Human seminal plasma protein allergy: a diagnosis rarely considered

Women with seminal plasma protein allergy (SPPA) have an immunologic response to human semen. Symptoms vary from local inflammation and pruritus to systemic anaphylaxis after exposure. The first case was documented in Germany in 1958. Prevalence is difficult to determine because of the sensitive nature of the symptoms and resultant underreporting. The immunologic etiology of the allergy is not clearly understood; however, it is thought to be an IgE-mediated response from mast cells. Patients with SPPA often have recurrent vaginitis associated with intercourse and are unresponsive to traditional therapies. The gold standard of diagnosis is absence of symptoms with condom use. Treatments include cromolyn vaginal cream for local reactions and immunotherapy with human seminal plasma. Treatment success has been varied. The implications and impact of SPPA on sexuality and reproduction are significant, and this allergy should be added to the provider's list of differential diagnoses for recurrent vaginitis in sexually active women.