title: Autoimmune progesterone dermatitis: clinical presentation and management with progesterone desensitization for successful in vitro fertilization.
abstract: 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.
  
  
  METHODS
  Clinical description.
  
  
  METHODS
  Institutional hospitalary practice. Allergy Division.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Progesterone skin test results. Tolerance to P desensitization. Achievement of viable pregnancies.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Prieto-Garcia
authors.forename: David E
authors.initials: DE
authors.lastname: Sloane
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Gargiulo
authors.forename: Anna M
authors.initials: AM
authors.lastname: Feldweg
authors.forename: Mariana
authors.initials: M
authors.lastname: Castells
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000276:immunology; D003888:Desensitization, Immunologic / Q000379:methods*; D003875:Drug Eruptions / Q000276:immunology*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy* / Q000276:immunology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011374:Progesterone / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology
chemical_list: D011374:Progesterone