A NUTTY CASE: RARE PRESENTATION OF ALLERGIC VAGINITIS

Abstract

<h3>Introduction</h3> This case describes a female patient with a history of IgE-mediated anaphylaxis to peanut and tree nuts with a new complaint of vaginitis after male ejaculation during intercourse. Her symptoms resolved with targeted food elimination from her partner's diet. This case demonstrates the importance of an expanded differential for vaginitis, including allergic causes. <h3>Case Description</h3> A 28-year-old female with an atopic history presented with vaginal pain and burning after male ejaculation during intercourse, reducing her chance of natural conception. She notably tolerated intercourse both without male ejaculation and with male ejaculation while using a condom. Gynecologic testing for infectious etiologies was normal, prompting evaluation for human seminal plasma (HSP) hypersensitivity. Given her known history of IgE-mediated allergy to peanut and tree nuts, it was recommended they trial intercourse after a period of targeted food elimination for her partner. The patient was subsequently able to tolerate male ejaculation during intercourse without vaginitis symptoms. <h3>Discussion</h3> Although Type IV hypersensitivity reactions exceed Type I in most cases of allergic vaginitis, it is important to consider the numerous antigens within seminal fluid that may cause hypersensitivity. This includes not only HSP but also food allergens, posing an increased risk for reactions in patients with a history of IgE-mediated food allergy in the context of allergen exposure from the seminal fluid of their sexual partners. Furthermore, targeted food elimination from the male partner's diet may provide an effective means allowing for intercourse without subsequent hypersensitivity.