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Autoimmune progesterone dermatitis: clinical presentation and management with progesterone desensitization for
Alicia Prieto-Garcia1, David E Sloane, Antonio R Gargiulo
1Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Objective:
To report clinical cases of autoimmune progesterone (P) dermatitis, its relationship to IVF, and the potential for P desensitization to treat these cases to achieve viable pregnancies.
Design:
Clinical description.
Setting:
Institutional hospitalary practice. Allergy Division.
Patient(S):
Six patients from the Allergy Clinic consulting for cyclic rashes or anaphylaxis related to the luteal phase of the menstrual cycle. Three of the conditions were related to IVF.
Intervention(S):
Skin tests were performed with P. For IVF, rapid 8- and 10-step P desensitization protocols were performed, with increasing doses administered every 20 minutes via intravaginal suppositories. A rapid oral desensitization protocol was performed in one patient who required an oral contraceptive for uterine bleeding.
Main Outcome Measure(S):
Progesterone skin test results. Tolerance to P desensitization. Achievement of viable pregnancies.
Result(S):
Skin tests were positive in all patients and negative in 10 controls. Desensitization was successful in four patients: three patients for IVF, resulting in viable pregnancies. Another patient achieved tolerance to oral contraceptives.
Conclusion(S):
Women with autoimmune P dermatitis can be desensitized successfully to P. We provide the first evidence of successful P desensitization in patients requiring IVF culminating in successful pregnancies.
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