Clinical characteristics of exogenous progestogen hypersensitivity

Abstract

Background: Autoimmune progesterone dermatitis is a rare disease characterized by eruption recurrence in the luteal phase of each menstrual cycle. As synthetic progesterones are increasingly used for assisted reproductive techniques (ARTs) for infertility or prevention of abortion, cases of dermatitis caused by exogenous progesterone have been reported. Objective: To investigate the clinical characteristics of exogenous progestogen hypersensitivity (PH). Methods: We retrospectively reviewed data from patients presenting with dermatitis induced by exogenous progesterone between 2011 and 2016. Results: Nine patients had exogenous PH. Six patients were treated with progesterone for threatened abortion, and three for ARTs. Their mean age was 33.6 years, and their mean body mass index was 26.3 kg/m2. They had never experienced an adverse drug reaction. The mean latency to symptom onset was 5.8 days (range 1 h to 11 days). The patients complained of hives, erythema and itching, and one developed anaphylaxis. All patients were treated with antihistamines, and six patients were treated with systemic corticosteroids. Epinephrine was administered to one patient with hypotension. The symptom duration was 1-14 days. Skin tests were performed in four patients; all were positive. Two patients were treated successfully by progesterone desensitization. Conclusions: The clinical features of exogenous PH were similar to those of type I hypersensitivity reactions, but tended to develop later and did not respond to antihistamines or steroids. As use of progesterone increases, an understanding of the clinical features of exogenous PH becomes ever-more important.