title: A case of progesterone-induced anaphylaxis, cyclic urticaria/angioedema, and autoimmune dermatitis.
abstract: OBJECTIVE
  Women have exhibited anaphylaxis, urticaria/angioedema, and autoimmune progesterone dermatitis (APD) coinciding with the progesterone premenstrual rise. We report a detailed immunological evaluation of such a woman responsive to a gonadotropin hormone-releasing agonist (GHRA).
  
  
  METHODS
  Skin testing, enzyme-linked immunosorbent assays (ELISAs), leukocyte histamine release (LHR), and inhibition assays were performed to demonstrate progesterone immunoresponsiveness.
  
  
  RESULTS
  Serum specific-progesterone immunoglobulin G (IgG) and IgE were detected initially and disappeared 6 months after GHRA treatment. Dose-response LHR using patient basophils was observed for different hormones but after 3 months persisted only for 5β-pregnanediol. Preincubation with mouse antiprogesterone monoclonal antibody (PmAb) or mifepristone, a progesterone inhibitor, over a range of doses inhibited specific progesterone-induced LHR. Experiments with varying progesterone concentrations and a fixed dose of anti-IgE resulted in 100% LHR at a concentration as low as 0.016 nmol/mL, which, without anti-IgE, failed to release histamine.
  
  
  CONCLUSIONS
  This is the first report of combined recurrent anaphylaxis, cyclic urticaria/angioedema, and APD induced by immunoresponsiveness to progesterone.
authors.affiliation: Department of Internal Medicine, Division of Immunology/Allergy Section, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0563, USA.
authors.forename: I Leonard
authors.initials: IL
authors.lastname: Bernstein
authors.forename: David I
authors.initials: DI
authors.lastname: Bernstein
authors.forename: Zana L
authors.initials: ZL
authors.lastname: Lummus
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Bernstein
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced* / Q000188:drug therapy; D000799:Angioedema; D000818:Animals; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000139:chemically induced; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000009:adverse effects; D003280:Contraceptives, Oral, Synthetic / Q000008:administration & dosage / Q000009:adverse effects*; D003872:Dermatitis; D003875:Drug Eruptions; D004797:Enzyme-Linked Immunosorbent Assay; D004967:Estrogens / Q000008:administration & dosage / Q000009:adverse effects*; D004997:Ethinyl Estradiol / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007074:Immunoglobulin G / Q000276:immunology; D051379:Mice; D008875:Middle Aged; D015735:Mifepristone / Q000627:therapeutic use; D017274:Nafarelin / Q000627:therapeutic use; D009640:Norethindrone / Q000008:administration & dosage / Q000009:adverse effects*; D011374:Progesterone / Q000009:adverse effects* / Q000627:therapeutic use; D014581:Urticaria / Q000139:chemically induced
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D003277:Contraceptives, Oral, Combined; D003280:Contraceptives, Oral, Synthetic; D004967:Estrogens; D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D007074:Immunoglobulin G; D017274:Nafarelin; D015735:Mifepristone; D007987:Gonadotropin-Releasing Hormone; D007073:Immunoglobulin E; D004997:Ethinyl Estradiol; D011374:Progesterone; D009640:Norethindrone