Cyclical hypersensitivity, anaphylaxis, and related hormonal reaction

Abstract

Although endogenous or exogenous exposure to progesterone or estrogen that induce a spectrum of hypersensitivity reactions and/or other skin eruptions are believed to be uncommon, their prevalence is currently unknown. Clinical manifestations are heterogeneous but typically involve cyclical manifestation of a spectrum of dermatitis conditions and/or systemic symptoms. Diagnosis is made primarily by history in conjunction with in vitro assays to measure specific IgE and provocation challenge testing when appropriate; judicious use of skin testing is recommended because of their irritant-causing effects. Pathomechanisms are incompletely understood but likely involve IgE-mediated immediate-type hypersensitivity. Treatment is aimed at symptomatic control with nonsedating histamine 1 antihistamines, short-term use of systemic glucocorticoids, progesterone desensitization, and/or suppression of ovulation by a pharmacologic or, as a last resort, surgical approach. Instructions Credit can now be obtained, free for a limited time, by reading the review article and completing all activity components. Please note the instructions listed below: Review the target audience, learning objectives and all disclosures. Complete the pre-test. Read the article and reflect on all content as to how it may be applicable to your practice. Complete the post-test/evaluation and claim credit earned. At this time, physicians will have earned up to 1.0 AMA PRA Category 1 Credit TM. Minimum passing score on the post-test is 70%. Overall Purpose Participants will be able to demonstrate increased knowledge of the clinical treatment of allergy/asthma/immunology and how new information can be applied to their own practices.

Autoimmune Progesterone Dermatitis: A Systematic Review

“…One hundred twelve articles were found to include a case report meeting our inclusion criteria 3–114 . Within these articles, 132 unique cases of AIPD were identified.…”

Whole course of treatment of autoimmune progesterone dermatitis that had spontaneously resolved during pregnancy: A case report and review of the literature

“…Based on current clinical data, progesterone patch is not effective and is not routinely performed. Alternatively, intramuscular injection of progesterone using a concentration of 12.5 to 25 mg of progesterone can be used as an alternative diagnostic test ( 55 ). Both intramuscular or oral progesterone can induce the disease.…”

“…Both intramuscular or oral progesterone can induce the disease. However, it is not carried out much in clinical practice due to pain at the intramuscular injection site and poor patient cooperation ( 34 , 55 ). In vitro tests are also increasingly important for detecting APD, such as the leukocyte histamine test (LHR) to assess histamine release from basophils and the interferon-gamma release test to assess progesterone-related T-cell-mediated activity, as well as the enzyme-linked immunosorbent assay (ELISA) to assess progesterone-specific IgE (sIgE), as mentioned earlier ( 34 , 35 , 56 , 57 ).…”

Critérios clínicos para diagnóstico e tratamento adequado da anafilaxia perioperatória

“…Esse resultado apresentou como causa mais comum os BNM que são responsáveis por 69.2% das reações alérgicas, seguidos pelo látex com 12.1% e os antibióticos com 8% dos valores totais, esses tipos de reações de hipersensibilidade mediada por IgE (Misbah & Krishna, 2019). Com prevalência de incidência anual no gênero feminino (Lavery & Bernstein, 2019).…”

“…Assim, distribui-se os casos anafiláticos assumindo as respectivas porcentagens de incidência: bloqueadores neuromusculares como agentes em 50 a 70%, látex em 12% a 16%, antibióticos ficando com 15%, hipnóticos com 3,0% e opioides com 1,3% (Haque & Nossaman, 2012). Já em questão de prevalência o quadro de anafilaxia tem maior reiteração no sexo feminino aproximadamente 3:1 se comparado com o sexo masculino, tendo uma ligação direta com os hormônios sexuais (Lavery & Bernstein, 2019).…”