Challenges in skin testing for progestogen hypersensitivity

Abstract

Progestogen hypersensitivity (PH) is an increasingly recognized heterogeneous clinical entity that presents as hypersensitivity symptoms associated with progesterone surge during the luteal phase of the menstrual cycle or after exposure to exogenous progestins.1 The diagnosis of PH requires a careful clinical history and assessment to evaluate other potential triggers, and at minimum, compatible symptoms associated with exposure to endogenous or exogenous progestogens. Testing modalities used to support the diagnosis include progesterone skin testing, progesterone challenge, inhibition of ovulation with gonadotropin-releasing hormone agonists, response to progesterone desensitization, and several in vitro assays.