Allergic reactions to seminal plasma
- David I Bernstein, MD
David I Bernstein, MD
- Professor of Clinical Medicine and Environmental Health
- University of Cincinnati College of Medicine
The term "human seminal plasma" (HSP) refers to the components of human semen other than spermatozoa. Allergic reactions to proteins in HSP usually present as either systemic reactions or localized vaginal reactions during or following vaginal sexual intercourse, which are prevented by condom use. The clinical manifestations, epidemiology, pathophysiology, diagnosis, and management of HSP allergy will be discussed in this topic review.
Allergic reactions to human seminal plasma (HSP) proteins present either as systemic-allergic reactions/anaphylaxis or as localized vaginal reactions.
Signs and symptoms — The largest review of published cases included 74 women. Seventy percent (52 patients) experienced systemic symptoms. Forty percent of those with systemic reactions also had local reactions, whereas approximately one-third of patients had only local reactions . All types of reactions are prevented by the use of condoms, which is a critical component of the clinical history. (See 'Clinical history' below.)
Systemic reactions — Anaphylactic reactions to HSP typically begin within minutes after ejaculation. Initial symptoms commonly include localized vulvar and vaginal pruritus and/or edema, followed by diffuse pruritus, nasal obstruction, itchy eyes, urticaria, and/or angioedema, often involving the face, lips, tongue, and throat. Gastrointestinal symptoms and respiratory symptoms of dyspnea, wheezing, and stridor have also been reported during systemic reactions. Life-threatening anaphylaxis with profound hypotension and cardiovascular collapse requiring emergency treatment was reported in 16 patients in the series of 74 women mentioned previously, indicating that severe reactions are not characteristic . Anaphylactic deaths attributable to HSP allergy have not been confirmed .
In addition to immediate-type systemic reactions, there are case reports of a patient presenting with a fixed cutaneous eruption  and a serum sickness-like reaction . Another uncommon reaction is worsening of pre-existing eczema during the days following HSP anaphylaxis .
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- The author's program, which is based at the University of Cincinnati College of Medicine, in Cincinnati, Ohio, can be accessed at the URL provided. The author is not aware of other centers in the United States that perform HSP fractionation and subcutaneous immunotherapy. www.Seminalplasmaallergy.org (Accessed on April 02, 2012).
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- The author's program for HSP fractionation and desensitization can be accessed through the website listed. The program is based at the University of Cincinnati College of Medicine, Cincinnati, Ohio. The author is not aware of other centers in the United States that have published experience in fractionating HSP. Seminalplasmaallergy.org (Accessed on April 01, 2012).
- Tan J, Bernstein JA. Fertility and human seminal plasma (HSP) hypersensitivity. Ann Allergy Asthma Immunol 2013; 111:145.
- CLINICAL MANIFESTATIONS
- Signs and symptoms
- - Systemic reactions
- - Local reactions
- Emotional impact
- Natural history
- RISK FACTORS
- DIAGNOSTIC EVALUATION
- Clinical history
- Objective testing
- - In vitro testing
- - Skin testing with whole seminal plasma
- Interpretation of results
- Referral for advanced evaluation
- DIFFERENTIAL DIAGNOSIS
- Epinephrine for anaphylaxis
- Prophylactic antihistamines and cromolyn
- Prevention of localized reactions
- Conception and pregnancy
- - Intravaginal
- - Subcutaneous immunotherapy
- Outcomes and fertility
- SUMMARY AND RECOMMENDATIONS