PROGESTOGEN HYPERSENSITIVITY – A CASE SERIES

Abstract

<h3>Introduction</h3> Progestogen hypersensitivity (PH) is characterized by recurring heterogenous symptoms after endogenous progesterone or exogenous progestogen exposure. The pathogenesis of PH is poorly understood, and the diagnostic and therapeutic approach are not well established. Here we sought to characterize a PH cohort at our institution. <h3>Methods</h3> A retrospective chart review of adult women with symptoms suggestive of PH was conducted across the 3 Mayo Clinic sites. Data regarding the symptomatology, diagnostic approach, treatment decision, and outcome were collected and analyzed. <h3>Results</h3> Forty-two patients had a clinical presentation consistent with PH. Mean age of onset was 30.5 years. 24% of patients had an exogenous progestogen trigger. Of the exogeneous triggers, 50% were oral contraceptives, 20% progesterone intrauterine devices, 20% progesterone supplementation for <i>in vitro</i> fertilization or risk reduction of premature birth, and 10% vaginal rings. 57% (n=24) had a medical history of atopy. The most common clinical manifestation was dermatologic (93%). Symptoms included dermatitis (48%), urticaria (48%), angioedema (50%), mouth sores (7%), vesiculobullous eruptions (14%). Three patients presented with anaphylactic reaction. Progesterone skin testing was performed in 29/42 (69%) patients, with 9/29 (31%) being positive. Non-hormonal treatment strategies included oral steroids (43%), topical steroids (31%), and monoclonal antibodies (12%). Hormone-based therapies included oral contraceptives (26%), GnRH antagonist (26%), and oophorectomy (10%). A desensitization protocol was performed in 12% of patients. 48% of patients improved with treatment. <h3>Conclusion</h3> Here we report a large case series of PH patients. Further studies addressing the diagnostic challenges and treatment outcomes are warranted.