A Case of Progesterone-Induced Anaphylaxis, Cyclic Urticaria/Angioedema, and Autoimmune Dermatitis

David I. Bernstein, Zana L. Lummus, Jonathan A. Bernstein
In: Journal of Women's Health · 2011 · vol. 20(4) , pp. 643–648 · doi:10.1089/jwh.2010.2468 · PMID:21417747 · W2094065173
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This case report details a patient with progesterone-induced anaphylaxis, cyclic urticaria, and autoimmune dermatitis who responded to gonadotropin-releasing hormone agonist therapy, which eliminated specific progesterone antibodies.

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Abstract

OBJECTIVE: Women have exhibited anaphylaxis, urticaria/angioedema, and autoimmune progesterone dermatitis (APD) coinciding with the progesterone premenstrual rise. We report a detailed immunological evaluation of such a woman responsive to a gonadotropin hormone-releasing agonist (GHRA). METHODS: Skin testing, enzyme-linked immunosorbent assays (ELISAs), leukocyte histamine release (LHR), and inhibition assays were performed to demonstrate progesterone immunoresponsiveness. RESULTS: Serum specific-progesterone immunoglobulin G (IgG) and IgE were detected initially and disappeared 6 months after GHRA treatment. Dose-response LHR using patient basophils was observed for different hormones but after 3 months persisted only for 5β-pregnanediol. Preincubation with mouse antiprogesterone monoclonal antibody (PmAb) or mifepristone, a progesterone inhibitor, over a range of doses inhibited specific progesterone-induced LHR. Experiments with varying progesterone concentrations and a fixed dose of anti-IgE resulted in 100% LHR at a concentration as low as 0.016 nmol/mL, which, without anti-IgE, failed to release histamine. CONCLUSIONS: This is the first report of combined recurrent anaphylaxis, cyclic urticaria/angioedema, and APD induced by immunoresponsiveness to progesterone.

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