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Is skin testing reliable for confirming sensitization to seminal fluid proteins?

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To the Editor:

Challenging the validity of skin testing for seminal fluid allergy and offering an alternative interpretation.

Seminal plasma hypersensitivity (SPH) is a rare condition in which women experience systemic or localized symptoms after contact with their sexual partner's semen. 1 Women with systemic SPH can develop generalized hives and pruritus, with or without angioedema, and can experience respiratory or gastrointestinal symptoms. 1,2 In the worst case scenario, this can be associated with vascular collapse. Localized SPH appears to be a more common condition in which women experience localized vaginal pain and severe burning, with or without itching immediately after contact with seminal plasma. 3 Both systemic and localized reactions are diagnosed based on a clinical history of symptoms after unprotected intercourse and with resolution of symptoms with the use of a condom (excluding vibration or latex hypersensitivity). Positive skin prick testing and/or serologic-specific-IgE to seminal plasma proteins (SPP) can be demonstrated in systemic reactors, which correlates with their clinical symptoms. In contrast, women with localized SPH often have negative or equivocal skin prick test responses to whole seminal fluid or fractionated SPPs. 4-6 Interestingly, when evaluating women with either systemic or localized SPH with SPP skin testing by using their male sexual partner as a negative control, we observed that approximately 65% of the male sexual partners exhibit positive skin test responses to their own SPP (unpublished data), which has previously been dismissed as an irritant response and not clinically relevant because serum-specific IgE responses to SPP in these men have been negative. 7

Skin testing to semen also has been proposed to be a useful diagnostic test for men with postorgasmic illness syndrome (POIS), which is a rare syndrome characterized as extreme fatigue and a flu-like syndrome that lasts several days after ejaculation, irrespective of how ejaculation...