Clinical characteristics of exogenous progestogen hypersensitivity

Area of Science:

• Dermatology
• Allergy and Immunology
• Reproductive Endocrinology

Background:

• Autoimmune progesterone dermatitis is a rare condition linked to the menstrual cycle.
• Exogenous progestogen hypersensitivity (PH) cases are increasing due to widespread use of synthetic progesterones in assisted reproductive techniques (ARTs) and pregnancy support.

Purpose of the Study:

• To investigate the clinical characteristics of exogenous progestogen hypersensitivity (PH).

Main Methods:

• Retrospective review of data from patients diagnosed with dermatitis induced by exogenous progesterone between 2011 and 2016.
• Analysis of patient demographics, clinical presentation, latency to symptom onset, treatment, and outcomes.
• Skin testing was performed in a subset of patients.

Main Results:

• Nine patients with exogenous PH were identified, primarily treated for threatened abortion or ARTs.
• Symptoms included hives, erythema, itching, and one case of anaphylaxis, with a mean latency of 5.8 days.
• While treated with antihistamines and corticosteroids, two patients successfully underwent progesterone desensitization.

Conclusions:

• Clinical features of exogenous PH resemble type I hypersensitivity but present with delayed onset and reduced response to standard treatments.
• Increased progesterone use necessitates greater awareness and understanding of exogenous PH clinical features.
• Progesterone desensitization may be a viable treatment option for select patients.