Q:

3/25/2013
Patient with auto immune progesterone dermatitis (positive skin test) is off "progesterone" birth control but still symptomatic monthly. Can we desensitize for progesterone?

A:

Thank you for your inquiry.

The article, abstracted and copied below, will give you protocols for desensitization to progesterone, and also a bibliography from which you can find other protocols. In addition, we have a number of entries on our Ask the Expert website regarding autoimmune progesterone dermatitis as well as progesterone anaphylaxis and urticaria. These will give further protocols for skin testing and other information which you may find helpful in the future management of your patient.

Thank you again for your inquiry and we hope this response is helpful to you.

Fertil Steril. 2011 Mar 1;95(3):1121.e9-13. doi: 10.1016/j.fertnstert.2010.10.038. Epub 2010 Nov 18.
Autoimmune progesterone dermatitis: clinical presentation and management with progesterone desensitization for successful in vitro fertilization.
Prieto-Garcia A, Sloane DE, Gargiulo AR, Feldweg AM, Castells M.
Source
Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Abstract
Objective: To report clinical cases of autoimmune progesterone (P) dermatitis, its relationship to IVF, and the potential for P desensitization to treat these cases to achieve viable pregnancies.
Design: Clinical description.
Setting: Institutional hospitalary practice. Allergy Division.
Patient(s):  Six patients from the Allergy Clinic consulting for cyclic rashes or anaphylaxis related to the luteal phase of the menstrual cycle. Three of the conditions were related to IVF.
Intervention(s): Skin tests were performed with P. For IVF, rapid 8- and 10-step P desensitization protocols were performed, with increasing doses administered every 20 minutes via intravaginal suppositories. A rapid oral desensitization protocol was performed in one patient who required an oral contraceptive for uterine bleeding.
Main Outcome Measure(s): Progesterone skin test results. Tolerance to P desensitization. Achievement of viable pregnancies.
Results(s):  Skin tests were positive in all patients and negative in 10 controls. Desensitization was successful in four patients: three patients for IVF, resulting in viable pregnancies. Another patient achieved tolerance to oral contraceptives.
Conclusion(s): Women with autoimmune P dermatitis can be desensitized successfully to P. We provide the first evidence of successful P desensitization in patients requiring IVF culminating in successful pregnancies.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology