Catamenial anaphylaxis

Introduction: It is well documented that the hormonal changes during menstrual cycle influences systemic diseases, among them are allergic disorders. There are some reports of cyclic anaphylactic reactions during menstrual period which is reffered as "Catamenial anaphylaxis". It must be differentiated from a closely related condition called "APD" or autoimmune progesterone dermatitis which is also a rare condition . It seems that hormonal changes especially rising progesterne levels and other mechanisms like back-diffusion of prostaglandines from contracting uterus into the systemic circulation may have some role in pathogenesis of these conditions. In catamenial anaphylaxis symptoms appear in direct association with the start of the menstrual flow but in APD, sign and symptoms begin earlier in the pre-menstrual phase. Case report: A 19 year old girl (not married) was referred because of a 8-months history of recurrent monthly urticarial and anaphlactoid reactions. Her symptoms began at first day of menstruation and lasted 1 to 2 days. The eruptions started as a sense of flushing and intense pruritus all over the body. Soon urticarial lesion as giant hives appeared which in some instances was associated with respiratory distress. The patient denied any changes in her diet and had taken no medications. Complete blood Ccunt and erytrocyte sedimentation rate (ESR) revealed no abnormalities but VDRL positivity led us to consider rheumatological background like systemic lupus erythematosous. Anti cardioLipin antibody (ACLA) was surprisingly above normal laboratory values. Her serum was taken in an episode of cyclic anaphylactic reactions and stored to be used later in her cycle when no more menstruating. Skin prick test with autologous serum collected during menstruation is performed at the midcycle and also in the late-cycle period in another ovulatory cycle. Both prick tests led to resurgence of severe allergic reactions as flushing, urticaria, pruritus and dry cough which were managed approprately. The patient's history and physical examination and hormonal assay were consistent with catamenial anaphylaxis. She is currently under control and follow up, using cyclic conjugated estrogens.