Introduction
Women of reproductive age can develop hypersensitivity reactions to progestogens, manifesting as a diverse array of cutaneous or systemic allergic reactions that temporally correspond with relative peaks in serum progesterone levels. Exogenous or endogenous sources of progesterone may be responsible for these effects. Progestogen hypersensitivity manifests itself in various ways, and in women of reproductive age, it can appear at any point from menarche to menopause.
People with progestogen hypersensitivity may get skin problems that worsen three to ten days before their period. Anaphylaxis may develop from progestogen hypersensitivity. An allergic reaction that is abrupt and potentially fatal has occurred.
Progestogen hypersensitivity has an unclear specific etiology, but many affected women have been exposed to progesterone from outside sources, such as oral contraceptives or fertility medications. Some women have progestogen hypersensitivity in reaction to the body's natural progesterone production.
The symptoms, a clinical examination, and a skin test are used to make the diagnosis. Progesterone-blocking or progesterone-inhibiting drugs may be part of a treatment plan focusing on symptom management.
What Is the Biology Behind Progesterone?
Progesterone is a cholesterol-derived steroid hormone that plays various metabolic and physiological roles in the menstrual cycle, pregnancy, embryogenesis, and breastfeeding. Progesterone not only aids in reproduction but also works as an anti-inflammatory and a regulator of T-lymphocyte-mediated immune responses.
Progesterone levels increase soon before ovulation and peak during the luteal phase of a 28-day menstrual cycle or around one week before the onset of menstruation. The ovary's corpus luteum primarily produces progesterone and is crucial in promoting endometrial alterations that prepare the uterus for embryo implantation. Without implantation, the corpus luteum will recede, and the ensuing decline in progesterone will cause menstruation.
The corpus luteum first produces progesterone, but subsequently, the placenta takes over as the primary source of progesterone in pregnancy. If pregnancy does occur, progesterone levels climb throughout the pregnancy. Progesterone helps to facilitate pregnancy during gestation by lowering maternal immunological responses. It also has additional physiological effects, such as reducing uterine smooth muscle contraction and preventing lactation during pregnancy.
What Causes Progesterone Hypersensitivity?
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There is no recognized cause of progesterone hypersensitivity. According to some scientists, hormonal birth control may be involved. It might also be connected to progesterone-containing supplements.
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The hormone may become sensitive as a result of these exposures. This is when an allergen, a chemical that triggers an allergic reaction, no longer bothers the body as much.
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Progesterone sensitization may also be brought on by pregnancy. The immune system might be affected by pregnancy. It may also involve various allergy diseases.
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Other hormones, such as estrogen, can also cause allergic responses. But these are much less typical.
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The increased use of progestins for contraception, fertility treatment, and hormone replacement therapy will increase the risk of progesterone hypersensitivity.
What Are the Symptoms of Progesterone Hypersensitivity?
Progesterone hypersensitivity signs typically show up three to ten days before the start of menstruation. They start to disappear one to two days following the first day of the period.
Various symptoms can be associated with progesterone hypersensitivity. The majority, if not all, include rashes on the skin.
Progesterone hypersensitivity can cause various skin rashes, such as:
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Eczema - An itchy, red rash is a symptom of the skin disorder.
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Hives - Raised bumps that develop on the skin's surface.
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Erythema Multiforme - It is a reaction that typically affects the hands and arms. Fixed drug eruption is a reaction that recurs in the same place in the body.
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Angioedema - It is an under-the-skin hive-like swelling.
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Anaphylaxis.
How Is Autoimmune Progesterone Dermatitis Diagnosed?
Autoimmune progesterone dermatitis is often diagnosed based on clinical history (particularly the timing of symptoms around the menstrual cycle) and signs of progesterone-induced skin response. Progesterone is typically administered via skin pricking or needle injection into the skin (intradermal) or muscle (intramuscular). Testing is successful when a skin rash known as a "wheal-and-flare" appears and lasts for at least 24 to 48 hours.
Eosinophil count, quantitative immunoglobulin and complement measures, and the examination of hormonal variables, including luteinizing hormone, progesterone, and estradiol, are a few other diagnostic procedures documented in the medical literature.
How to Treat Progesterone Hypersensitivity?
The following plan is commonly used in the treatment of progesterone hypersensitivity:
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Some allergists may perform a skin test. However, this form of testing has yet to be confirmed.
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Antihistamines can be used to treat progesterone hypersensitivity. These medications work by inhibiting the action of substances that cause allergic responses.
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Oral or injectable corticosteroids can also be used to treat progesterone hypersensitivity. These are anti-inflammatory medications.
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Unfortunately, these medications merely treat the symptoms. They do not address the underlying cause of the problem.
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Other therapies prevent the ovaries from producing an egg. Leuprolide, a prescription medication, reduces the increase in progesterone after ovulation. If antihistamines do not work, this is a possibility.
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Surgery to remove the uterus and ovaries is only used in rare cases. This is done in severe circumstances when drugs fail to control the symptoms.
Conclusion
For women of reproductive age, progesterone hypersensitivity is an underdiagnosed syndrome yet has significant repercussions. The pathobiology of the disease is unknown; however, considering the broad spectrum of symptoms in progesterone hypersensitivity patients, it is probably complex.
The clinical manifestations are diverse and might include cutaneous symptoms, including dermatitis, urticaria, erythema multiforme, fixed drug eruptions, and more severe hypersensitivity reactions like bronchospasm or anaphylaxis.
For the syndrome to be identified, it is essential to link the onset of the symptoms to either endogenous or exogenous progesterone exposure. The pillars of treatment for progesterone hypersensitivity, particularly for people interested in fertility and pregnancy, are medical management like corticosteroids and desensitization.
