McKibbin Lundy R, Siu Sidney Kin-Hung, Roberts Hannah T, Shkrum Michael, Jeimy Samira
Division of Clinical Immunology and Allergy, Department of Medicine, St. Joseph's Hospital, Western University, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
Department of Pathology and Laboratory Medicine, University Hospital and Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Allergy Asthma Clin Immunol. 2021 Oct 18;17(1):110. doi: 10.1186/s13223-021-00611-9.
Intimacy-related allergic reactions, including anaphylaxis, are under-reported due to social stigma, lack of awareness, and misdiagnosis. The differential diagnosis for intimacy-related anaphylaxis is extensive and includes systemic human seminal plasma allergy, exercise-induced anaphylaxis, asthma exacerbation, latex allergy, and transference of food or drug allergens through saliva or seminal fluid.
Two adolescents met on a popular dating phone application. One individual had a long-standing history of asthma and peanut allergy. Although they never kissed, the male with peanut allergy received fellatio, while the other male had eaten peanut butter before they met. During fellatio, the peanut allergic male developed respiratory symptoms, used his bronchodilator, and collapsed. He remained unconscious despite aggressive interventions by emergency personnel called to the site. The clinical history and autopsy results suggested anaphylaxis to peanut allergen exposure from the intimate exposure as the cause of death.
To date, nearly all reported cases of intimacy-related anaphylaxis involve symptomatic women. This is the first report of intimacy-related anaphylaxis involving men who have sex with men and the first report of potential allergen transfer from oral mucosa to a patient receiving fellatio. Based on the paucity of published cases, death from intimacy-related anaphylaxis is exceedingly rare. Post-mortem analysis is inherently difficult, as an elevated tryptase level has myriad potential causes; nevertheless, the authors suggest that intimacy-related anaphylaxis due to peanut allergy is the most likely diagnosis. With increasing popularity of relationship applications, especially amongst stigmatized populations, this case highlights the importance of allergy awareness and patient education to decrease risk, particularly in the adolescent population, who are already at increased risk of severe anaphylaxis. Especially amongst those participating in intimate activities, disclosure of one's allergies warrants discussion, as the outcome can be fatal. Our case demonstrates the crucial need for increased advocacy in food allergy, education around intimacy-related anaphylaxis, and the importance of allergy awareness and prevention across all populations.
由于社会 stigma、认识不足和误诊，包括过敏反应在内的与亲密行为相关的过敏反应报告不足。与亲密行为相关的过敏反应的鉴别诊断范围广泛，包括全身性人类精浆过敏、运动诱发的过敏反应、哮喘加重、乳胶过敏以及食物或药物过敏原通过唾液或精液的转移。
两名青少年在一款热门约会手机应用程序上相识。其中一人有长期哮喘和花生过敏史。尽管他们从未亲吻，但患有花生过敏的男性接受了口交，而另一名男性在见面之前吃过花生酱。在口交过程中，对花生过敏的男性出现了呼吸道症状，使用了支气管扩张剂，随后晕倒。尽管现场的急救人员进行了积极干预，但他仍未苏醒。临床病史和尸检结果表明，因亲密接触导致花生过敏原暴露引发的过敏反应是死亡原因。
迄今为止，几乎所有报告的与亲密行为相关的过敏反应病例都涉及有症状的女性。这是首例涉及男同性恋者的与亲密行为相关的过敏反应报告，也是首例潜在过敏原从口腔黏膜转移至接受口交者的报告。基于已发表病例的稀缺性，因与亲密行为相关的过敏反应导致的死亡极为罕见。尸检分析本身就很困难，因为类胰蛋白酶水平升高有多种潜在原因；然而，作者认为花生过敏导致的与亲密行为相关的过敏反应是最可能的诊断。随着约会应用程序越来越受欢迎，尤其是在受 stigma 影响的人群中，该病例凸显了过敏意识和患者教育对于降低风险的重要性，特别是在青少年人群中，他们本来就有更高的严重过敏反应风险。尤其是在参与亲密活动的人群中，讨论自身过敏情况很有必要，因为后果可能是致命的。我们的病例表明，迫切需要加强对食物过敏的宣传、围绕与亲密行为相关的过敏反应进行教育，以及提高所有人群的过敏意识和预防意识。
