Autoimmune progesterone dermatitis: Clinical presentation and management with progesterone desensitization for successful in vitro fertilization

Abstract

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. ©2011 by American Society for Reproductive Medicine.