Koh Y I, Choi I S, Lee H C, Na H S, Oh S T
Department of Internal Medicine, Chonnam National University Medical School and Research Institute of Medical Science, Kwangju, Korea.
Ann Allergy Asthma Immunol. 2001 Nov;87(5):434-8. doi: 10.1016/S1081-1206(10)62928-6.
Urine-derived gonadotropins have been used to treat infertility but may cause allergic reactions. IgE-mediated hypersensitivity reactions can be treated with desensitization, especially when new therapies such as recombinant human gonadotropins are unavailable.
This case is described to highlight a successful intervention with desensitization in a woman with a complicated history of secondary infertility. She had been treated with ovulation-induction regimens, such as IVF-M (in vitro fertilization-human menopausal gonadotropin [hMG]) and IVF-C (human chorionic gonadotropin [hCG]), for intrauterine insemination. During treatment, however, she experienced reactions to IVF-M and IVF-C. Because she strongly wanted a baby and no alternative preparation was available, desensitization was attempted.
Intradermal tests with IVF-M and IVF-C using both negative and positive controls were performed on the patient and four normal control subjects. Immediate wheal-and-flare reactions occurred only in the patient. ELISA and ELISA inhibition tests showed positive responses to IVF-M and IVF-C, but not to highly purified hMG, hCG, or D-mannitol, a preservative in IVF-M and IVF-C. Desensitization to IVF-M and IVF-C was done with a protocol used for parenteral desensitization to penicillin.
During the IVF-M desensitization, the intramuscular injections were well tolerated. For the next 2 days, daily administration of IVF-M was uneventful. Thirty-six hours later, desensitization to IVF-C was performed successfully. The patient had two intrauterine inseminations and became pregnant.
Nongonadotropin proteins in urine-derived gonadotropins cause IgE-mediated hypersensitivity reactions. Acute desensitization to urine-derived gonadotropins can be performed effectively, as shown in our current case.
尿源性促性腺激素已被用于治疗不孕症，但可能会引起过敏反应。IgE介导的超敏反应可用脱敏疗法治疗，尤其是在没有重组人促性腺激素等新疗法的情况下。
本病例旨在强调对一位有继发性不孕症复杂病史的女性进行脱敏成功干预的情况。她曾接受过诱导排卵方案治疗，如用于宫内人工授精的体外受精-人绝经期促性腺激素（hMG）（IVF-M）和人绒毛膜促性腺激素（hCG）（IVF-C）。然而，在治疗期间，她对IVF-M和IVF-C出现了反应。由于她非常想要一个孩子且没有其他替代制剂，因此尝试进行脱敏治疗。
对该患者和四名正常对照受试者进行了IVF-M和IVF-C的皮内试验，同时使用阴性和阳性对照。仅患者出现了即刻风团和红晕反应。酶联免疫吸附测定（ELISA）和ELISA抑制试验显示对IVF-M和IVF-C呈阳性反应，但对高度纯化的hMG、hCG或IVF-M和IVF-C中的防腐剂D-甘露醇无阳性反应。采用用于青霉素胃肠外脱敏的方案对IVF-M和IVF-C进行脱敏。
在IVF-M脱敏过程中，肌肉注射耐受性良好。在接下来的2天里，每日注射IVF-M均无异常。36小时后，成功进行了IVF-C脱敏。该患者进行了两次宫内人工授精并怀孕。
尿源性促性腺激素中的非促性腺激素蛋白会引起IgE介导的超敏反应。如我们当前病例所示，对尿源性促性腺激素进行急性脱敏可有效进行。
