Seminal fluid

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Code: o70
IgE antibodies to seminal fluid have also been shown to be one factor involved in infertility (16).

Allergen Exposure

Seminal plasma. The major allergens involved have been reported to be 20-30 kD glycoproteins present in the seminal plasma (7-8).

Potential Cross-Reactivity

No information available.

Clinical Experience

Local reactions may appear within minutes of coitus and develop into generalized urticaria, swelling, and anaphylaxis (1-6). The reactions are IgE-mediated and IgE antibodies to seminal plasma proteins can be detected in skin and in serum. IgE antibodies to seminal fluid have also been shown to be one factor involved in infertility (16).
 
Review
Allergic reactions in women caused by sensitization to seminal plasma are a relatively rare but serious problem. Local reactions may appear within minutes of coitus and develop into generalized urticaria, swelling , and anaphylaxis (1-6). The reactions are IgE-mediated and IgE antibodies to seminal plasma proteins can be detected in skin and in serum.

The major allergens involved have been reported to be 20-30 kD glycoproteins present in the seminal plasma (7-8).

Localized vaginal allergic responses without systemic reactions have also been observed. Clinical and immunological findings indicated that cell-mediated immunity to seminal fluid antigens may be causing the inflammatory reaction (9).
 
Local reactions may also involve recurrent Candida infections as a secondary phenomenon to an IgE-mediated vaginal response (10), or be induced by an allergic reaction initiated by sexually transmitted IgE antibodies from the male (11).

The use of a condom during intercourse effectively eliminates exposure to seminal plasma and is a major consideration treating the disease (12, 13), although concurrent sensitivity to seminal fluid and latex has been observed (14). Local and cutaneous reactions have been treated with intravaginal cromolyn (15).

IgE antibodies to seminal fluid have also been shown to be one factor involved in infertility (16). Infertility as a consequence of avoidance is often an undesired complication and several immunotherapy protocols have therefore been designed to treat the disease and allow induction of pregnancy. Injection therapy with allergenic fractions of human seminal plasma was shown to be effective with a dramatic decrease of IgE antibody concentration as well as of clinical symptoms (17-19). Local intravaginal rush desensitization followed by frequent unprotected intercourse seems to be as effective and has been reported to induce successful pregnancy (20-22). Pregnancy has also been induced in women with seminal plasma allergy by artificial insemination with washed spermatozoa, devoid of the allergenic seminal plasma proteins (23-24). 

References

  1. Halpern BN, Ky T, Robert B. Clinical and immunological study of an exceptional case of reaginic type sensitization to human seminal fluid. Immunology 1967;12(3):247-58.
  2. Frankland AW, Parish WE. Anaphylactic sensitivity to human seminal fluid. Clin Allergy 1974;4(3):249-53.
  3. Mikkelsen EJ, Henderson LL, Leiferman KM, Gleich GJ. Allergy to human seminal fluid. Ann Allergy 1975;34(4):239-43.
  4. Reunala T, Koskimies AI, Bjorksten F, Janne J, Lassus A. Immunoglobulin e-mediated severe allergy to human seminal plasma. Fertil Steril 1977;28(8):832-5.
  5. Mumford DM, Haywood TJ, Daily LJ, Jr., McLerran CJ, McGovern JP. Female allergy to seminal plasma - a case report. Ann Allergy 1978;40(1):40-3.
  6. Mathias CG, Frick OL, Caldwell TM, Yunginger JW, Maibach HI. Immediate hypersensitivity to seminal fluid and atopic dermatitis. Arch Dermatol 1980;116(2):209-12.
  7. Siraganian RP, Schenkein I, Levine BB. Immunologic studies of a patient with seminal plasma allergy. Clin Immunol Immunopathol 1975;4(1):59-66.
  8. Kooistra JB, Yunginger JW, Santrach PJ, Clark JW. In vitro studies of human seminal plasma allergy. J Allergy Clin Immunol 1980;66(2):148-54.
  9. Bernstein IL, Englander BE, Gallagher JS, Nathan P, Marcus ZH. Localized and systemic hypersensitivity reactions to human seminal fluid. Ann Intern Med 1981;94(4 pt 1):459-65.
  10. Witkin SS, Jeremias J, Ledger WJ. A localized vaginal allergic response in women with recurrent vaginitis. J Allergy Clin Immunol 1988;81(2):412-6.
  11. Witkin SS, Jeremias J, Ledger WJ. Recurrent vaginitis as a result of sexual transmission of IgE antibodies [see comments]. Am J Obstet Gynecol 1988;159(1):32-6.
  12. Ludman BG. Human seminal plasma protein allergy: a diagnosis rarely considered. J Obstet Gynecol Neonatal Nurs 1999;28(4):359-63.
  13. Prandini M, Marchesi S. Allergy to human seminal fluid: a case of self-diagnosis. Allergy 1999;54(5):530.
  14. Yocum MW, Jones RT, Yunginger JW. Concurrent sensitization to natural rubber latex and human seminal fluid [letter]. J Allergy Clin Immunol 1996;98(6 Pt 1):1135-6.
  15. Bosso JV, Aiken MJ, Simon RA. Successful prevention of local and cutaneous hypersensitivity reactions to seminal fluid with intravaginal cromolyn. Allergy Proc 1991;12(2):113-6.
  16. Mathur S, Williamson HO, Baker ER, Fudenberg HH. Immunoglobulin E levels and antisperm antibody titers in infertile couples. Am J Obstet Gynecol 1981;140(8):923-30.
  17. Bernstein IL, Gallagher JS, Friedman SA, Marcus ZH. Standardized immunotherapy protocol for IgE-mediated anaphylaxis to human seminal plasma. Contrib Gynecol Obstet 1985;14:151-9.
  18. Blair H, Parish WE. Asthma and urticaria induced by seminal plasma in a woman with IgE antibody and T-lymphocyte responsiveness to a seminal plasma antigen. Clin Allergy 1985;15(2):117-30.
  19. Ohman JL, Jr., Malkiel S, Lewis S, Lorusso JR. Allergy to human seminal fluid: characterization of the allergen and experience with immunotherapy. J Allergy Clin Immunol 1990;85(1 Pt 1):103-7.
  20. Matloff SM. Local intravaginal desensitization to seminal fluid. J Allergy Clin Immunol 1993;91(6):1230-1.
  21. De Cuyper C, Bogaerts Y, Vandekerckhove F, Gunst J. Intravaginal desensitization and successful pregnancy in a woman with seminal fluid allergy. J Allergy Clin Immunol 1996;97(6):1427-8.
  22. Dijkstra AT, Bruijnzeel-Koomen CA. [Allergy to human semen]. Ned Tijdschr Geneeskd 1997;141(14):690-2.
  23. Shapiro SS, Kooistra JB, Schwartz D, Yunginger JW, Haning RV, Jr. Induction of pregnancy in a woman with seminal plasma allergy. Fertil Steril 1981;36(3):405-7.
  24. Iwahashi K, Miyazaki T, Kuji N, Yoshimura Y. Successful pregnancy in a woman with a human seminal plasma allergy. A case report. J Reprod Med 1999;44(4):391-3.

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.