Ms. C’s clinician refers her to an allergist, who diagnoses her with SPH and advises her to engage in intercourse only with condoms. However, the couple is unhappy with this solution because they would like to conceive.

Dr. Bernstein’s Comments:

For couples who do not wish to use condoms, several approaches have been suggested, including pretreatment with oral antihistamines, nonsteroidal anti-inflammatory drugs (NSAIDs), or intravaginal cromolyn sodium. But overall, the response to these medications is poor. The most effective approach for women with IgE-mediated SPH has been desensitization using the partner’s seminal fluid.

There are two approaches to this process. Graded intravaginal challenge involves using dilutions of whole seminal fluid that are serially introduced into the vaginal vault over a 2- to 3-hour period of time. Although it is the easiest to implement, the level and duration of protection is not always complete. 

If this approach is not effective, then subcutaneous immunotherapy using relevant fractionated seminal plasma proteins (SPPs) is very effective. In either approach, to maintain tolerance to SPPs, it is necessary for intercourse to be continued on a regular basis, usually 2 to 3 times a week.

Ms. C is treated with intravaginal graded challenge, but it is only partially successful. She is then treated with rapid subcutaneous desensitization using fractionated relevant SPPs, and is able to enjoy unprotected sex with her husband. However, she is worried that her condition may interfere with conception.

Dr. Bernstein’s Comments:

Infertility is not an inherent complication of SPH. Women with both localized and systemic SPH who have been successfully treated with subcutaneous immunotherapy are usually able to conceive and have children—however, women with SPH can experience fertility issues unrelated to SPH and should seek evaluation and treatment from an infertility expert.

References

1. Sublett JW, Bernstein JA. Seminal plasma hypersensitivity reactions: an updated review. Mt Sinai J Med. 2011;78(5):803-809.

2. Bernstein JA, Sugumaran R, Bernstein DI, Bernstein IL. Prevalence of human seminal plasma hypersensitivity among symptomatic women. Ann Allergy Asthma Immunol. 1997;78(1):54-58.

3. Bernstein JA. Human seminal plasma hypersensitivity: an under-recognized women’s health issue. Postgrad Med. 2011;123(1):120-125.

4. Tan J, Bernstein JA. Fertility and human seminal plasma (HSP) hypersensitivity. Ann Allergy Asthma Immunol. 2013 Aug;111(2):145-6.