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Current Allergy and Asthma Reports

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01-01-2018 | Anaphylaxis and Drug Allergy (DA Khan and M Castells, Section Editors)

Progestogen Hypersensitivity

Authors: Rung-Chi Li, Kathleen M. Buchheit, Jonathan A. Bernstein

Published in: Current Allergy and Asthma Reports | Issue 1/2018

Abstract

Purpose of Review

Progestogen hypersensitivity (PH) is a rare disorder which usually occurs in women of childbearing age with symptoms ranging from urticaria with or without angioedema, multiple organ involvement consistent with allergic anaphylaxis, to a spectrum of other non-evanescent skin eruptions. In this review, we present a clinical vignette of PH and discuss the clinical presentation and proposed pathomechanisms, diagnosis, and treatment of PH.

Recent Findings

The hypersensitivity symptoms are associated with exogenous progestin exposure (e.g., contraceptive medicines, in vitro fertilization therapy) or endogenous progesterone from progesterone surges during the luteal phase of the menstrual cycle and pregnancy. Recognition of this condition can be challenging to the clinician due to its heterogeneous clinical presentation. It has been recently proposed to use the new term “progestogen hypersensitivity” to replace “autoimmune progesterone dermatitis” due to the lack of evidence supporting an autoimmune mechanism for this disorder. In addition, diagnostic and treatment algorithms are now available that can lead to successful management of this condition. More new developments of Progesterone desensitization protocols are now available which appear to be the safest and most effective long-term treatment option for PH.

Summary

With the extensive use of oral contraceptives and increased use of supra-physiologic doses of progesterone to support pregnancy in in vitro fertilization, there is likely to be a higher prevalence of PH in the future than currently recognized. Therefore, the allergist-immunologist will be required to collaborate with gynecologists and reproductive endocrinologists to diagnose and treat this condition.

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Title: Progestogen Hypersensitivity
Authors: Rung-Chi Li
Kathleen M. Buchheit
Jonathan A. Bernstein
Publication date: 01-01-2018
Publisher: Springer US
Published in: Current Allergy and Asthma Reports / Issue 1/2018
Print ISSN: 1529-7322
Electronic ISSN: 1534-6315
DOI: https://doi.org/10.1007/s11882-018-0758-x

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Progestogen Hypersensitivity

Abstract

Purpose of Review

Recent Findings

Summary

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Abstract

Purpose of Review

Recent Findings

Summary

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