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Cyclical Seminal Plasma Sensitivity in a Woman with Progesterone Autoimmune Dermatitis
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Erin H. Penn, M.D., M.S., Paige G. Wickner, MD MPH FAAAAI, Mariana C. Castells, MD PhD FAAAAI
Rationale: Human Seminal Plasma (HSP) Sensitivity is a rare condition which can manifest from local irritation to anaphylaxis and is seen in higher frequency in patients with atopy and asthma. Risk factors include long intercourse-free periods, menopause, hysterectomy, IUD and a partner with prostatectomy or vasectomy reversal. Allergenic proteins include prostate specific antigen, dog epithelial and urine antigens. HSP has not been reported in a cyclic pattern or associated with progesterone sensitivity. Here, we present a case of proven progesterone autoimmune dermatitis, with subsequent symptoms of HSP sensitivity, occurring around the time of peak progesterone sensitivity.

Methods: Skin-prick testing.

Results: 39 yo F with cyclic abdominal and facial rashes at the peak of progesterone surges with positive progesterone skin-prick testing, presented with vulvar irritation and anterior truncal rash, similar to her progesterone-induced rash, following contact with semen. She recently re-initiated unprotected intercourse after 2 years of abstinence. HSV and urine testing were unremarkable. She denied asthma or atopy. Symptoms were absent with condom use and unprotected intercourse mid-cycle, but present with unprotected intercourse the week prior to menses.

Conclusions: This is a novel case of cyclic seminal plasma sensitivity with concomitant progesterone sensitivity. This presentation suggests cross reactivity between progesterone and seminal plasma allergens, such as testosterone, which shares similar chemical/structural properties with progesterone and is found in semen. Further studies such a skin testing to seminal plasma proteins are needed to prove seminal sensitivity and identify cross-reactive allergens. Routine screening for symptoms of progesterone sensitivity may be reasonable in patients with seminal sensitivity.