Autoimmune progesterone dermatitis: clinical presentation and management with progesterone desensitization for successful in vitro fertilization.

Fertil Steril 2011 Mar 18;95(3):1121.e9-13. Epub 2010 Nov 18.

Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.

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.

Result(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.

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Source
http://dx.doi.org/10.1016/j.fertnstert.2010.10.038DOI Listing
March 2011

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