Application of Precision Medicine to the Treatment of Anaphylaxis

Marina Labella; Marlene Garcia-Neuer; Mariana Castells


Curr Opin Allergy Clin Immunol. 2018;18(3):190-197. 

In This Article

Clinical Vignette: Successful Management

Progestogen hypersensitivity presents with heterogeneous symptoms, which can range from urticaria to dyspnea, cough, and can lead to anaphylaxis. Symptoms are triggered by endogenous progesterone or exogenous progestogen exposure. Endogenous progesterone triggers are defined as symptoms associated with menses or pregnancy without additional hormone supplementation. Exogenous progestogen triggers are defined as symptoms proximal to exposure to any progesterone source not naturally occurring, such as IVF. Desensitization to progestogens has provided a successful avenue for patients with progestogen hypersensitivity to manage symptoms and tolerate fertility treatments.[70] A recent clinical communication describes a case of rapid and sustained regression of cyclic episodes of anaphylaxis due to progestogen hypersensitivity induced successfully by Omalizumab.[71]

Skin testing with progesterone was performed on our patient to confirm progesterone hypersensitivity. Skin intradermal test was positive with 3 × 6 mm wheal at 1 : 100 dilution. Intramuscular progesterone desensitization was performed 5 days before of the embryo transfer (determined by the fertility team) (Table 1).

Premedication was administered 30 min before the start of the desensitization and included: cetirizine 10 mg, famotidine 20 mg, montelukast 10 mg and two puffs of albuterol. The patient tolerated the desensitization without any HSR or symptoms with a final cumulative dose of 25 mg. She continued with 50 mg of progesterone daily. Five days later, the embryo was transferred and the patient had a successful pregnancy.