From the Guidelines
Catamenial anaphylaxis should be treated with epinephrine as the first-line pharmacotherapy, and patients should always carry an epinephrine auto-injector and wear a medical alert bracelet. The diagnosis of catamenial anaphylaxis is based on the clinical presentation of severe allergic reactions during the menstrual cycle.
Prevention and Treatment
For prevention, the following measures can be taken:
- Oral contraceptives to suppress ovulation
- GnRH agonists (e.g., leuprolide) to suppress menstruation
- Antihistamines (e.g., cetirizine 10mg daily) during menstruation
- Leukotriene inhibitors (e.g., montelukast 10mg daily) For emergency management:
- Epinephrine auto-injector (0.3mg for adults) at first sign of anaphylaxis
- Seek immediate medical attention after using epinephrine It's crucial to work closely with an allergist to develop a personalized treatment plan, as recommended by 1 and 1. The exact mechanism of catamenial anaphylaxis is not fully understood, but it's believed to be related to hormonal fluctuations during the menstrual cycle, which may trigger mast cell degranulation, leading to the release of histamine and other inflammatory mediators, resulting in anaphylactic symptoms, as discussed in 1.
Key Considerations
Key considerations in the management of catamenial anaphylaxis include:
- Prompt administration of epinephrine, as delayed injection can be associated with poor outcomes, including fatality, as noted in 1 and 1
- The importance of patient education on anaphylaxis, including avoidance of identified triggers, presenting signs and symptoms, biphasic anaphylaxis, treatment with epinephrine, and the use of epinephrine auto-injectors, as emphasized in 1
- The need for ongoing monitoring and follow-up with an allergist to adjust the treatment plan as needed, as recommended in 1 and 1
From the Research
Diagnosis of Catamenial Anaphylaxis
- Catamenial anaphylaxis is a complex clinical syndrome with poorly reported incidence and prevalence in the literature review 2
- The underlying mechanism is still not fully understood, although a few proposed hypotheses are stated 2
- Early recognition of symptoms is crucial to bring optimal treatment and prevent unnecessary intubation and complications 2
Treatment of Catamenial Anaphylaxis
- Epinephrine is the medication of choice for the immediate treatment of anaphylaxis, including catamenial anaphylaxis 3, 4, 5
- Epinephrine auto-injectors (EAI) are the preferred method for administering the treatment of anaphylaxis in the community setting 4
- Other second-line therapies, such as inhaled beta-2 agonists, H1 and H2 receptor antagonists and corticosteroids, may play a role in resolving respiratory and cutaneous signs and symptoms 5
- Long-term management of anaphylaxis is focused on the prevention of new episodes, and may include etiologic diagnosis, patient education, and immunomodulatory and etiologic treatments 4
Management of Anaphylaxis
- Anaphylaxis is a severe, acute and potentially life-threatening condition that requires prompt recognition and treatment 3, 4, 5, 6
- Healthcare professionals need to know how to recognize anaphylaxis and the importance of treating it promptly 6
- Strategies to overcome gaps in the acute management of anaphylaxis include novel injection devices and research of new routes for epinephrine delivery, as well as electronic health solutions 4