Thank you for your inquiry.
As you know from reading previous responses to “Ask the Expert” questions regarding seminal fluid allergy, Dr. Jonathan Bernstein is an internationally recognized expert in this disorder. He has published extensively in this area, and therefore I am asking Dr. Bernstein to respond to your inquiry. When we receive his response, we will forward it to you.
Thank you again for your inquiry.
Phil Lieberman, M.D.
We received a response from Dr. Jonathan Bernstein. Thank you again for your inquiry and we hope this response is helpful to you.
Phil Lieberman, M.D.
Response from Dr. Jonathan Bernstein:
In response to your questions:
1) I would test her by PST to whole seminal fluid. This requires letting the ejaculate liquefy for 30min and centrifuge for 10 minutes to separate Seminal fluid from spermatozoa. I would also test her sexual partner as a negative control. You do not have to sterilize the seminal fluid for prick testing. Intracutaneous testing to whole seminal fluid should not be performed as it will cause an irritant response.
2) Both the patient and her sexual partner should be screened for STD's.
3) Previously she had no problem with other men. This is variable. Some women have trouble with all men whereas other have symptoms with only one.
4) For localized seminal plasma hypersensitivity, skin testing is not always concordant with serologic testing. I have been offering patients the opportunity to send their serum and their sexual partner's serum and a 5 day pooled ejaculate to our laboratory to test for sIgE to whole seminal plasma.
5) There is no additional recent information about cross reactivity between dog allergens and seminal plasma. In our experience with our patients we have not found there to be cross reactivity with dog allergen and PSA.
6) We are recommending that patients with localized seminal plasma hypersensitivity first undergo intravaginal graded challenge; dilute whole seminal fluid with sterile water to 1:100,000 dilution and instill 10 cc of volume intravaginally every 10-15 minutes up to a `1:1 dilution to see if this alleviates symptoms. There are reported cases that this may be effective. If not then she may be a candidate for subcutaneous desensitization to relevant fractionated seminal plasma proteins.
Jonathan Bernstein, M.D.