1. A case of progesterone-induced anaphylaxis, cyclic urticaria/angioedema, and autoimmune dermatitis.
- Author
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Bernstein IL, Bernstein DI, Lummus ZL, and Bernstein JA
- Subjects
- Anaphylaxis drug therapy, Angioedema, Animals, Antibodies, Monoclonal, Murine-Derived therapeutic use, Autoimmune Diseases chemically induced, Contraceptives, Oral, Combined administration & dosage, Contraceptives, Oral, Combined adverse effects, Contraceptives, Oral, Synthetic administration & dosage, Dermatitis, Drug Eruptions, Enzyme-Linked Immunosorbent Assay, Estrogens administration & dosage, Ethinyl Estradiol administration & dosage, Female, Fertility Agents, Female therapeutic use, Gonadotropin-Releasing Hormone therapeutic use, Hormone Antagonists therapeutic use, Humans, Immunoglobulin E immunology, Immunoglobulin G immunology, Mice, Middle Aged, Mifepristone therapeutic use, Nafarelin therapeutic use, Norethindrone administration & dosage, Progesterone therapeutic use, Urticaria chemically induced, Anaphylaxis chemically induced, Contraceptives, Oral, Synthetic adverse effects, Estrogens adverse effects, Ethinyl Estradiol adverse effects, Norethindrone adverse effects, Progesterone adverse effects
- 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.
- Published
- 2011
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