Hi Muon and Cicco,
Thanks to both of you for this interesting link.
What I have found the most useful and interesting in this article, is that fact that, for the first time, a scientific article acknowledge that there are more than one type of POIS, a hypothesis I have been supporting for a long time now on this forum. This is obvious here :
« Hyposensitization therapy, or AIT, can have therapeutic effects in patients with POIS in whom allergies are a dominant etiologic factor. The present patient was judged to belong to this group of patients and received ILIT, which alleviated his POIS-related symptoms »
I am so glad they had the courage to write this
The symptoms they had the best results with, with that new desens method, is sneezing, which is the only symptom that completely disappeared in this case report, and is clearly an allergy-like symptom ( it is interesting to note that the technique they used was first studied in allergic rhinitis). It also helped for some flu-like symptoms like fever, at around 80% relief at the end of treatment protocol. However, there have been only about 30% to 50% on average for other allergy-like symptoms like burning eyes and for the relief for other types of symptoms like neuropsychiatric symptoms. There was no relief at all for local inflammation symptoms like weak stream and voiding difficulties, signs of prostate inflammation. See table 1 for all the details about the symptoms relief. Overall, they have not « cured » the patient, and were honest enough to recognize the implication, that is, there is more at play in POIS than a simple allergy, and it is more complex than, for example, allergic rhinitis.
So, they clearly share the view expressed in Waldinger latest article, that POIS is more than just an « allergy to semen », and more research is necessary to understand its mechanism.
In the discussion part they clearly state, as Cicco have mentioned, that allergy alone cannot explain all the symptoms seen in POIS.
This article also accept what have been found in the Chinese study, that is, that the skin-prick test is not specific for the diagnosis of POIS, and, also, that all POIS sufferers will not necessarily have specific IgE for their own semen, only those with the allergic component.
They also share some interesting details about their IgE testing :
« The IgE immunoblotting of autologous seminal fluid incubated with serum from the patient and 1 healthy control showed IgE binding bands at 14, 16, 34, and 55 kD (eFigure 3). The IgE binding band at 55 kD was particularly prominent before ILIT, but it was fainter when seminal fluid was incubated with serum obtained from the patient 8 months after ILIT. In addition, ELISA analysis showed that the level of semen-specific IgE was increased in the patient's serum before ILIT compared with the healthy control, but it had deceased to levels similar to those of the healthy control 8 months after ILIT (eFigure 4) »
Could this 55 kD IgE test become an objective test that could establish the presence or not of the alllergy-like part of POIS? It would be very interesting to simply have many POIS sufferers and many healthy, control subjects have these tests done, even if no treatment is tested, just to validate this potential objective test for at least a part of POIS diagnosis. This could confirm that the prominence of this 55kD IgE band is specific for those who have allergy-like POIS symptoms, and not in healthy subjects, and even not in POIS sufferers that have no allergy-like symptoms.
I note that what I have called emotional symptoms ( irritability, anxiety, depression,..), are called « neuropsychiatric symptoms" in the article – see table 1. I introduced the term « emotional symptoms" when I fist arrived on the forum to distinguish them from cognitive symptoms ( brain fog, speech impairment, loss of problem-solving capacities, memory problems, …), rather then include both in « Brain symptoms » or « mental symptoms » as it was used to be then.
Again, about emotional and cognitive symptoms, I note the this Korean patient didn't report any cognitive symptoms ( no mention of brain fog, concentration issues, memory impairment, …). He has allergy-like, flu-like and emotional/neuropsychiatric symptoms, but no mention of cognitive impairment in POIS.
One thing I would have like is some comments about how the subject reacted to the last, full concentration injection. They gave discomfort reports for the other injections, but not for that last one.
Overall, about this article, I feel it is a good thing that this case report attracts attention to our rare syndrome. The authors have been courageous to share some of their conclusions, like the fact that there is more than one type of POIS and that it cannot be explained by IgE and allergy alone, and they have been honest in defining the limits of this report of only one case. The results they had with their method were not that impressive, and surely not a complete cure for POIS, but it has helped this POIS sufferer in diminishing the intensity of many of his symptoms, and some of the duration as well. I feel it is an improvement over the 3 years protocol that Waldinger had used ( but stopped using), both for the dramatically reduced duration and injecitons number, and for patient comfort ( less semen sample collection, less injections, etc..).
I wouldn't trade my pre-pack method and try their protocol, because I have no allergy like symptoms, and have no fever, but even if I had those, my 80% to 100% relief level is better than what they achieved. However, I am happy to see the time these MDs have invested in this case, and that they cared to published their results.
