Catamenial anaphylaxis in three patients
Keywords:Anaphylaxis, Menstrual period, Allergic reactions
AbstractCatamenial anaphylaxis, also called cyclical anaphylaxis, describesrecurrent episodes of multi-system allergic reactionsoccurring at the time of menstruation. This case reports demonstratesthe management of three women with catamenialanaphylaxis. The first patient is a 38 years old woman whopresented with symptoms consistent with anaphylaxis in relationto her menstrual cycle. Her symptoms were controlledwith cetirizine at a dose of 20 mg daily. The second patient is33 years old with similar symptoms coinciding with her menses.We were able to control her symptoms with leuprolide(Lupron), a luteinizing hormone releasing hormone (LHRH)agonist. The third was a 29 years old woman with catamenialanaphylaxis who was successfully treated with Depo-Provera(medroxyprogesterone). Catamenial anaphylaxis is a rare yetan important presentation to the Allergist/Clinical immunologist.The management of the patients we present hererepresents a spectrum of the different therapies tried in themedical literature. Here, we report the first successful use ofmedroxyprogesterone for such rare, yet critical medical condition.
Farah FS, Shbaklu Z. Autoimmune Progesterone Urticaria. J Allergy Clin Immunol. 1971;48:257-61.
Gibbs CJ, Couts II, Lock R, Finnegan OC, White RJ. Premenstrual exacerbation of asthma. Thorax. 1984;39:833-6.
Meggs WJ, Pescovitz OH, Metacalfe D, Loriaux DL, Cutler G, Kaliner, M. Progesterone sensitivity as a cause of recurrent anaphylaxis. N Engl J Med. 1984;311:1236-8.
Basomba A, Guerrero M, Campos A, Pelaz A, Villalmanzo IG. Grave anaphylactic-like reaction in the course of menstruation. Allergy. 1987;42:477-9.
Slater JE, Raphael G, Cutler GB 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;70:542-6.
Simpson G, Roomes D, Humphrey MD. Anaphylactoid reactions associated with menstruation affecting two sisters. Med J Aust. 2001;175:415-7.
Burstein M, Rubinow A, Shalit M. Cyclic anaphylaxis associated with menstruation. Ann Allergy. 1991;66:36-8.
Metcalfe DD. Differential diagnosis of the patient with unexplained flushing/anaphylaxis. Allergy Asthma Proc. 2000;21:21-4.
Szczeklik A. Adverse reactions to aspirin and nonsteroidal anti-inflammatory drugs. Ann Allergy. 1987;59:113-8.
Tauber AI, Kaliner M, Stechschulte DJ, Austen KF. Immunologic release of histamine and slow reacting substance of anaphylaxis from human lung. J Immunol. 1973;111:27-32.
Lin RY, Schwartz LB, Curry A, Pesola GR, Knight RJ, Lee HS, et al. Histamine and tryptase levels in patients with acute allergic reactions: an emergency department-based study. J Allergy Clin Immunol. 2000;106:65-71.
Harada S, Horikawa T, Ashida M, Kamo T, Nishioka E, Ichihashi M. Aspirin enhances the induction of type I allergic symptoms when combined with food and exercise in patients with food-dependent exercise-induced anaphylaxis. Br J Dermatol. 2001;145:336-9.
Shirai T, Matsui T, Uto T, Chida K, Nakamura H. Nonsteroidal anti-inflammatory drugs enhance allergic reactions in a patient with wheat-induced anaphylaxis. Allergy. 2003;58:1071.
Wojnar RJ, Hearn T, Starkweather S. Augmentation of allergic histamine release from human leukocytes by nonsteroidal anti-inflammatory-analgesic agents. J Allergy Clin Immunol. 1980;66:37-45.
Fontaine C, Bousquet PJ, Demoly P. Anaphylactic shock caused by a selective allergy to celecoxib, with no allergy to rofecoxib or sulfamethoxazole. J Allergy Clin Immunol. 2005;115:633-4.
Grob M., Pichler WJ, Wuthrich B. Anaphylaxis to celecoxib. Allergy. 2002;57:264-5.
Wiggins CA, Dykewicz MS, Patterson R. Idiopathic anaphylaxis: classification, evaluation, and treatment of 123 patients. J Allergy Clin Immunol. 1988;82:849-55.
Ditto AM, Harris KE, Krasnick J, Miller MA, Paterson R. Idiopathic anaphylaxis: a series of 335 cases. Ann Allergy Asthma Immunol. 1996;77: 285-91.
Wong S, Patterson R, Harris KE, Dykewicz MS. Efficacy of ketotifen in corticosteroid-dependent idiopathic anaphylaxis. Ann Allergy. 1991;67:359-64.