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. 2023 Dec;11(12):3606-3613.e2.
doi: 10.1016/j.jaip.2023.07.050. Epub 2023 Aug 12.

Progestogen Hypersensitivity

Sergio E Chiarella  1 , Kathleen M Buchheit  2 , Dinah Foer  2
Affiliations

Progestogen Hypersensitivity

Sergio E Chiarella et al. J Allergy Clin Immunol Pract. 2023 Dec.

Abstract

Progestogen hypersensitivity (PH) is a heterogeneous disease characterized by diverse cutaneous manifestations, bronchospasm, and/or anaphylaxis. Possible triggers include ovarian progesterone and exogenous progestogens. The timing of symptoms is critical to diagnose PH: during the luteal phase of the menstrual cycle for the endogenous form and after exposure to progestins for exogenous PH. Diagnostic modalities such as progesterone skin testing have low sensitivity and specificity for PH. When exogenous PH is suspected, the allergist should consider a progestogen challenge. Treatment strategies should be tailored for each patient, including symptom-directed therapies, ovulation suppression, and progesterone desensitization. Future studies should explore the mechanisms of PH, validation of diagnostic criteria, and standardization of treatment strategies.

Keywords: Autoimmune progesterone dermatitis; Endocrine allergy; Infertility; Menstrual cycle; Progesterone; Progestin; Steroid hormone allergy.

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Conflict of interest statement

Conflicts of interest:

The authors declare that they have no conflict of interest.

Figures

Figure 1.
Figure 1.
Mechanisms contributing to the pathogenesis of progestogen hypersensitivity include: (A) Type I (immediate); (B) type III (immune complex); and (C) type IV (cell-mediated or delayed) hypersensitivity reactions.
Figure 2.
Figure 2.
The (A) timing and (B) clinical manifestations of progestogen hypersensitivity.
Figure 3:
Figure 3:
Progestogen hypersensitivity management decision tree. A goal-based guide for a systematic approach to manage PH based on patients’ preference/expectations, specifically symptom control versus the need for progestogens for fertility treatments. PH = Progestogen hypersensitivity
See this image and copyright information in PMC

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