PROGESTERONE-INDUCED URTICARIA - RESPONSE TO BUSERELIN

We report a 41-year-old Caucasian woman with polycystic liver and kidn ey disease, and a 9-year history of severe cyclical urticaria related to her menses. The urticaria was not adequately controlled by antihist amines or Prempak-C(R) (conjugated oestrogens and norgestrel). Intrade rmal, testing with progesterone was strongly positive at 30 min and 18 h. Buserelin, administered intranasally at doses of up to 800 mu g da ily, controlled the urticaria within 4 weeks, and she was completely s ymptom-free thereafter. She had therapy-induced amenorrhoea and occasi onal hot flushes. Unfortunately, her liver cysts progressively enlarge d, and a right hepatectomy was performed in June 1992, but she died af ter complications 3 weeks later. Prior to this she had been free of ur ticaria for 6 months after starting buserelin. Buserelin, a gonadotrop hin-releasing hormone analogue, may be useful in the management of pro gesterone-induced urticaria, in patients in whom conjugated oestrogens are contraindicated or unhelpful.