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

The autoimmune bases of infertility and pregnancy loss

“…Intolerance to sex steroid hormones is not uncommon and may present in numerous forms including premenstrual syndrome, dysmenorrhea, and mammary pain with a cyclic pattern resembling the menstrual cycle. In some cases, infertility and recurrent miscarriages may manifest in patients with progesterone hypersensitivity [5,6] through enigmatic mechanisms, possibly similar to IgE-associated drug hypersensitivity. The most used therpaeutic approach is based on hormone desensitization, commonly in three steps, resulting in successful IVF [5].…”

“…Similarly, cytokine modulation can also be used acting on Th2 and Th1 molecules, albeit in opposite ways. The possibility of an autoimmune response to steroid hormones presenting with infertility [5] or pregnancy loss [6] should be considered in this scenario.…”

Autoimmune progesterone dermatitis: Case report of an unexpected treatment reaction

“…Regarding the pathogenesis of this particular case, it seems to be IgE mediated, due to urticaria manifestations, but is also T‐cell driven in light of the vasculitic aspect of some lesions and the inflammatory systemic reaction after contact with a vaginal ring. Some authors have described a process of desensitising patients by using vaginal suppositories with incremental doses of progesterone . Nevertheless, there are no published data on the use of the hormonal vaginal ring in this setting.…”

Autoimmune progesterone dermatitis: Case report with history of urticaria, petechiae and palpable pinpoint purpura triggered by medical abortion

“…[6,[10][11][12] APD is a rare disorder characterised by cyclic eruption of varying morphology and distribution. [9,[14][15][16] The eruption is induced by hypersensitivity to endogenous progesterone, and typically occurs during the luteal phase of the menstrual cycle as serum levels of this hormone increase. Partial to complete resolution occurs within days of menstruation, with recurrence during the next menstrual cycle.…”