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Cyclical hypersensitivity, anaphylaxis, and related hormonal reaction

2018; Elsevier BV; Volume: 122; Issue: 2 Linguagem: Inglês

10.1016/j.anai.2018.11.016

1534-4436

William J. Lavery, Jonathan A. Bernstein,

Food Allergy and Anaphylaxis Research

Key Messages•Although endogenous or exogenous exposure to progesterone or estrogen that induce a spectrum of hypersensitivity reactions and/or other skin eruptions are believed to be uncommon, their prevalence is currently unknown.•Clinical manifestations are heterogeneous but typically involve cyclical manifestation of a spectrum of dermatitis conditions and/or systemic symptoms.•Diagnosis is made primarily by history in conjunction with in vitro assays to measure specific IgE and provocation challenge testing when appropriate; judicious use of skin testing is recommended because of their irritant-causing effects.•Pathomechanisms are incompletely understood but likely involve IgE-mediated immediate-type hypersensitivity.•Treatment is aimed at symptomatic control with nonsedating histamine1 antihistamines, short-term use of systemic glucocorticoids, progesterone desensitization, and/or suppression of ovulation by a pharmacologic or, as a last resort, surgical approach.InstructionsCredit can now be obtained, free for a limited time, by reading the review article and completing all activity components. Please note the instructions listed below:•Review the target audience, learning objectives and all disclosures.•Complete the pre-test.•Read the article and reflect on all content as to how it may be applicable to your practice.•Complete the post-test/evaluation and claim credit earned. At this time, physicians will have earned up to 1.0 AMA PRA Category 1 CreditTM. Minimum passing score on the post-test is 70%.Overall PurposeParticipants will be able to demonstrate increased knowledge of the clinical treatment of allergy/asthma/immunology and how new information can be applied to their own practices.Learning ObjectivesAt the conclusion of this activity, participants should be able to:•Define the 3 main identified types of cyclical hypersensitivity and appreciate their clinical presentations.•Describe the proposed etiology and pathomechanisms of cyclical hypersensitivities.•Discuss how to diagnose and treat cyclical hypersensitivity disorders.Release Date: February 1, 2019Expiration Date: January 31, 2021Target AudiencePhysicians involved in providing patient care in the field of allergy/asthma/immunologyAccreditationThe American College of Allergy, Asthma & Immunology (ACAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.DesignationThe American College of Allergy, Asthma & Immunology (ACAAI) designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Disclosure PolicyAs required by the Accreditation Council for Continuing Medical Education (ACCME) and in accordance with the American College of Allergy, Asthma and Immunology (ACAAI) policy, all CME planners, presenters, moderators, authors, reviewers, and other individuals in a position to control and/or influence the content of an activity must disclose all relevant financial relationships with any commercial interest that have occurred within the past 12 months. All identified conflicts of interest must be resolved and the educational content thoroughly vetted for fair balance, scientific objectivity, and appropriateness of patient care recommendations. It is required that disclosure be provided to the learners prior to the start of the activity. Individuals with no relevant financial relationships must also inform the learners that no relevant financial relationships exist. Learners must also be informed when off-label, experimental/investigational uses of drugs or devices are discussed in an educational activity or included in related materials. Disclosure in no way implies that the information presented is biased or of lesser quality. It is incumbent upon course participants to be aware of these factors in interpreting the program contents and evaluating recommendations. Moreover, expressed views do not necessarily reflect the opinions of ACAAI.Disclosure of Relevant Financial RelationshipsAll identified conflicts of interest have been resolved. Any unapproved/investigative uses of therapeutic agents/devices discussed are appropriately noted.Planning Committee•Jonathan A. Bernstein, MD (Annals CME Subcommittee): Consultant, Fees: Imedics; Consultant/Principal Investigator, Grants/Fees: Boehringer Ingelheim, GlaxoSmithKline; Consultant/Principal Investigator/Speaker, Grants/Fees: AstraZeneca, CSL Behring, Novartis/Genentech, Shire; Speaker, Fees: Baxalta•Guha Krishnaswamy, MD (Annals CME Subcommittee): Clinical Research, Grant: CSL Behring•Gailen D. Marshall, Jr, MD, PhD (Editor-in-Chief): Clinical Research, Grants: Sanofi, Stallergenes•Anna Nowak-Wegrzyn, MD (CME Series Editor, Deputy Editor): Clinical Research, Grant: Nutricia, Nestle, ITN NIH, DBV, Astellas; Speaker, Fees: Nutricia, Nestle, Thermofisher; Contributor, Royalties: UpToDate: Clinical Trial DMC Member: Merck; Board Member: Gerber, IFPIES•John J. Oppenheimer, MD (Annals CME Subcommittee, Associate Editor): Consultant, Other financial gains: DBV Technologies, GlaxoSmithKline, Kaleo; Clinical Research, Grants: AstraZeneca, Boehringer Ingelheim, NovartisAuthors•Jonathan A. Bernstein, MD; Consultant/Private Investigator, Grants/Fees: Allakos; Private Investigator/Speaker/Consultant, Grants/Fees: AstraZeneca; Private Investigator, Grants/Fees: Genentech/Novartis•William J. Lavery, MD, PhD has no relevant financial relationships to disclose.Recognition of Commercial Support: This activity has not received external commercial support.Copyright Statement: ©2015-2019 ACAAI. All rights reserved.CME Inquiries: Contact the American College of Allergy, Asthma & Immunology at [email protected] or 847-427-1200. •Although endogenous or exogenous exposure to progesterone or estrogen that induce a spectrum of hypersensitivity reactions and/or other skin eruptions are believed to be uncommon, their prevalence is currently unknown.•Clinical manifestations are heterogeneous but typically involve cyclical manifestation of a spectrum of dermatitis conditions and/or systemic symptoms.•Diagnosis is made primarily by history in conjunction with in vitro assays to measure specific IgE and provocation challenge testing when appropriate; judicious use of skin testing is recommended because of their irritant-causing effects.•Pathomechanisms are incompletely understood but likely involve IgE-mediated immediate-type hypersensitivity.•Treatment is aimed at symptomatic control with nonsedating histamine1 antihistamines, short-term use of systemic glucocorticoids, progesterone desensitization, and/or suppression of ovulation by a pharmacologic or, as a last resort, surgical approach. Credit can now be obtained, free for a limited time, by reading the review article and completing all activity components. Please note the instructions listed below:•Review the target audience, learning objectives and all disclosures.•Complete the pre-test.•Read the article and reflect on all content as to how it may be applicable to your practice.•Complete the post-test/evaluation and claim credit earned. At this time, physicians will have earned up to 1.0 AMA PRA Category 1 CreditTM. Minimum passing score on the post-test is 70%. Overall Purpose Participants will be able to demonstrate increased knowledge of the clinical treatment of allergy/asthma/immunology and how new information can be applied to their own practices. Learning Objectives At the conclusion of this activity, participants should be able to:•Define the 3 main identified types of cyclical hypersensitivity and appreciate their clinical presentations.•Describe the proposed etiology and pathomechanisms of cyclical hypersensitivities.•Discuss how to diagnose and treat cyclical hypersensitivity disorders. Release Date: February 1, 2019 Expiration Date: January 31, 2021 Target Audience Physicians involved in providing patient care in the field of allergy/asthma/immunology Accreditation The American College of Allergy, Asthma & Immunology (ACAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Designation The American College of Allergy, Asthma & Immunology (ACAAI) designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Disclosure Policy As required by the Accreditation Council for Continuing Medical Education (ACCME) and in accordance with the American College of Allergy, Asthma and Immunology (ACAAI) policy, all CME planners, presenters, moderators, authors, reviewers, and other individuals in a position to control and/or influence the content of an activity must disclose all relevant financial relationships with any commercial interest that have occurred within the past 12 months. All identified conflicts of interest must be resolved and the educational content thoroughly vetted for fair balance, scientific objectivity, and appropriateness of patient care recommendations. It is required that disclosure be provided to the learners prior to the start of the activity. Individuals with no relevant financial relationships must also inform the learners that no relevant financial relationships exist. Learners must also be informed when off-label, experimental/investigational uses of drugs or devices are discussed in an educational activity or included in related materials. Disclosure in no way implies that the information presented is biased or of lesser quality. It is incumbent upon course participants to be aware of these factors in interpreting the program contents and evaluating recommendations. Moreover, expressed views do not necessarily reflect the opinions of ACAAI. Disclosure of Relevant Financial Relationships All identified conflicts of interest have been resolved. Any unapproved/investigative uses of therapeutic agents/devices discussed are appropriately noted. Planning Committee•Jonathan A. Bernstein, MD (Annals CME Subcommittee): Consultant, Fees: Imedics; Consultant/Principal Investigator, Grants/Fees: Boehringer Ingelheim, GlaxoSmithKline; Consultant/Principal Investigator/Speaker, Grants/Fees: AstraZeneca, CSL Behring, Novartis/Genentech, Shire; Speaker, Fees: Baxalta•Guha Krishnaswamy, MD (Annals CME Subcommittee): Clinical Research, Grant: CSL Behring•Gailen D. Marshall, Jr, MD, PhD (Editor-in-Chief): Clinical Research, Grants: Sanofi, Stallergenes•Anna Nowak-Wegrzyn, MD (CME Series Editor, Deputy Editor): Clinical Research, Grant: Nutricia, Nestle, ITN NIH, DBV, Astellas; Speaker, Fees: Nutricia, Nestle, Thermofisher; Contributor, Royalties: UpToDate: Clinical Trial DMC Member: Merck; Board Member: Gerber, IFPIES•John J. Oppenheimer, MD (Annals CME Subcommittee, Associate Editor): Consultant, Other financial gains: DBV Technologies, GlaxoSmithKline, Kaleo; Clinical Research, Grants: AstraZeneca, Boehringer Ingelheim, Novartis Authors•Jonathan A. Bernstein, MD; Consultant/Private Investigator, Grants/Fees: Allakos; Private Investigator/Speaker/Consultant, Grants/Fees: AstraZeneca; Private Investigator, Grants/Fees: Genentech/Novartis•William J. Lavery, MD, PhD has no relevant financial relationships to disclose. Recognition of Commercial Support: This activity has not received external commercial support. Copyright Statement: ©2015-2019 ACAAI. All rights reserved. CME Inquiries: Contact the American College of Allergy, Asthma & Immunology at [email protected] or 847-427-1200.