A case of oral desensitization for hypersensitivity to exogenous progesterone

Young-Chan Kim; Kook-Hwan Choi; Dong-Yoon Kang; Kyung Hee Sohn; Sang-Heon Cho; Kyung-Up Min; Hye-Ryun Kang

doi:10.4168/aard.2017.5.5.294

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Kim, Choi, Kang, Sohn, Cho, Min, and Kang: A case of oral desensitization for hypersensitivity to exogenous progesterone

Case Report

Allergy Asthma Respir Dis 2017;5(5):294-297.

Published online: 5 September 2017

DOI: https://doi.org/10.4168/aard.2017.5.5.294

A case of oral desensitization for hypersensitivity to exogenous progesterone

Young-Chan Kim^1,², Kook-Hwan Choi¹, Dong-Yoon Kang³, Kyung Hee Sohn^1,², Sang-Heon Cho^1,^2,³, Kyung-Up Min^1,², Hye-Ryun Kang^1,^2,³

¹Department of Internal Medicine, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea

²Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea

³Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea

Correspondence to: Hye-Ryun Kang https://orcid.org/0000-0002-2317-4201 Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-0820, Fax: +82-2-764-2199, E-mail: helenmed@snu.ac.kr

• This research was supported by a grant from Ministry of Food and Drug Safety to the Regional Pharmacovigilance Center in 2016.

Received 22 November 201631 December 2016 Accepted 5 January 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hypersensitivity reaction to progesterone is a rare pathologic condition which consists of autoimmune response to endogenous progesterone, known as autoimmune progesterone dermatitis, and hypersensitivity reaction to exogenous progestogen. We report the case of a 31-year-old woman with a history of whole body urticaria during exogenous progesterone supplementation for in vitro fertilization (IVF). She was admitted to the hospital for the diagnosis and management of progestogen hypersensitivity. An intradermal test with progesterone revealed positivity to 5 mg/mL of progesterone. For her next IVF, progesterone desensitization was performed in a method combining oral and intramuscular progesterone administration. After successfully achieving a target dose of 100 mg per day, the route of progesterone administration was converted to intravaginal tablet (90 mg twice a day) without any hypersensitivity reactions.

Keywords: Progesterone, Drug hypersensitivity, Fertilization in vitro, Immunologic desensitization

REFERENCES

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Fig. 1.

Delayed reaction to progesterone after intradermal progesterone skin test.

Table 1.

The result of skin prick test and intradermal test with progesterone

Test	Wheal (mm)
Skin prick test
Histamine	3.0×3.0
Saline	0×0
Progesterone (50 mg/mL)	0×0
Intradermal test
Saline	No increase
Progesterone (1:10, 5 mg/mL)	6.0×6.0

Table 2.

Progesterone desensitization protocol via oral and intramuscular routes

Day/route	Step	Concentration (mg/mL)	Amount (mL)	Interval (hr)	Dose, administered (mg)	Dose, accumulated (mg)
Day 1 PO	1	0.2	0.1		0.02	0.02
	2	0.2	0.2	1	0.04	0.06
	3	0.2	0.5	1	0.1	0.16
	4	0.2	1	1	0.2	0.36
	5	0.2	2	1	0.4	0.76
	6	0.2	4	1	0.8	1.56
	7	0.2	8	1	1.6	3.16
Day 2 PO	8	2.0	1.5		3	6.16
	9	2.0	3	3	6	12.16
	10	2.0	6	3	12	24.16
	11	2.0	12	3	24	48.16
	12	100 mg/tablet	0.5 Tablet	3	50	98.16
Day 3 IM	13	50	1	-	50	148.16
Day 3 IM	14	50	1	1	50	198.16

Solution for step 1–7: Provera 5 mg + dextrose 5% in water 100 mL (0.2 mg/mL); solution for step 8–11: Provera 5 mg + dextrose 5% in water 10 mL (2 mg/mL). PO, per os; IM, intramuscular.

Table 3.

Summary of reported desensitization protocols for progesterone hypersensitivity

Study	Step	Administration route	Initial dose (mg)	Final dose (mg)	Total administration duration
Foer et al.¹³	9	PO	0.00125	1	9 Days
Foer et al.¹³	6	IM	1	18.5	150 Minutes
Prieto-Garcia et al.¹⁹	8	Intravaginal	0.05	100	160 Minutes
	10	Intravaginal	0.1	20	200 Minutes
	7	PO	0.001	0.100	210 Minutes
Hill and Carr²⁰	-	IM	0.001	26.1	180 Minutes

PO, per os; IM, intramuscular.

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