Dermographic Urticaria Associated With The Use Of Progesterone In Cottonseed Oil

Abstract

RationaleWe report a series of nine patients who developed acute urticaria with a major dermographic component, and one patient with an anaphylactic reaction, after serial intramuscular injections with progesterone in cottonseed oil for the treatment of infertility.MethodsSkin testing with progesterone powder in cottonseed oil (50 mg/mL) mixed with 10% benzyl alcohol was performed in ten patients. Immunocap RAST testing was completed for cottonseed oil.ResultsPositive skin prick testing to progesterone in cottonseed oil was documented in four patients, while skin prick testing to cottonseed oil alone was negative in all patients. Intradermal skin tests were positive to progesterone in cottonseed oil in all ten patients, while intradermal testing in four controls were negative. Graded scratch challenges were performed in seven patients and confirmed severe dermographism. RAST testing to cottonseed was negative (<0.35 KU/L) in eight patients. Oral challenge to progesterone was performed in a single patient with no adverse reaction, and the anaphylactic patient was successfully desensitized using an oral protocol.ConclusionsProgesterone in cottonseed oil may lead to the development of an acute dermographic response. Although a severe anaphylactic reaction is possible to this therapy, it may be successfully desensitized. We propose this unusual allergic reaction to the combination of progesterone in cottonseed oil and not to the individual components. Patients may be treated alternatively with progesterone suppositories without severe allergic responses. RationaleWe report a series of nine patients who developed acute urticaria with a major dermographic component, and one patient with an anaphylactic reaction, after serial intramuscular injections with progesterone in cottonseed oil for the treatment of infertility. We report a series of nine patients who developed acute urticaria with a major dermographic component, and one patient with an anaphylactic reaction, after serial intramuscular injections with progesterone in cottonseed oil for the treatment of infertility. MethodsSkin testing with progesterone powder in cottonseed oil (50 mg/mL) mixed with 10% benzyl alcohol was performed in ten patients. Immunocap RAST testing was completed for cottonseed oil. Skin testing with progesterone powder in cottonseed oil (50 mg/mL) mixed with 10% benzyl alcohol was performed in ten patients. Immunocap RAST testing was completed for cottonseed oil. ResultsPositive skin prick testing to progesterone in cottonseed oil was documented in four patients, while skin prick testing to cottonseed oil alone was negative in all patients. Intradermal skin tests were positive to progesterone in cottonseed oil in all ten patients, while intradermal testing in four controls were negative. Graded scratch challenges were performed in seven patients and confirmed severe dermographism. RAST testing to cottonseed was negative (<0.35 KU/L) in eight patients. Oral challenge to progesterone was performed in a single patient with no adverse reaction, and the anaphylactic patient was successfully desensitized using an oral protocol. Positive skin prick testing to progesterone in cottonseed oil was documented in four patients, while skin prick testing to cottonseed oil alone was negative in all patients. Intradermal skin tests were positive to progesterone in cottonseed oil in all ten patients, while intradermal testing in four controls were negative. Graded scratch challenges were performed in seven patients and confirmed severe dermographism. RAST testing to cottonseed was negative (<0.35 KU/L) in eight patients. Oral challenge to progesterone was performed in a single patient with no adverse reaction, and the anaphylactic patient was successfully desensitized using an oral protocol. ConclusionsProgesterone in cottonseed oil may lead to the development of an acute dermographic response. Although a severe anaphylactic reaction is possible to this therapy, it may be successfully desensitized. We propose this unusual allergic reaction to the combination of progesterone in cottonseed oil and not to the individual components. Patients may be treated alternatively with progesterone suppositories without severe allergic responses. Progesterone in cottonseed oil may lead to the development of an acute dermographic response. Although a severe anaphylactic reaction is possible to this therapy, it may be successfully desensitized. We propose this unusual allergic reaction to the combination of progesterone in cottonseed oil and not to the individual components. Patients may be treated alternatively with progesterone suppositories without severe allergic responses.