From the Research
Auto-desensitization in progesterone hypersensitivity typically occurs between 10 to 12 weeks of pregnancy. During this time, the body naturally adapts to the increasing levels of progesterone produced by the placenta, leading to a reduction or complete resolution of hypersensitivity symptoms. This natural desensitization process is why women with autoimmune progesterone dermatitis or other progesterone hypersensitivity conditions often experience improvement in their symptoms during pregnancy, despite the high progesterone levels. The mechanism behind this auto-desensitization involves immunological adaptations that occur during pregnancy to prevent rejection of the fetus, including shifts in T-cell populations and cytokine profiles that modify the immune response to progesterone 1.
For women with known progesterone hypersensitivity who become pregnant, it's essential to monitor symptoms closely during the first trimester, as the adaptation process may not be immediate. Most patients will notice a gradual improvement in symptoms as pregnancy progresses beyond the first trimester. The use of exogenous progestins, such as those used in in vitro fertilization, can trigger hypersensitivity symptoms, and desensitization protocols have been developed to manage these cases 2, 3.
Key points to consider in the management of progesterone hypersensitivity include:
- Monitoring symptoms closely during the first trimester of pregnancy
- Gradual improvement in symptoms as pregnancy progresses beyond the first trimester
- Use of desensitization protocols for women undergoing in vitro fertilization or other treatments involving exogenous progestins
- Importance of recognizing the heterogeneous clinical presentation of progesterone hypersensitivity, including cyclical dermatitis, urticaria, angioedema, asthma, and anaphylaxis 4, 5.
In clinical practice, it's crucial to be aware of the potential adverse effects of progesterone use during pregnancy and to consider autoimmune progesterone dermatitis in the differential diagnosis of patients presenting with pruritic lesions 5.