Diagnosis and treatment of human seminal plasma hypersensitivity.

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.

The approach to conception for women with seminal plasma protein hypersensitivity.

PROBLEM: Allergic reactions to human seminal plasma protein has become increasingly recognized in the medical community. Treatment for most allergic conditions usually begins with avoidance of the offending allergen. For women with seminal plasma protein hypersensitivity (SPH) who desire to conceive, this approach is unacceptable. We describe a case report of a woman with an SPH who desired to have unprotected intercourse in order to conceive. METHODS: The patient underwent skin prick testing to her fiancé's fresh undiluted semen. Serum-specific IgG and IgE was performed by ELISA to the fiancé's whole seminal plasma and seminal plasma proteins (SPP). The patient underwent an intravaginal graded challenge to whole seminal fluid. Intrauterine insemination with washed spermatozoa was attempted but in vitro fertilization was subsequently required. RESULTS: The patient had a positive prick test to whole seminal plasma but negative specific IgG and IgE ELISA to SPPs. An intravaginal graded challenge to whole seminal plasma was well tolerated. However, she experienced a subsequent severe local reaction after unprotected intercourse. She deferred treatment with systemic desensitization to relevant SPPs. She failed intrauterine insemination but successfully conceived with in vitro fertilization. CONCLUSION: This case report emphasizes that SPH is not associated with sterility. It also indicates that whole seminal plasma graded challenge is not uniformly successful for the treatment of SPH.

Case report of an anaphylactoid reaction to arginine.

BACKGROUND: Arginine is an agent commonly used to evaluate adequacy of growth hormone (GH) secretion. Because arginine is a simple amino acid, it is considered safe and rarely causes adverse reactions. OBJECTIVE: To report the second anaphylactoid reaction to arginine in a child undergoing stimulation testing with arginine for assessing GH secretion. METHODS: Allergy skin testing to arginine was performed with a protocol similar to penicillin testing 4 weeks after the anaphylactoid reaction. RESULTS: Testing revealed a positive response to the arginine. CONCLUSIONS: The use of intravenous arginine as a test of GH reserve remains safe and effective, but it is prudent to have the equipment and medication available to treat an allergic reaction.