Estrogen and progesterone sensitivity and desensitization

Question:

3/7/2018
I was asked to consult on a is 12-year-old female that presented vaginal bleeding for 3 weeks. She was placed on high dose Ortho Tri-Cyclen taper. She had a negative pregnancy test and a normal TSH at that time. She was also prescribed Zofran to help with nausea associated with taking large amounts of OCP's. After her 3rd day of Ortho Tri-Cyclen and Zofran she developed facial swelling and throat closing and so presented to our ED. She remained alert and active. She had no cough wheezing or chest pain. She had no abdominal pain or vomiting. She had no urticaria only associated facial swelling. She has never had a known allergic reaction in the past. She did report feeling like her throat was tight and mildly closing. She had no stridor or wheezes. She had clear lung sounds and a soft benign abdominal exam. She was standing up in the room changing clothes on initial evaluation without difficulty. Secondary to her feeling of throat closing she was given 0.3 mg of IM epinephrine in the ED. She was also treated her with Benadryl and Zantac and prednisone. I was contacted by her Ob-Gyn to assist in desensitization to estrogen as she was placed on Medroxyprogesterone 10 mg after this episode and although had no reactions continued to have significant vaginal bleeding. Unfortunately, I have not been able to find any desensitization protocols for estrogen. My questions for her Ob-Gyn are as follows:

1. Are there any alternatives of a combined estrogen/progesterone pill that she might be able to use?
2. She likely needs skin testing first to progesterone (we stock) and also estrogen (I’ve seen 2 places to order in prior ask the expert questions) but most due to estrogen dermatitis not reported 'anaphylaxis'.
3. Almost exclusive data is on progesterone not estrogen in regards to steroid allergy and desensitization. I could find very few case reports of estrogen dermatitis and fewer (if any estrogen desensitization protocols) and most due to PMS, recurrent miscarriage, etc.
4. Would it be useful to do a patch test to a combination OCP with estrogen and then– if she tolerates that form – is that sufficient (knowing that is more for a delayed reaction).
5. She had no labs IgE/CBC or tryptase – indicating for sure IgE mediated reaction.
6. Is there a desensitization protocol for estrogen and would it be useful for this patient?

I appreciate you input on this patient.