Autoimmune Progesterone DermatitisAutoimmune progesterone dermatitis (APD) occurs as a result of an allergic reaction to a woman's own progesterone. Symptoms typically occur anywhere from 3 to 10 days prior to the onset of menses, and begin to resolve within 1 to 2 days after the onset of menstruation. APD can have a variety of different symptoms, although most, if not all, include skin rashes. These include eczema, hives, fixed drug eruptions, erythema multiforme, angioedema, and even anaphylaxis. It may not initially be obvious to the affected woman that her symptoms are worsened during the premenstrual period, and it often takes a physician to ask the question of worsening symptoms related to the menstrual cycle before the pattern is obvious to the woman.
APD may be caused initially by a woman taking birth control pills or another hormone supplement containing progesterone that results in sensitization to the hormone. Pregnancy can also result in sensitization to progesterone, and pregnancy can have significant effects on the immune system and can dramatically affect a variety of allergic conditions. Other women may develop APD as a result of cross-reactivity with corticosteroids, which have similar molecular structures to hormones. While allergic reactions to other hormones, such as estrogen, can occur, these are far less common than reactions to progesterone.
The diagnosis of APD requires the demonstration of IgE antibodies against progesterone, which is performed with allergy skin testing. Skin testing with progesterone can be performed by most allergists, which may be followed by a drug challenge through the injection of progesterone with close monitoring for symptoms. This procedure should only be performed by a physician skilled in the diagnosis and treatment of allergies and anaphylaxis, given the possibility that a dangerous allergic reaction could occur as a result of the testing.
Treatment of APD may be successful with the use of antihistamines and oral or injected corticosteroids, although these medications would only be useful to treat the symptoms rather than correcting the problem. Therapies that suppress ovulation, such as leuprolide, prevent the rise of progesterone during the menstrual cycle and are the preferred treatments for APD. Rarely, surgical removal of the ovaries and uterus is required in severe cases of APD when medications are unable to control the symptoms.
Catamenial AnaphylaxisCatamenial anaphylaxis is another condition that is related to the menstrual cycle. Woman who have this condition experience symptoms of anaphylaxis as soon the menstrual flow begins, and symptoms continue until the menses flow stops. Unlike APD, however, catamenial anaphylaxis is not an allergic condition, but rather is caused by prostaglandins released from the lining of the uterus (endometrium), which may be absorbed into the bloodstream. The diagnosis is usually made on a clinical basis, as allergy testing to progesterone (and other hormones) is negative. Treatment of catamenial anaphylaxis has been successful with the use of non-steroidal anti-inflammatory medications (NSAIDs), such as Indocin (indomethacin). Surgical removal of the ovaries and uterus is required in severe cases of catamenial anaphylaxis when medications are unable to control the symptoms.
Learn more about how asthma can worsen during a woman's menstrual period.
Snyder JL, Krishnaswamy G. Autoimmune Progesterone Dermatitis and its Manifestation as Anaphylaxis: A Case Report and Literature Review. Ann Allergy Asthma Immunol. 2003;90: 469-477.
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