RESUMO
Rhinitis is characterized by rhinorrhea, sneezing, nasal congestion, nasal itch and/or postnasal drip. Often the first step in arriving at a diagnosis is to exclude or diagnose sensitivity to inhalant allergens. Non-allergic rhinitis (NAR) comprises multiple distinct conditions that may even co-exist with allergic rhinitis (AR). They may differ in their presentation and treatment. As well, the pathogenesis of NAR is not clearly elucidated and likely varied. There are many conditions that can have similar presentations to NAR or AR, including nasal polyps, anatomical/mechanical factors, autoimmune diseases, metabolic conditions, genetic conditions and immunodeficiency. Here we present a case of a rare condition initially diagnosed and treated as typical allergic rhinitis vs. vasomotor rhinitis, but found to be something much more serious. This case illustrates the importance of maintaining an appropriate differential diagnosis for a complaint routinely seen as mundane. The case presentation is followed by a review of the potential causes and pathogenesis of NAR.
RESUMO
BACKGROUND: Human seminal plasma hypersensitivity is a rare disorder that is often misdiagnosed. While this disorder is well described in the allergy and immunology literature, few cases exist in the gynecologic literature. CASE: A young woman presented to our allergy clinic with recurrent vaginal burning, swelling, and itching occurring approximately 10 minutes postcoitally. Semen allergy was suspected. Using her partner's semen, intradermal testing produced 1.6-cm wheal and 6.0-cm flare. The patient underwent intravaginal desensitization, and she and her partner were instructed to have intercourse every 48 hours to maintain desensitization. At 5-month follow-up, they were practicing coitus interruptus with success. CONCLUSION: Human seminal plasma hypersensitivity may mimic chronic vaginitis. The intravaginal graded challenge, a form of immunotherapy used by allergists, remains a mainstay in treatment, but is only effective if maintained correctly.
