© 2004 American Thoracic Society
Asthma, Hypersensitivity, and CoitusTo the Editor:Dr. Kuna and colleagues (1) report an uncommon cause of asthma exacerbations after unprotected coitus in a 48-year-old male. The patient had aspirin-sensitive asthma, and the postcoital exacerbation was attributed to the aspirin ingested by his wife. The diagnosis was suspected because symptoms did not occur after condom usage. The objective of this communication is to highlight other manifestations of asthma and hypersensitivity reactions that can be related to coitus. Sexual activity can trigger off asthma in more ways than one (2). Asthma associated with coitus can be categorized as human seminal plasma allergy (HSPA) in female subjects (3), postcoital asthma and/or rhinitis (4), condom-induced asthma (5), and asthma subsequent to transfer of allergens during coitus (1, 3, 6). The latter three can occur in both sexes. In female subjects, HSPA may present as asthma along with other hypersensitivity manifestations (3). This little-known disorder is caused by sensitization to proteins present in the seminal fluid, and occurs during or soon after coitus. The symptoms are thought to be mediated by the classical IgE-mediated pathophysiologic mechanism. Postcoital asthma ("sexercise-induced asthma") and rhinitis ("honeymoon rhinitis") are not exercise-induced (athlete's nose) and cannot be ascribed to any cause other than sexual excitement (4). Anxiety and apprehension are a predominant feature in both patients and their partners. Intense emotional stimuli during sexual intercourse can possibly lead to autonomic imbalance with parasympathetic overreactivity, thereby releasing mediators and provoking symptoms. Condom usage can not only precipitate an asthmatic attack, but can also cause life-threatening anaphylaxis (5). This is caused by allergy to latex and can occur in either partner. Hypersensitivity reactions have occurred following transfer of allergens present in the seminal fluid. Reports have documented postcoital allergic reactions including asthma in female subjects due to ingestion of walnut, vinblastine, thioridazine, and penicillin by the male partner before coitus (3). Transfer of allergenic material from the vaginal fluid to a male partner during coitus has also been reported in a 34-year-old male, who developed a fixed drug eruption following coitus. His wife had ingested trimethoprim-sulphamethoxazole, to which he was known to be allergic (6). The untoward consequences of sexual activity described above are yet to receive the attention they deserve. Life-threatening asthma and anaphylaxis have been documented subsequent to coitus (2). These phenomena may easily be overlooked due to patient embarrassment and lack of physician awareness.
Vallabhbhai Patel Chest Institute Delhi, India FOOTNOTES Conflict of Interest Statement: A.S. does not have a financial relationship with a commercial entity that has an interest in the subject of this letter; C.P. does not have a financial relationship with a commercial entity that has an interest in the subject of this letter. REFERENCES
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