Allergic Reactions to Menstrual Hormones

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A number of different allergic skin conditions, including eczema, urticaria and angioedema, and erythema multiforme, can worsen during the premenstrual time period. When these conditions worsen three to 10 days prior to the onset of menses, the woman may have autoimmune progesterone dermatitis (APD). APD also has the ability to progress to anaphylaxis. Another form of anaphylaxis that is related to the menstrual cycle is catamenial anaphylaxis. These are both believed to be rare conditions.

Autoimmune Progesterone Dermatitis

Autoimmune progesterone dermatitis (APD) occurs as a result of an allergic reaction to a woman's own progesterone. Symptoms typically occur anywhere from three to 10 days prior to the onset of menses and begin to resolve within one to two days after the onset of menstruation.

APD can have a variety of different symptoms, although most, if not all, include skin rashes.

These include eczema, hives, fixed drug eruptions, erythema multiforme, angioedema, and even anaphylaxis. It may not initially be obvious to the affected woman that her symptoms are worsened during the premenstrual period, and it often takes a physician to ask the question of worsening symptoms related to the menstrual cycle before the pattern is obvious to the woman.

APD may be caused initially by a woman taking birth control pills or another hormone supplement containing progesterone that results in sensitization to the hormone. Pregnancy can also result in sensitization to progesterone, and pregnancy can have significant effects on the immune system and can dramatically affect a variety of allergic conditions. Other women may develop APD as a result of cross-reactivity with corticosteroids, which have similar molecular structures to hormones. While allergic reactions to other hormones, such as estrogen, can occur, these are far less common than reactions to progesterone.

The diagnosis of APD requires the demonstration of IgE antibodies against progesterone, which is performed with allergy skin testing. Skin testing with progesterone can be performed by most allergists, which may be followed by a drug challenge through the injection of progesterone with close monitoring for symptoms.

Skin testing should only be performed by a physician, ideally, an allergist, experienced in the diagnosis and treatment of anaphylaxis, given the possibility that a dangerous allergic reaction.

Treatment of APD may be successful with the use of antihistamines and ​oral or injected corticosteroids, although these medications would only be useful to treat the symptoms rather than correcting the problem. Therapies that suppress ovulation, such as leuprolide, prevent the rise of progesterone during the menstrual cycle and are the preferred treatments for APD. Rarely, surgical removal of the ovaries and uterus is required in severe cases of APD when medications are unable to control the symptoms.

Catamenial Anaphylaxis

Catamenial anaphylaxis is another condition that is related to the menstrual cycle. Women who have this condition experience symptoms of anaphylaxis as soon the menstrual flow begins and symptoms continue until the menses flow stops. Unlike APD, however, catamenial anaphylaxis is not an allergic condition but rather is caused by prostaglandins released from the lining of the uterus (endometrium), which may be absorbed into the bloodstream.

The diagnosis is usually made on a clinical basis, as allergy testing to progesterone (and other hormones) is negative. Treatment of catamenial anaphylaxis has been successful with the use of non-steroidal anti-inflammatory medications (NSAIDs), such as Indocin (indomethacin). Surgical removal of the ovaries and uterus is required in severe cases of catamenial anaphylaxis when medications are unable to control the symptoms.

When to Seek Emergency Care

While it is important to see if a doctor if you develop an allergy of any sort, you should call 911 or seek emergency care if a rash is accompanied by fever, wheezing, shortness of breath, facial swelling, rapid heart, nausea, vomiting, or fainting. These are all signs of anaphylaxis requiring urgent care.

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