Genital contact allergy: A diagnosis missed

Marfatia, Yogesh S; Patel, Dhruv; Menon, Devi Sathianadha; Naswa, Smriti

doi:10.4103/0253-7184.180286

Cited by 14 publications

(8 citation statements)

References 25 publications

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“…Recent evidence suggests that a significant portion of people exposed to MI developed the capacity for an allergic response [11,12], showed exacerbated inflammatory responses [13], and experienced tissue injury in the skin or lungs [12,14] after exposure. Allergic responses to MI have also been linked to vulvar dermatitis [15,16], but no connections between such dermatoses and the later development of vulvar pain have been made in the published clinical literature. Recently, Reed and colleagues identified exposures to household and workplace chemicals as a possible risk factor for the development of vulvodynia [17].…”

Section: Introductionmentioning

confidence: 99%

Repeated Vaginal Exposures to the Common Cosmetic and Household Preservative Methylisothiazolinone Induce Persistent, Mast Cell-Dependent Genital Pain in ND4 Mice

Arriaga-Gomez

Kline

Emanuel

et al. 2019

IJMS

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A history of allergies doubles the risk of vulvodynia—a chronic pain condition of unknown etiology often accompanied by increases in numbers of vulvar mast cells. We previously established the biological plausibility of this relationship in mouse models where repeated exposures to the allergens oxazolone or dinitrofluorobenzene on the labiar skin or inside the vaginal canal of ND4 Swiss Webster outbred mice led to persistent tactile sensitivity and local increases in mast cells. In these models, depletion of mast cells alleviated pain. While exposure to cleaning chemicals has been connected to elevated vulvodynia risk, no single agent has been linked to adverse outcomes. We sensitized female mice to methylisothiazolinone (MI)—a biocide preservative ubiquitous in cosmetics and cleaners—dissolved in saline on their flanks, and subsequently challenged them with MI or saline for ten consecutive days in the vaginal canal. MI-challenged mice developed persistent tactile sensitivity, increased vaginal mast cells and eosinophils, and had higher serum Immunoglobulin E. Therapeutic and preventive intra-vaginal administration of Δ9-tetrahydrocannabinol reduced mast cell accumulation and tactile sensitivity. MI is known to cause skin and airway irritation in humans, and here we provide the first pre-clinical evidence that repeated MI exposures can also provoke allergy-driven genital pain.

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Section: Introductionmentioning

confidence: 99%

Repeated Vaginal Exposures to the Common Cosmetic and Household Preservative Methylisothiazolinone Induce Persistent, Mast Cell-Dependent Genital Pain in ND4 Mice

Arriaga-Gomez

Kline

Emanuel

et al. 2019

IJMS

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“…The differential diagnoses for SPH are broad given the range of possible symptoms (Table 2). Initial diagnoses to consider include reaction to other allergens, with the most frequently tested ones being latex, lube, lotion, food, medications, Candida, and common inhalants 11,27,38,47–49 . Vaginal infection must also be ruled out, particularly herpes simplex, human immunodeficiency virus, hepatitis, gonorrhea, chlamydia, trichomonas, Candida, and bacterial vaginosis 6,34,41 .…”

Section: Resultsmentioning

confidence: 99%

“…6,34,41 There could also be structural causes such as dyspareunia, vulvodynia, and vibratory angioedema 6,24,47 or dermatologic causes including eczema, lichen sclerosis, Paget disease, psoriasis, pemphigus vulgaris, and Behcet disease. 47,49 For systemic reactions, exercise-induced asthma and honeymoon rhinitis may also be considered. 50…”

Section: Differential Diagnosismentioning

confidence: 99%

Seminal plasma hypersensitivity: A systematic review of clinical presentation, diagnostics, and management options

Schacher,

Dalloul,

Muneyyirci‐Delale

2024

American J Rep Immunol

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IntroductionSeminal plasma hypersensitivity (SPH) is a rare and often misdiagnosed condition characterized by local and/or systemic reactions to seminal plasma proteins following exposure to semen. We aimed to summarize key symptomatology, diagnostic features, and management options for SPH.MethodsThe databases PubMed, EMBASE, Web of Science, Google Scholar, and Cochrane Review were searched with key words “seminal plasma hypersensitivity” and “seminal fluid allergy” through September 2023. Exclusion criteria included non‐English articles, in vitro studies, publication before 1990, duplicates, and articles with no clinical relevance to SPH in women.ResultsThe search yielded 53 articles for review. Of these, 60.5% described systemic SPH and 39.5% described localized.ConclusionDiagnosis of SPH relies on a thorough patient history and confirmatory skin prick testing. The use of IgE assays is controversial and less accurate for cases of localized SPH. Knowledge of disease immunopathology, systemic versus localized symptom presentation, patient preference, and desire to conceive should guide management options. Artificial insemination has the potential for severe adverse reactions in systemic SPH so necessitates extra procedural precautions. SPH does not appear to impair fertility. Additional research on specific allergens implicated in SPH can aid in the development of more targeted immunotherapy approaches with improved safety and efficacy.

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“…While LPV affects 8-28% of cis-gender, female-identifying individuals during their lifetime ( Reed et al., 2004 ; Reed et al., 2012 ; Harlow et al., 2014 ), it is frequently misdiagnosed and lacks effective therapeutic approaches ( Merlino et al., 2022 ). However, self-reported history of allergies to pollen and insect venom, and recurrent vulvovaginal yeast infections are both associated with an increased incidence of vulvodynia ( Sarma et al., 1999 ; Witkin et al., 2002 ; Harlow et al., 2009 ; Marfatia et al., 2016 ; Harlow et al., 2023 ) suggesting that immune mechanisms may be involved in its underlying pathophysiology. Pain has been recognized as a cardinal sign of protective inflammation since at least 50 CE (in De Medicina by Roman encyclopedist Aulus Celsus) and is key to both healing, and withdrawal from harmful exposures.…”

Section: Introductionmentioning

confidence: 99%

Immune mechanisms in vulvodynia: key roles for mast cells and fibroblasts

Tonc,

Omwanda,

Tovar

et al. 2023

Front. Cell. Infect. Microbiol.

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Vulvodynia is a debilitating condition characterized by painful sensitivity to touch and pressure in the vestibular tissue surrounding the vaginal opening. It is often a “diagnosis of exclusion” of idiopathic pain made in the absence of visible inflammation or injury. However, the association between increased vulvodynia risk and a history of yeast infections and skin allergies has led researchers to explore whether immune mechanisms of dysregulated inflammation might underlie the pathophysiology of this chronic pain condition. Here we synthesize epidemiological investigations, clinical biopsies and primary cell culture studies, and mechanistic insights from several pre-clinical models of vulvar pain. Taken together, these findings suggest that altered inflammatory responses of tissue fibroblasts, and other immune changes in the genital tissues, potentially driven by the accumulation of mast cells may be key to the development of chronic vulvar pain. The association of increased numbers and function of mast cells with a wide variety of chronic pain conditions lends credence to their involvement in vulvodynia pathology and underscores their potential as an immune biomarker for chronic pain. Alongside mast cells, neutrophils, macrophages, and numerous inflammatory cytokines and mediators are associated with chronic pain suggesting immune-targeted approaches including the therapeutic administration of endogenous anti-inflammatory compounds could provide much needed new ways to treat, manage, and control the growing global pandemic of chronic pain.

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Genital contact allergy: A diagnosis missed

Cited by 14 publications

References 25 publications

Repeated Vaginal Exposures to the Common Cosmetic and Household Preservative Methylisothiazolinone Induce Persistent, Mast Cell-Dependent Genital Pain in ND4 Mice

Repeated Vaginal Exposures to the Common Cosmetic and Household Preservative Methylisothiazolinone Induce Persistent, Mast Cell-Dependent Genital Pain in ND4 Mice

Seminal plasma hypersensitivity: A systematic review of clinical presentation, diagnostics, and management options

Immune mechanisms in vulvodynia: key roles for mast cells and fibroblasts

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