Allergy Asthma Respir Dis.  2017 Sep;5(5):294-297. 10.4168/aard.2017.5.5.294.

A case of oral desensitization for hypersensitivity to exogenous progesterone

• Kim YC
• Choi KH
• Kang DY
• Sohn KH
• Cho SH
• Min KU
• Kang HR

• KMID: 2392406
• DOI: http://doi.org/10.4168/aard.2017.5.5.294

Abstract

Hypersensitivity reaction to progesterone is a rare pathologic condition which consists of autoimmune response to endogenous progesterone, known as autoimmune progesterone dermatitis, and hypersensitivity reaction to exogenous progestogen. We report the case of a 31-year-old woman with a history of whole body urticaria during exogenous progesterone supplementation for in vitro fertilization (IVF). She was admitted to the hospital for the diagnosis and management of progestogen hypersensitivity. An intradermal test with progesterone revealed positivity to 5 mg/mL of progesterone. For her next IVF, progesterone desensitization was performed in a method combining oral and intramuscular progesterone administration. After successfully achieving a target dose of 100 mg per day, the route of progesterone administration was converted to intravaginal tablet (90 mg twice a day) without any hypersensitivity reactions.

Keyword

Progesterone; Drug hypersensitivity; Fertilization in vitro; Immunologic desensitization

MeSH Terms

Adult
Autoimmunity
Dermatitis
Desensitization, Immunologic
Diagnosis
Drug Hypersensitivity
Female
Fertilization in Vitro
Humans
Hypersensitivity*
Intradermal Tests
Methods
Progesterone*
Urticaria
Progesterone

Figure

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  Fig. 1. Delayed reaction to progesterone after intradermal progesterone skin test.

Reference

1. Hart R. Autoimmune progesterone dermatitis. Arch Dermatol. 1977; 113:426–30.

2. Nosarka S, Kruger T, Siebert I, Grové D. Luteal phase support in in vitro fertilization: metaanalysis of randomized trials. Gynecol Obstet Invest. 2005; 60:67–74.

3. Cristaudo A, Bordignon V, Palamara F, De Rocco M, Pietravalle M, Picardo M. Progesterone sensitive Interferon-gamma producing cells detected by ELISpot assay in autoimmune progesterone dermatitis. Clin Exp Dermatol. 2007; 32:439–41.

4. Geber J. Desensitization in the treatment of menstrual intoxication and other allergic symptoms. British Journal of Dermatology. 1939; 51:265–8.

5. Guy WH, Jacob FM, Guy WB. Sex hormone sensitization (corpus lute-um). AMA Arch Derm Syphilol. 1951; 63:377–8.

6. Shelley WB, Preucel RW, Spoont SS. Autoimmune progesterone dermatitis. Cure by oophorectomy. JAMA. 1964; 190:35–8.

7. Katayama I, Nishioka K. Autoimmune progesterone dermatitis with peristent amenorrhoea. Br J Dermatol. 1985; 112:487–91.

8. Snyder JL, Krishnaswamy G. Autoimmune progesterone dermatitis and its manifestation as anaphylaxis: a case report and literature review. Ann Allergy Asthma Immunol. 2003; 90:469–77.

9. Baptist AP, Baldwin JL. Autoimmune progesterone dermatitis in a patient with endometriosis: case report and review of the literature. Clin Mol Allergy. 2004; 2:10.

10. Wintzen M, Goor-van Egmond MB, Noz KC. Autoimmune progesterone dermatitis presenting with purpura and petechiae. Clin Exp Dermatol. 2004; 29:316.

11. Asai J, Katoh N, Nakano M, Wada M, Kishimoto S. Case of autoimmune progesterone dermatitis presenting as fixed drug eruption. J Dermatol. 2009; 36:643–5.

12. Lee MK, Lee WY, Yong SJ, Shin KC, Lee SN, Lee SJ, et al. A case of autoimmune progesterone dermatitis misdiagnosed as allergic contact dermatitis. Allergy Asthma Immunol Res. 2011; 3:141–4.

13. Foer D, Buchheit KM, Gargiulo AR, Lynch DM, Castells M, Wickner PG. Progestogen hypersensitivity in 24 cases: diagnosis, management, and proposed renaming and classification. J Allergy Clin Immunol Pract. 2016; 4:723–9.

14. Stranahan D, Rausch D, Deng A, Gaspari A. The role of intradermal skin testing and patch testing in the diagnosis of autoimmune progesterone dermatitis. Dermatitis. 2006; 17:39–42.

15. Farah FS, Shbaklu Z. Autoimmune progesterone urticaria. J Allergy Clin Immunol. 1971; 48:257–61.

16. Jones WN, Gordon VH. Auto-immune progesterone eczema. An endogenous progesterone hypersensitivity. Arch Dermatol. 1969; 99:57–9.

17. Cernadas JR, Brockow K, Romano A, Aberer W, Torres MJ, Bircher A, et al. General considerations on rapid desensitization for drug hypersensitivity: a consensus statement. Allergy. 2010; 65:1357–66.

18. Scherer K, Brockow K, Aberer W, Gooi JH, Demoly P, Romano A, et al. Desensitization in delayed drug hypersensitivity reactions: an EAACI position paper of the Drug Allergy Interest Group. Allergy. 2013; 68:844–52.

19. Prieto-Garcia A, Sloane DE, Gargiulo AR, Feldweg AM, Castells M. Autoimmune progesterone dermatitis: clinical presentation and management with progesterone desensitization for successful in vitro fertilization. Fertil Steril. 2011; 95:1121.e9–13.

20. Hill JL, Carr TF. Iatrogenic autoimmune progesterone dermatitis treated with a novel intramuscular progesterone desensitization protocol. J Allergy Clin Immunol Pract. 2013; 1:537–8.