Localized and Systemic Hypersensitivity Reactions to Human Seminal Fluid

Abstract

Reaginic humoral antibodies to human seminal plasma were present in two women with systemic reactions. In one patient, IgE antibodies were demonstrated by direct skin tests, leukocyte histamine release, passive transfer to a nonallergic human recipient, the radioallergosorbent test, inhibition of the radioallergosorbent test and neutralization of passive transfer antibodies. A similar mechanism was established in the other case by direct skin tests and antigen-induced leukocyte histamine release. Sephadex G-100 fraction 2, derived from human seminal plasma, showed greater reaginic activity than other chromatographic fractions. Two other patients with histories of localized reactions did not develop humoral antibodies but did evince cell-mediated immunity to seminal fluid antigens. One patient with localized reactions also had significant titers of IgM and IgG sperm agglutinating antibodies to seminal plasma. Both reaginic and cell-mediated sensitization to human sperm extract were also observed in this series of patients. Histocompatibility leukocyte antigen (HLA) typing of all patients and their sexual partners showed a marked degree of shared histocompatibility focus antigens in members of each of two couples.

The diagnosis and management of anaphylaxis: An updated practice parameter

“…In this case skin test reagents with high diagnostic sensitivity should be obtained by means of gel filtration (Sephadex G-100) of whole seminal plasma to isolate allergen-rich fractions. [149][150][151] Percutaneous or intracutaneous responses to relevant seminal plasma protein fractions have been detected in all reported cases of anaphylaxis. The presence of positive serologic specific IgE antibodies to these fractions and specific skin tests to the same fractions is highly predictive of a successful treatment outcome with seminal plasma protein desensitization.…”

“…[148][149][150] In rare cases spermatozoa have been identified as the source of allergens inducing a cell-mediated reaction. 151 Coital anaphylaxis has also been attributed to exposure to exogenous allergens transferred through semen during sexual intercourse. Such unusual reactions occur when a male partner ingests a food (eg, walnuts) or drug (eg, penicillin) to which there is established sensitization in the female partner.…”

“…If anaphylaxis is caused by seminal transfer of exogenous allergens, the male partner should avoid the causative food or drug before engaging in sexual intercourse. 151,152 It is essential that patients and spouses be trained in the emergency use of subcutaneous epinephrine. Although there are reports of successful use of precoital treatment with antihistamines or intravaginal cromolyn sodium, these options have generally been ineffective in the prevention of severe anaphylaxis.…”

“…Semen is allowed to liquefy at room temperature and centrifuged at 4°C to separate seminal plasma containing supernatant from spermatozoa, which is then filter sterilized. [149][150][151] The male donor is also tested to control for irritant responses. A positive response is defined as a wheal of 3 mm greater than or equal to that produced with saline with a flare and a concomitant negative response in the male donor.…”

Successful pregnancy by insemination of spermatozoa in a woman with a human seminal plasma allergy: should in vitro fertilization be considered first?

“…Skin prick tests are used to diagnose human seminal plasma allergy, as IgE-mediated immune response is the most common mechanism to explain the symptoms, as in this case report. However, type III or IV immune response also is described in the literature (12,13).…”