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Clinical case:
A seven- years- old female Sheltie with blue Merle color was presented because of recurrent dermatitis, mainly at the paws but also at the head. The lesions regularly occurred during the weeks after heat and then disappeared again. Histopathological examination of a biopsy revealed a severe inflammation with unclear cause. During the phases of skin disease, the dog was treated with Oclacitinib (Apoquel, Zoetis, Switzerland) which seemed to help according to the owner. Because of the remarkable pattern of the occurrence of the skin disorders, progesterone was measured in the blood serum in a commercial laboratory using chemiluminescence (Immulite 2000 XPi, Siemens Healthcare GmbH, Erlangen, Germany). In addition, blood serum was tested with an uncertified ELISA essay for progesterone antibodies (1). The amount of immunoglobulins in the serum was determined using ELISA plates coated with 100 μl of progesterone bovine serum albumin. Anti- progesterone- IgE was not found in most of the samples. The amount of anti- progesterone- IgM, however, might have corresponded to high progesterone concentrations and dermatitis as their concentrations were higher in the luteal phase. The dog was neutered and never developed a dermatitis thereafter.
Discussion:
The results of this case report must be interpreted very cautiously as the assay is uncertified, and only one dog was studied during a single sexual cycle. Nevertheless, the results indicate that it might be worthwhile to investigate a potential individual autoimmune response to progesterone in dogs as it has been reported in humans (2). More than 50 case reports about autoimmune progesterone reactions in humans during the luteal phase with a variety of presentations including erythema multiforme, eczema, urticaria, angioedema, and progesterone- induced anaphylaxis, have been published. The underlying etiology, however, is still not clear. A similar approach has been described by Krachudel et al. 2013 (1) in the context of a potential etiology of canine hypoluteoidism. It can be hypothesized that anti- progesterone- IgM- antibodies may play a role in the observed cycle stage- dependent occurrence of dermatitis in this dog.