nafarelin and Dermatitis

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).. Skin testing, enzyme-linked immunosorbent assays (ELISAs), leukocyte histamine release (LHR), and inhibition assays were performed to demonstrate progesterone immunoresponsiveness.. 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.. This is the first report of combined recurrent anaphylaxis, cyclic urticaria/angioedema, and APD induced by immunoresponsiveness to progesterone.

Topics: Anaphylaxis; Angioedema; Animals; Antibodies, Monoclonal, Murine-Derived; Autoimmune Diseases; Contraceptives, Oral, Combined; Contraceptives, Oral, Synthetic; Dermatitis; Drug Eruptions; Enzyme-Linked Immunosorbent Assay; Estrogens; Ethinyl Estradiol; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Immunoglobulin E; Immunoglobulin G; Mice; Middle Aged; Mifepristone; Nafarelin; Norethindrone; Progesterone; Urticaria

Topics: Adult; Autoimmune Diseases; Dermatitis; Estrogens; Female; Histamine H1 Antagonists; Histamine H2 Antagonists; Humans; Nafarelin; Progesterone; Rare Diseases; Treatment Failure