

I never thought of putting Benadryl cream on the actual needle itself (I use the needle sets), but I may try it.

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