Chronic autoimmune urticaria with worsening during the luteal phase suggestive of progesterone hypersensitivity successfully treated with rituximab.
Hannah Hardin, Rachel Odin, Jonathan A Bernstein
✦ AI-curated · Sources linked
Case in brief
A 30-year-old woman with glucocorticoid-dependent chronic spontaneous urticaria (CSU) presented with cyclical worsening of symptoms during her luteal phase. Previous treatments, including high-dose antihistamines, omalizumab, and cyclosporin, were ineffective. She was diagnosed with progesterone hypersensitivity and chronic autoimmune urticaria. Treatment with rituximab successfully eliminated her symptoms, allowing her to taper off prednisone and conceive without recurrence of hives.
What made this case unusual
The case highlights a unique association between chronic autoimmune urticaria and progesterone hypersensitivity, with cyclical symptom exacerbation linked to the menstrual cycle.
Diagnostic / clinical pearl
Clinicians should consider progesterone hypersensitivity in women with chronic spontaneous urticaria that worsens during the luteal phase.
Why it matters
This case underscores the potential for rituximab to effectively treat chronic autoimmune urticaria associated with hormonal fluctuations.