My personal thoughts about life with a disability and all other things I consider important in my life.

Monday, April 14, 2008

More on Progesterone Allergy

I've gotten more than one person emailing me about this possiblity of hormones inducing an allergic response.

I've done a little more research using different words and have come up with some more links. I'm also thinking of a theory to state. Not that it'll be of any use, but you never know....

First, some of the articles I've found:
While I don't completely agree with some of the observations and theories, the article makes some very good points.

Here's another:

And an excerpt:
While many women complain of worsening acne and water retention during their menstrual cycle, there exist a small number in whom the menstrual cycle is associated with a variety of other skin manifestations such as urticaria, eczema, folliculitis, and angioedema. This condition is known as autoimmune progesterone dermatitis (APD) due to the fact that progesterone is most frequently identified as the etiologic agent. In women with irregular menses, the diagnosis may remain elusive for years. We present a case of APD, and review the current literature in regards to clinical features, pathogenesis, diagnosis, and treatment options.

And another:
Current therapeutic modalities often attempt to inhibit the secretion of endogenous (body-made) progesterone by the suppression of ovulation. Table 2 lists some of the pharmacologic strategies used in APD. Oral contraceptives (OCPs) are often tried as initial therapy, but have had limited success, possibly due to the fact that virtually all OCPs have a progesterone component. Conjugated estrogens have also been used in the treatment of APD. These did show improvement in many of the patients, but often required high doses [2,16,22]. However, due to the increased risk of endometrial carcinoma with unopposed conjugated estrogens, this treatment is not commonly used today [39].

2 of the sources that might be of use:

Snyder JL, Krishnaswamy G: Autoimmune progesterone dermatitis and its manifestation as anaphylaxis: a case report and literature review.
Ann Allergy Asthma Immunol 2003, 90:469-77; quiz 477, 571. PubMed Abstract Publisher Full Text
Return to text
Slater JE, Raphael G, Cutler G. B., Jr., Loriaux DL, Meggs WJ, Kaliner M: Recurrent anaphylaxis in menstruating women: treatment with a luteinizing hormone-releasing hormone agonist--a preliminary report.
Obstet Gynecol 1987, 70:542-546. PubMed Abstract Publisher Full Text

Another article excerpt that I had to sign on to PubMed to get to:

Alternatively, leukocytes have progesterone receptors, and progesterone, like many other steroid hormones, can affect immune function. Progesterone can potentiate immune responses to other stimuli, so it is possible that progesterone could be a factor in enhancing allergic reactions or skin reactions caused by other substances or conditions. For example, some women with chronic urticaria (hives) experience cyclical exacerbations of their skin condition corresponding with the menstrual cycle, and it is possible that progesterone plays a role in this process.

If this doc's theory is correct, I'm thinking Singulair might be a good treatment. Leukotrienes are produced by leukocytes and are the cause of allergic inflammation throughout the body.
Please note that Singulair is being watched for mood alteration - as in depression and suicide. Since I am already on an antidepressant, I'm avoiding Singulair.

However, since it has been approved for adult allergies (allergic rhinitis, sinusitis, etc.), and not just asthma, it might be worth it to see if your doc will prescribe it for a 3 month trial.

Another note about Singulair - I did take it before I was on the antidepressant. While I did not note a significant improvement while taking it, the rebound of symptoms worsening when I quit taking it was profound. If you take it and decide to stop, please don't stop suddenly. It might not be pretty.

One of the articles I read has a theory about the connection between hormonal birth control (the pill) and this progesterone allergic response. This makes total sense since prior to the recent SLEW of pills on the market, the incidence of this type of allergic response was virtually unheard of. When the pill first came on the market, it was almost completely estrogen and at very high doses. Since then, it has become a mix of hormones, mostly synthetic and at far lower doses.

Women are taking them for longer periods of time - decades versus a few years. My part of the theory takes this one step further. How many women go on the pill, go off, then start having issues? Mine actually started after my second round of birth control that lasted for a whopping 12 month period. Then WHAM - I was in the ER with hives allllll over my body.

I'm willing to bet there's a very link and the med companies will do anything they can to keep this from being found out. The bottom line, not the patient, is what they care about.

I'd like to work with someone who has the time and ability to go into women's chat rooms to ask if any of them have allergic responses on a monthly basis. I'd like to come up with a FAQs file for them, and I'd like to find out exactly how prevelant it is now. I'd like to know if there is a connection between hormonal birth control (and then subset it into the oral, transdermal and intradermal administration).

Anyone game?

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A Vascular Surgeons Dream

That's what Mom's surgeon calls her.

To recap the last few months, Mom has had 4 angioplasties. Actually, 1 ended up being an angioGRAM, which means the docs just looked around. But we got some great pictures!

Our local renal vascular dude couldn't, well, revascularize her kidneys. 1 is dead. DRT - Dead Right There. Her other was about 85% occluded and he couldn't get the catheter into the arteries (she has 2 to that kidney), so couldn't stent. The only option was renal bypass.

Now, when I started this blog, it was covering just ME. It was a pity party. Still is, mostly. But there are so many hidden medical problems that cause morbidity (disability) and mortality (death) that it's coming to me that I need to expand. So - I'm going 1 step out and talking about my mom.

With Mom having 3 very inquisitive children, she soon found out that there were other options besides renal bypass, the odds of success with renal bypass, the frequency with which her condition (renal artery stenosis, or RAS for those in the know) occurs, signs and symptoms of RAS, survival rates after going into renal failure with RAS, and a slew of other odds and ends. I'll write about those later.

What my sister found out is the hospital she works at has a head surgeon who actually advertises his email! Ha! So she had no clue he was the grand poo bah (her words) of surgery when she emailed him. Had she known, she probably wouldn't have, thinking it not appropriate and we wouldn't be where we are today. And where we are - is in the best dream a vascular surgeon could ever have.

He was able to stent her kidney. The first artery - which he thought would be the most difficult - went flawlessly. That stent was placed just like it had always lived there. The second artery was a bit more problematic. It took an hour just to get the catheter placed. But, then went beautifully.

Since then, she has had her right arm (subclavian artery) stented, which means she now has a pulse in that arm again and is scheduled to have her right leg (femoral) done April 24. Her right arm is now warmer than her left, which means she'll probably have to have that one done sometime in the future.

One good note - her carotid artery (the one open one in her neck) is staying at about only 60% occluded which means they won't touch it until at least next year. Since it's been at 60% occlusion for about 5 years, I'm guessing it'll hold its position. We all are since her cardiologist down at my sister's hospital says she can't handle a stent being placed and would need a full endarterectomy. We don't want her sliced open if we can avoid it.

But her right femoral artery is 80% occluded. Which brings me to another post - how pissed I am at her local docs.

For YEARS she has complained about her leg being weak, getting tired quickly, aching and feeling numb. For YEARS they stated it was NOT vascular. Even last year during her open heart surgery, the vascular surgeon stated there was no way it was a vascular condition. And here we are, hoping it can be stented since a bypass would most likely be out of the question.

So, between her RAS being totally missed and BOTCHED, her right leg is in danger as well. Smooth move exlax.

And so this year continues. 3 trips out of town so far, and at least 2 to go.

Her blood pressure is coming down. Before the kidney work, it was holding steady at 180-190 systolic. After the kidney, it was holding steady at 160-170 systolic. Since the arm was stented, it was holding in the 140's, but over the weekend crashed to 90 systolic. We reduced one of her meds by half during the time it crashes to keep it up between 140 and 160. Considering how quickly it has dropped (within a month's time) and her risk for stroke, I am not letting it get that low again. Ischemic stroke due to a shock-like BP - take your BP and then drop it by half within 30 days. See how you feel. Anyway, a stroke due to her BP crashing is not the way things should end.

We take her pressure at least 3 times a day to make sure all is on an even keel.

Slowly, she is feeling better. Each stent brings more relief, more energy and more hope.

For me, it brings no physical relief, but hope things will improve for all of us in this house.

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