> Antibiotics that are administered perioperatively can cause immunologic or nonimmunologic reactions. (B)
> Blood transfusions can elicit a variety of systemic reactions, some of which might be IgE-mediated or mediated through other immunologic mechanisms. (B)
> Neuromuscular blocking agents, such as succinylcholine, can cause nonimmunologic histamine release, but there have also been reports of IgE- mediated reactions in some patients. (B)
> Reactions to opioid analgesics are usually caused by direct mast cell-mediator release rather than IgE-dependent mechanisms. (B)
> Thiopental allergy has been documented by skin tests. (B) Seminal Fluid Anaphylaxis
> Protamine can cause severe systemic reactions through IgE-mediated or nonimmunologic mechanisms. (B)
> Methylmethacrylate (bone cement) has been associated with hypotension and various systemic reactions, although no IgE mechanism has been documented. (C)
ÎCoital anaphylaxis caused by human seminal fluid has been shown to be due to IgE-mediated sensitization to seminal plasma proteins of varying molecular weight. (C)
ÎPost-coital local reactions to human seminal plasma are probably IgE-mediated based on skin testing. (C)
ÎHistory of atopic disease is the most consistent risk factor for seminal fluid-induced anaphylaxis. (C)
ÎThe diagnosis of seminal plasma anaphylaxis may be confirmed by skin testing with fresh whole human seminal plasma or its fractions obtained from the male partner.
It is essential to exclude other
underlying causes such as allergens in natural rubber latex condoms, or in drugs or foods passively transferred via seminal plasma. (D)
ÎGreater than 90% of the allergenic proteins range between 12 to 75 kd. Prostate specific antigen has been demonstrated to be a relevant allergen in some cases. (C)
ÎSystemic and localized reactions to seminal plasma can be prevented by correct use of condoms. Nevertheless, in the event of barrier failure, sexual partners should be prepared to treat acute anaphylaxis. (C)
ÎSubcutaneous immunotherapy to properly prepared fractions of seminal plasma collected from male partners has been successful in preventing anaphylaxis to seminal plasma. (C)
ÎSuccessful intravaginal graded challenge with whole seminal plasma of the male partner has been reported in a few cases but the duration of protection is unknown. This treatment approach may be considered prior to pursuing desensitization using relevant seminal plasma protein fractions. (C)
ÎPatients with seminal plasma allergy may be able to conceive without undergoing desensitization, by artificial insemination with washed spermatozoa. (C)
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