Elduque C, Navarro B, Botey E, Morales M, Claver A, Sureda C, Gil R, Cisteró-Bahíma A.

Allergy Department “Al.lèrgia-Dexeus”, Hospital Universitari Dexeus-GQS. UAB. Barcelona, Spain.
Farmacy Department. Hospital Universitari Dexeus-GQS. UAB. Barcelona, Spain.

Allergic reactions induced by high-dose exogenous progesterone required for in vitro fertilization (IVF) can limit the patient’s ability to achieve pregnancy. Patients with demonstrated progesterone hypersensitivity can be treated with desensitization protocols.

A 40-year-old woman with personal history of allergy to hymenoptera venom (Apis mellifera) treated with immunotherapy and infertility was referred to our Allergy department for evaluation of local reactions after injection of exogenous progesterone and local pruritus and generalized urticaria after administration of intravaginal progesterone ovules. Her obstetrician advised us that high-dose of systemic progesterone (25 mg of Prolutex® twice a day) was needed to achieve significant rise of progesterone levels to successful IVF.

Skin test (both prick and intradermorreaction) with exogenous progesterone(dilutions 1/1000, 1/100, 1/10) were performed, showing positive results in intradermorreaction to all of them.

For our patient, intravaginal progesterone preparations were not an option, as she had presented local reaction and generalized urticaria when this treatment was performed, and progesterone levels were not enough using this route. As an alternative, we adapted previously described intramuscular progesterone desensitization protocol, using a 2-day scheme and the subcutaneous route, without premedication, resulting in good tolerance (final dose tolerated: 50 mg) and correct progesterone levels to initiate IVF programme.

We present a case of progesterone hypersensitivity successfully treated with a modified desensitization protocol, with no premedication and using the subcutaneous route.