The increased prevalence in recent decades of allergic reactions to certain food substances, pollen, mould, dust mites, insects and animals, and atopic conditions including eczema, rhinitis and asthma is well recognised in both scientific circles and by the general population.[1,2] However what is not as well recognised is that an allergic reaction to steroid hormones can also occur.
Steroid hormone allergy is where exposure to exogenous or endogenous steroid hormones triggers an immune response and subsequent activation of local and/or systemic symptoms.[4,5]
The clinical picture of steroid hormone allergy can be diverse in terms of symptom type and severity. It can include: skin issues (dermatitis, acne, eczema, stomatitis, papules, urticarial, vulvovaginal pruritus, erythema multiforme); reproductive issues (premenstrual syndrome, menstrual-associated asthma or migraines/headaches, low libido, dysmenorrhoea, infertility, recurrent miscarriage, premature birth); or more general symptoms (weight problems, loss of short-term memory, fatigue, mood swings, anxiety, fibromyalgia, interstitial cystitis, arthritis, chronic fatigue syndrome).[3-6]
While steroid hormone allergy is something of an under-investigated topic, the type and pattern of symptom onset seems to vary depending on whether it is an allergy to exogenous or endogenous steroid hormones.
From what is currently understood, symptoms associated with an endogenous steroid hormone allergy are more likely to present (or exacerbate) during pregnancy or in a cyclic manner in correlation with the menstrual hormonal fluctuations.
Symptoms associated with endogenous oestrogen hypersensitivity commonly occur during the premenstrual phase, while endogenous progesterone allergic symptoms often present during the luteal phase and dissipate following menstruation. However, this is not always the case, with symptoms sometimes occurring in the absence of a specific activating event and continuing throughout the menstrual cycle.
Conversely, symptoms associated with hypersensitivity to exogenous steroid hormones usually occur following specific exposure, either orally, dermally or vaginally (e.g. oral contraceptive pill, IVF medications, xeno-oestrogens, endocrine-disrupting compounds such as bisphenol A).[3,4,6]
The pathophysiology associated with steroid hormone allergy is thought to involve one of the following mechanisms:
1) TYPE I REACTION (IMMEDIATE) [3-5,7]
Oestrogen and/or progesterone recognised by body as antigens and taken up by antigen presenting cells
Activation of T cells and IgE synthesis
Release of histamine, Th2 cytokines and leukotrienes
2) TYPE IV REACTION (DELAYED) 
Oestrogen and/or progesterone bind to blood proteins forming a complex
Lymphocytes react to complex
Synthesis of lymphocytes and cytokines
Steroid hormone allergy is diagnosed using a combination of clinical assessment, skin testing (prick test, intradermal or patch test) and serum testing for anti-hormone antibodies. Current treatment involves symptom management and either rapid or gradual desensitisation protocols.[4-7]
- Tang ML, Mullins RJ. Food allergy: is prevalence increasing? Intern Med 2017;47(3):256-261. [Abstract]
- Prescott SL, Pawankar R, Allen KJ, et al. A global survey of changing patterns of food allergy burden in children. World All Organisation J 2013;6:18. [Abstract]
- Itsekson AM, Seidman DS, Zolti M, et al. Steroid hormone hypersensitivity: clinical presentation and management. Fertil Steril 2011;95(8):2571-2573. [Abstract]
- Untersmayr E, Jensen AN, Walch K. Sex hormone allergy: clinical aspects, causes and therapeutic strategies – update and secondary publication. World Allergy Org J 2017;10: 45.[Abstract]
- Shah S. Hormonal link to autoimmune allergies. Int Schol Res Network Allergy;2012:2012:Article ID 910437.[Abstract]
- Buccheit KM, Bernstein JA. Progestogen hypersensitivity. UpToDate 9 April 2018. Viewed 4 Sept 2018, [Source]
- Li RC, Buchheit KM, Bernstein JA. Progestogen hypersensitivity. Curr All Asthma Rep 2018;18:1.[Abstract]