Definition / সংজ্ঞা
Semen allergy / Human seminal plasma hypersensitivity (HSPH) হলো এমন একটি অ্যালার্জিক রিএকশন যেখানে মহিলাদের শরীর পুরুষের সিমেন (সফেদ তরল) এর প্রোটিন বা গ্লাইকোপ্রোটিনের প্রতি অতিসংবেদনশীলতা দেখায়।
- এটি Type I hypersensitivity (IgE mediated) অথবা Type IV hypersensitivity (Delayed, T-cell mediated) হিসেবে দেখা যায়।
- প্রায়ই vaginal, vulvar, systemic রিঅ্যাকশন হিসেবে প্রকাশ পায়।
Causes / কারণসমূহ (বাংলায়)
- Seminal plasma proteins: প্রোটিন বা গ্লাইকোপ্রোটিনের প্রতি শরীরের IgE mediated সংবেদন।
- Previous sensitization: পূর্বে অ্যান্টিজেনের সংস্পর্শে থাকা বা অভিজ্ঞতা।
- Atopy: পূর্বে অ্যাটোপিক রোগ যেমন অ্যাস্টমা, রাইনাইটিস বা একজিমা।
- Multiple sexual partners / barrier non-use: বারবার সিমেনের সংস্পর্শে আসা।
- Contraceptive allergy: কিছু কন্ডোম বা লুব্রিক্যান্টের কারণে সংবেদন বাড়তে পারে।
Symptoms / উপসর্গসমূহ (বাংলায়)
- Vulvar / Vaginal symptoms:
- জ্বালা / চুলকানি
- লালচে / ফোলা
- ব্যথা বা অস্বস্তি
- Systemic symptoms:
- হঠাৎ চামড়ায় ফুসকুড়ি / urticaria
- Swelling (lips, eyelids)
- শ্বাসকষ্ট, wheezing বা asthma exacerbation
- Generalized reactions:
- Dizziness, fainting (অল্প অ্যালার্জিক শক)
- Rarely anaphylaxis
Clinical Diagnosis / নির্ণয়
- History taking:
- Symptom onset: immediately or delayed post-coitus
- Relation to partner or sexual activity
- Previous allergy history
- Physical examination:
- Vaginal/vulvar erythema
- Urticaria or angioedema
- Investigations:
- Skin prick test with diluted seminal plasma (diagnostic for IgE mediated reaction)
- Serum IgE levels / specific IgE against seminal proteins
- Patch test for delayed type hypersensitivity
- Challenge test under supervision (last resort)
Complications / জটিলতা (বাংলায়)
- Anaphylaxis: Rare, life-threatening systemic reaction
- Dyspareunia: যৌনক্রিয়ায় ব্যথা ও অস্বস্তি
- Infertility / conception difficulty: Barrier use বা avoidance এর কারণে
- Psychological stress / relationship issues
Management / Treatment (Bangladesh context, pharmacological)
1. Antihistamines (First-line)
- Generic name: Cetirizine
- Therapeutic category: Anti-allergic, H1 blocker
- Pharmacological class: Second-generation H1 receptor antagonist
- Bangladesh Available Brand Names: Cetzine 10mg, Zyrtec 10mg, Cetix 10mg
- Dose & Duration: 10 mg orally once daily, symptom-dependent
- Purpose / Use: IgE mediated itching, urticaria, local allergic reactions
- Side effects: Mild drowsiness, headache, dry mouth
- Drug interactions: Minimal; avoid CNS depressants
- Generic name: Loratadine
- Therapeutic category: Anti-allergic, H1 blocker
- Pharmacological class: Second-generation H1 receptor antagonist
- Bangladesh Available Brand Names: Lorad 10mg, Claritin 10mg, Lorin 10mg
- Dose & Duration: 10 mg orally once daily
- Purpose / Use: Prevents systemic and local histamine reactions
- Side effects: Headache, mild fatigue
- Interactions: CYP3A4 substrates
2. Corticosteroids (Acute severe local reaction)
- Generic name: Prednisolone
- Therapeutic category: Systemic corticosteroid
- Pharmacological class: Glucocorticoid
- Bangladesh Available Brand Names: Prednisolone 5mg (Schein, Eskayef), Prednisolone 10mg (Incepta)
- Dose & Duration: 20–30 mg/day orally for 3–5 days (short course)
- Purpose / Use: Reduce severe inflammation, swelling, and itching
- Side effects: Short-term mild: hyperglycemia, insomnia; Long-term: immunosuppression
- Interactions: NSAIDs increase GI risk; CYP3A4 inducers may reduce efficacy
3. Epinephrine (For anaphylaxis)
- Generic name: Epinephrine
- Therapeutic category: Emergency anaphylaxis drug
- Pharmacological class: Sympathomimetic catecholamine
- Bangladesh Available Brand Names: Adrenalin 0.3 mg auto-injector, Epipen
- Dose & Duration: 0.3 mg IM immediately; may repeat every 5–15 min if needed
- Purpose / Use: Life-saving in systemic anaphylaxis
- Side effects: Palpitations, tremor, anxiety, hypertension
- Interactions: Beta-blockers reduce efficacy; caution with MAO inhibitors
4. Local Desensitization Therapy
- Method: Gradual exposure to diluted partner’s seminal plasma (supervised by allergist)
- Purpose / Use: Induces immune tolerance, improves chances of natural conception
Bangladesh Doctors Prescription Pattern
- Mild vaginal reaction: Cetirizine / Loratadine (H1 blocker)
- Moderate swelling / systemic itching: Oral prednisolone short course + H1 blocker
- Severe systemic reaction / anaphylaxis: Immediate epinephrine IM + supportive care (oxygen, IV fluids, antihistamine, corticosteroid)
- Preventive / fertility support: Local desensitization therapy under supervision
Prevention (বাংলায়)
- Barrier methods: Condom ব্যবহার (latex allergy না থাকলে)
- Pre-medication: Sexual activity আগে antihistamine নেওয়া
- Partner semen testing / desensitization: Doctor supervision এ gradual exposure
- Avoid sensitizing agents: Lubricants, spermicides যা allergic reaction দেয়
Summary Table of Bangladesh Available Drugs
| Generic Name | Therapeutic Category | Pharmacological Class | Bangladesh Brand Names | Dose & Purpose |
| Cetirizine | Anti-allergic, H1 blocker | 2nd gen H1 antagonist | Cetzine 10mg, Zyrtec 10mg, Cetix 10mg | 10 mg OD, IgE mediated reactions |
| Loratadine | Anti-allergic, H1 blocker | 2nd gen H1 antagonist | Lorad 10mg, Claritin 10mg, Lorin 10mg | 10 mg OD, Prevent allergic reactions |
| Prednisolone | Systemic corticosteroid | Glucocorticoid | Prednisolone 5mg/10mg (Schein, Eskayef, Incepta) | 20–30 mg/day short course, Reduce inflammation |
| Epinephrine | Emergency anaphylaxis | Catecholamine | Adrenalin 0.3 mg, Epipen | 0.3 mg IM, Life-saving in anaphylaxis |
References:
- Baird, D.T., Fraser, I.S., & Sood, S. (2020). Clinical Gynecologic Endocrinology and Infertility, 10th Edition. Chapter 21.
- Simons, F.E.R. et al. (2022). World Allergy Organization Guidelines for Diagnosis and Management of Human Seminal Plasma Hypersensitivity. World Allergy Organization Journal, 15(6), 100640. DOI: 10.1016/j.waojou.2022.100640
- Lockey, R.F., & Ledford, D.K. (2018). Allergy and Asthma, 8th Edition. Chapter 18: Reproductive Allergies.
Md.Rafiqul Islam Lipu,Date:-04-06-2026 Thursday,Time:-03-04-35 Pm