Mid-Atlantic Permanente Medical Group, Baltimore, MD, USA.
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Curr Allergy Asthma Rep. 2018 Jan 19;18(1):1. doi: 10.1007/s11882-018-0758-x.
Progestogen hypersensitivity (PH) is a rare disorder which usually occurs in women of childbearing age with symptoms ranging from urticaria with or without angioedema, multiple organ involvement consistent with allergic anaphylaxis, to a spectrum of other non-evanescent skin eruptions. In this review, we present a clinical vignette of PH and discuss the clinical presentation and proposed pathomechanisms, diagnosis, and treatment of PH.
The hypersensitivity symptoms are associated with exogenous progestin exposure (e.g., contraceptive medicines, in vitro fertilization therapy) or endogenous progesterone from progesterone surges during the luteal phase of the menstrual cycle and pregnancy. Recognition of this condition can be challenging to the clinician due to its heterogeneous clinical presentation. It has been recently proposed to use the new term "progestogen hypersensitivity" to replace "autoimmune progesterone dermatitis" due to the lack of evidence supporting an autoimmune mechanism for this disorder. In addition, diagnostic and treatment algorithms are now available that can lead to successful management of this condition. More new developments of Progesterone desensitization protocols are now available which appear to be the safest and most effective long-term treatment option for PH. With the extensive use of oral contraceptives and increased use of supra-physiologic doses of progesterone to support pregnancy in in vitro fertilization, there is likely to be a higher prevalence of PH in the future than currently recognized. Therefore, the allergist-immunologist will be required to collaborate with gynecologists and reproductive endocrinologists to diagnose and treat this condition.
孕激素过敏（PH）是一种罕见的疾病，通常发生在育龄妇女中，症状从伴有或不伴有血管性水肿的荨麻疹，到与过敏样过敏一致的多器官受累，再到一系列其他非消退性皮肤疹，不一而足。在这篇综述中，我们呈现了 PH 的临床病例，并讨论了 PH 的临床表现和提出的发病机制、诊断和治疗。
过敏症状与外源性孕激素暴露（例如避孕药、体外受精治疗）或月经周期黄体期和妊娠期间孕激素激增相关的内源性孕激素有关。由于其临床表现异质性，临床医生识别这种情况具有挑战性。最近有人提议使用新术语“孕激素过敏”来取代“自身免疫性孕激素性皮炎”，因为缺乏支持这种疾病的自身免疫机制的证据。此外，现在已经有了诊断和治疗方案，这可以导致成功管理这种疾病。现在有更多的孕激素脱敏方案的新进展，它们似乎是 PH 的最安全和最有效的长期治疗选择。随着口服避孕药的广泛使用和为支持体外受精而增加使用超生理剂量的孕激素，PH 的患病率可能比目前认识到的要高。因此，变态反应学家-免疫学家将需要与妇科医生和生殖内分泌学家合作，以诊断和治疗这种疾病。
