Intrauterine uterine contraception and chronic urticaria: a case series

Chronic Urticaria Suspected to be Caused by a 13.5 mg Levonorgestrel Intrauterine Device (Skyla®)

“…However, the study did not specify the dosages of progesterone in their IUDs. Thus, we cannot confirm if Skyla® caused symptoms in any of these patients [ 5 ]. Two papers described the incidence of acute urticarial rash in patients two hours after implantation of Mirena®, with a resolution of the rash after IUD removal [ 1 , 9 ].…”

“…Pathogenesis is poorly understood. There may be a combination of both type I and IV immune reactions through a T-helper (Th2) lymphocyte-mediated reaction [ 1 , 4 , 5 ]. Sensitization may occur from cross-sensitivity between progesterone products in the production of immunoglobulin E synthesis [ 4 ].…”

“…Skin prick tests with levonorgestrel can be used to confirm progesterone hypersensitivity. However, the sensitivity and specificity of this test are not well documented, suggesting the need to develop a standardized vial of progesterone for testing [ 5 ]. Testing for CD203, a nonspecific marker for mast and basophil cell activation, has also been reported in the literature [ 5 , 10 ].…”

“…Females with progesterone hypersensitivity or "autoimmune progesterone dermatitis" may have recurrent monthly outbreaks of urticarial lesions [1][2][3]. Some females may be sensitized to progesterone; however, they may not have cyclical urticaria and may only show symptoms with the addition of exogenous progesterone, such as when taking birth control [3][4][5]. In this report, we explore a chronic urticarial rash in a young female, which seems to be associated with her 13.5 mg levonorgestrel (progesterone)-releasing intrauterine device.…”