Progestogen Hypersensitivity: Heterogeneous Manifestations with a Common Trigger

Hypersensitivity to progestogen, previously known as autoimmune progesterone dermatitis, is an increasingly recognized clinical entity that presents specific diagnostic and treatment challenges. Clinical presentations are heterogeneous, but can consist of hypersensitivity symptoms associated with the progesterone surge during the luteal phase of the menstrual cycle or after exposure to exogenous progestins. With the increasing use of exogenous progesterone for contraception and fertility, more cases of hypersensitivity to exogenous progestins have been described. Here we will review proposed pathomechanisms for progestogen hypersensitivity (PH) as well as the clinical presentation of PH, testing strategies to aid in diagnosis, and treatment options for patients with hypersensitivity to progestogens.