Every 5 weeks, almost to the day, I got "anaphylactoid" symptoms. What WILL the medical community think up next for terminology?!My doc thinks I'm crazy, but the first one brought about an ER visit. No airway involvement, but my body was pretty swollen and ITCHING. Ever since, I've had varying degrees of symptoms, but never that severe. Well, I started itching tonight. I've become used to it. My sister was looking at me, so I went and took my starter dose of benadryl and zantac. Sounds stupid, but stomach acid is triggered by a hystamine receptor. H2 to be precise. Allergies are H1 receptors. So - both get a kick in the pants when allergies rear their ugly heads. Knock both down with the appropriate meds and life is much better.Well, I decided to look around. After a couple of different wordings, I came up with one that worked and found this:Summary StatementsUnexplained episodes of anaphylaxis may be caused by unusual reactivity to progesterone. Anaphylactic symptoms tend to be premenstrual but may occur anytime during the menstrual cycle.
[this part makes sense for me because I'm perimenopausal.] In one report, lactation caused complete remission of symptoms. The pathogenesis of this disorder is unknown, but laboratory studies have shown that progesterone may either induce histamine release from basophils directly or make mast cells more susceptible to other mast cell degranulators. Treatment options include a leutinizing hormone-releasing hormone (LHRH) agonist analog (e.g., Naferelin) or oophorectomy in particularly resistant cases.
A differential consideration that may be confused with progesterone-induced anaphylaxis is catemenial anaphylaxis, which is not related to progesterone reactivity. Anaphylactic symptoms occur during menses, and full recovery after oophorectomy has been reported.
Among the causes of recurrent anaphylaxis in females is an uncommon syndrome caused by hyperreactivity to progesterone. It should be suspected in any female who is menstruating or pregnant and experiencing unexplained recurrent episodes of anaphylaxis. Although the anaphylactic episode tends to be premenstrual, it may occur anytime during the menstrual cycle.
This syndrome was first recognized in the evaluation of a patient who had unexplained recurrent anaphylaxis with total remission during lactation.
1 When the patient became pregnant, the frequency and severity of the attacks became worse. After delivery and the institution of breast feeding, she had complete cessation of the attacks. When lactation stopped and her menstrual cycle resumed, this patient had a recurrence of severe anaphylaxis, including laryngeal edema.
As part of her subsequent evaluation, she was provoked with both progesterone and luteinizing hormone-releasing hormone (LHRH), both of which induced anaphylactic events. Progesterone was suspected as the inciting agent because provocation with follicle-secreting hormone (FSH), LH, and estrogen were uneventful. She was treated with a long-acting analog of LHRH, which competes with LHRH at a receptor level in the pituitary gland. Treatment with an LHRH analog causes the pituitary gland to become unresponsive to endogenous LHRH, with subsequent reduction in the secretion of FSH and (LH), which in turn leads to a reduction in estrogen and progesterone secretion. LHRH analog-treated patients cease menstruating and enter a temporary state of menopause. This agent caused a complete cessation of her attacks. After a period of time on an LHRH analog, this patient underwent an oophorectomy with sustained remission of her attacks, which was still the case at follow-up 5 years later.
To determine if other women with unexplained recurrent anaphylaxis might have progesterone-induced anaphylaxis, four women experiencing recurrent anaphylaxis were recruited into a 4-month, double-blind, placebo-controlled cross-over study of the effects of LHRH analog on their anaphylaxis.
2 All four women thought that their attacks occurred more frequently during the premenstrual portion of their menstrual cycle and that the attacks during these times were more severe. In preliminary screening of the patients, two of the women experienced systemic reactions after challenge with methylprogesterone and LHRH. Only one of the patients who experienced anaphylaxis after provocation had a positive skin test response to progesterone. These two women improved during treatment with an LHRH analog, whereas the other two women did not. Urinary histamine levels, which had been elevated before treatment, were reduced in the two responsive women but not in the unresponsive women. Both women who responded subsequently had an oophorectomy with complete remission of anaphylaxis.
Patients with idiopathic anaphylaxis that worsened during the luteal phase of the menstrual cycle did not release histamine after incubation with progesterone.
3 However, a subsequent report demonstrated significant progesterone-induced histamine release in a patient with documented anaphylaxis after challenge with both synthetic and natural progesterone products.
4 In addition, incubation of her basophils with progesterone appeared to augment anti-IgE induced histamine release.To confirm progesterone-induced anaphylaxis, a controlled challenge may be necessary. After insertion of an intravenous line and with life-saving equipment immediately accessible, the usual approach is to inject progressively 1, 2, 5, 10, 25, and 50 mg of progesterone in oil in the arm every 60 to 90 minutes while keeping the patient under close supervision. Reactions usually are restricted to urticaria and flushing, although systemic anaphylaxis can occur.Treatment choices include an LHRH analog or oophorectomy. Most of the patients treated with an LHRH analog had total remission of anaphylaxis. However, side effects such as loss of secondary sexual characteristics and osteopenia may limit long-term use of this agent.
One woman has been reported to have episodes of anaphylaxis only during menstruation (a low progesterone state), with full recovery after hysterectomy with oophorectomy.
5 This apparently represents a syndrome of catamenial anaphylaxis not caused by progesterone.
References
1. Meggs J, Pescovitz OH, Metcalfe DD, Loriaux DL, Cutler G, Kaliner M. Progesterone sensitivity as a cause of recurrent anaphylaxis. N Engl J Med 1984;311:1236-8.
2. Slater JE, Raphael G, Cutler GB, Loriaux DL, Meggs WJ, Kaliner M. Recurrent anaphylaxis in menstruating women: treatment with a leutinizing hormone releasing hormone agonist, a preliminary report. Obstet Gynecol 1987;70:542-6.
3. Slater JE, Kaliner M. Effects of sex hormones on basophil histamine release in recurrent idiopathic anaphylaxis. J Allergy Clin Immunol 1987;80:285-90.
4. Scinto J, Enrione M, Bernstein D, Bernstein IL. In vitro leukocyte histamine release to progesterone and pregnanediol in a patient with recurrent anaphylaxis associated with exogenous administration of progesterone. J Allergy Clin Immunol 1990;85:228.
5. Burstein M, Rubinow A, Shalit M. Cyclic anaphylaxis associated with menstruation. Ann Allergy 1991;66:36-8.
Basically, there are two cycle related anaphylaxis symdromes women can get. I don't know which I have and I don't care. It's just nice to know there's a reason and I'm not nuts. Well, at least not about this.
