Progesterone Induced Anaphylaxis News

First, two other posts I've written on the subject:
My first Encounter With Progesterone Allergy

More Info About Progesterone Allergy
Please read the comments below each post - you'll see you're not alone!

And since I just got another email from an incredible husband researching to find some answers for his wife, I've done a little more digging...

I've found another term for it:
Catamenial Anaphylaxis is a syndrome of hypersensitivity induced by endogenous progesterone secretion. Patients may exhibit a cyclic pattern of attacks during the premenstrual part of the cycle.
There are several Catamenial syndromes - this being one of them. It may not be just progesterone related, as some women have it occur when the progesterone isn't being secreted. However, that doesn't mean it isn't all related and not part of the problem for one of you out there.

As for the research on Progesterone Induced Allergy (or Anaphylaxis):
A single case in Australia was treated successfully with a COX-2 inhibitor (Vioxx type). Nothing more has been written about it since 2001.

Another individual case in the US was treated with a chemical menopause - which ceased her symptoms untill she had her ovaries removed:

Treatment with an LHRH analog causes the pituitary to become unresponsive to endogenous LHRH, with subsequent reduction in the secretion of follicle secreting hormone (FSH) and leutinizing hormone (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 present at follow-up five years later.

My thinking
I know my efforts work wonders for me and fully believe additional efforts would work as well.

Benadryl - I take 50 mg a day. Since I have hay fever type allergies, which got worse after my first bout with PIA, I just take it daily. Once in awhile I can decrease the dose to 25 mg, but not often. If I start getting itchy, I also use a benadryl cream. That works wonders.

Zantac - if you do an acid reflux type med, it must be the H2 inhibitor type. Not all are, so do your homework. Zantac is OTC, so is easiest for me.

Methylpred 21-pack. My doc gives me a script to keep at home in case I need it. If the symptoms break through the benadryl and benadryl cream, I just start the methylpred. I know it's going to be a bad episode, so why wait until it's time to go to the ER? It's far cheaper and better on your body to not wait so long for the help, when you can do the same thing at home.

Herbal Therapy

So then I got thinking about other ways women may be exposed to estrogen, phytoestrogen and phytoprogesterone - yes, there is such a thing!

Basically, any of the herbal supplements for women having difficulty with their mensies or getting pregnant or for menopausal symptoms can have the phytoprogesterone in it.

The major players:
Red Clover
Chaste Tree (Agnus Castus)
Wild Yam
Black Cohosh

The Minor arcana
Alfalfa
Apple
Dandelion
Dates
Dong Quai
False Unicorn
Green Beans
Hops
Liquorice
Motherwort
Pomegranates
Sarsaparilla
Saw Palmetto
Willow

I fully believe with girls maturing far earlier than ever in history, as well as the use of chemical birth control being used by more and for longer periods, AND the advent of many that suppress mensies for months at a time, this will be far less common.

So fight with your doc! Keep a journal of when symptoms start, end and how severe along with your menstrual cycle. Then you can prove to him/her that it isn't in your head, it's in your ovaries.

You're not alone!

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:

http://www.onlineallergycenter.com/treatments/hormone_imbalance.htm
While I don't completely agree with some of the observations and theories, the article makes some very good points.

Here's another:
http://www.clinicalmolecularallergy.com/content/2/1/10

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
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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
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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?