Dictionary of Allergies .. Αutoimmune progesterone anaphylaxis (AIPD)  , [Αυτοάνοση αναφυλαξία στην προγεστερόνη]©.

Αutoimmune progesterone anaphylaxis is a disorder which  typically occurs in females due to an autoimmune phenomenon to endogenous progesterone production, but can also be caused by exogenous intake of a synthetic progestin. It is a rare disorder which clinically is inducing  usually dermatitis. 

The disorder is  not limited to ovulating females and  has also been reported to occur during  ,pregnancy, in the postpartum period  in post-menopausal women taking hormone replacement therapy, and even  in men taking exogenous synthetic progesterone [1,2].

The age of AIPD  onset is variable, with the earliest age  reported at menarche. Women with this  disorder commonly present with dermatologic lesions in the luteal phase of the menstrual cycle. Iif there are any other organ involvement in addition to skin (e.g. lung, GI) the reaction should be called as autoimmune progesterone anaphylaxis. 

The clinical symptoms of AIPD are  variable and may include urticaria  eczematous eruptions, vesicles, pustules, erythema multiform, vulvovaginal pruritus and stomatitis, but rarely does  the disorder present as an anaphylactic  reaction [3,4]. In such cases the disorder is called autoimmune progesterone  anaphylaxis. Autoimmune progesterone dermatitis manifests via the occurrence of cyclic skin eruptions [5].

Few reports have documented the uncommon association of the female menstrual cycle with anaphylaxis, an entity known as cyclic or catamenial anaphylaxis. Whether the mechanism causing cyclical anaphylaxis may involve hypersensitivity to progesterone or prostaglandins, the variable response to suppressive medications in these cases suggests that catamenial anaphylaxis is a heterogeneous disorder in which a number of mechanisms and mediators may play a role. It is an emergent and probably underrecognized entity in the medical literature [6].

The diagnosis is clinically  suspected and confirmed by progesterone-positive skin tests or intramuscular  progesterone challenge test, or both [7]. The  definitive etiologic treatment consists of  ovulation inhibition by pharmaceutical agents or by oophorectomy [1].

References
1. Stranahan D, Rausch D, Deng A, Gaspari A. The  role of intradermal skin testing and patch testing  in the diagnosis of autoimmune progesterone .dermatitis. Dermatitis 2006; 17 (1): 39-42
.2. Herzberg A, Strohmeyer C, Cirillo-Hyland V  Autoimmune progesterone dermatitis. J Am .Acad Dermatol 1995; 32: 333-8 Baptist AP, Baldwin JL. Autoimmune  progesterone dermatitis in a patient with  endometriosis: case report and review of the .literature. Clin Mol Allergy 2004; 2: 10
4. Snyder JL, Krishnaswamy G. Autoimmune  progesterone dermatitis and its manifestation as  .anaphylaxis: a case report and literature review .Ann Allergy Asthma Immunol 2003; 90: 469-77
5. Bemanian MH, Gharagozlou M, Farashahi MH, Nabavi M, Shirkhoda Z. Autoimmune progesterone anaphylaxis. Iran J Allergy Asthma Immunol. 2007 Jun;6(2):97-9.
6. Bauer CS, Kampitak T, Messieh ML, Kelly KJ, Vadas P. Heterogeneity in presentation and treatment of catamenial anaphylaxis. Ann Allergy Asthma Immunol. 2013 Aug;111(2):107-11. doi: 10.1016/j.anai.2013.06.001. Epub 2013 Jun 28.
7. Magen E, Feldman V. Autoimmune progesterone anaphylaxis in a 24 year old woman. Isr Med Assoc J. 2012 Aug;14(8):518-9.

©Gkelis’Encyclopedic Dictionary of Allergy. Vellerofontis Editions, Korinthos, 2013