You won't find elevated IgE when IgG4 is elevated because the latter suppresses IgE. Also IgG4 doesn't activate complement.
"After the chronic antigen exposure, IgG1 and IgG4 become the predominantly produced subclasses of IgG isotype. In addition, IgG4 is unable to activate the classical complement pathway and is then known as an anti-inflammatory immunoglobulin and a blocking antibody towards IgE antibodies."
Immunodominant Semen Proteins III: IgG1 and IgG4 Linkage in Female Immune InfertilityA potential antigen in seminal fluid can be located via IgG4. If characterized it can be checked if the same antigen is involved in hypersensitivity to semen in the case of my mother and brother plus potential crossreactivity with other types of antigens which have nothing in common with sexual fluids.
A comprehensive characterization of the peptide and protein constituents of human seminal fluidIgG4 could have been induced by SCIT.
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Allergen-specific intralymphatic immunotherapy in human and animal studies"In the study of Witten et al. [13], both serum allergen-specific IgE and IgG4 were increased after ILIT. Moreover, IL-4 and IL-10 production, as well as the expression of FoxP3 increased, whereas interferon (IFN)-? production by stimulated PBMCs decreased after ILIT."
Androgen therapy also increases expression of FOXP3. It might be one mechanism.
https://poiscenter.com/forums/index.php?topic=3127.msg37486#msg37486"In our study, serum allergen-specific IgE and IgG4 increased 4 months after ILIT, but they had decreased by 1 year later"
Even the 'failure' in the brazilian patient (fidalgo) might be the same mechanism which reversed over time.
https://sci-hub.se/10.1080/0092623x.2019.1677835"The patient was submitted to immunotherapy, and although he presented an improvement of symptoms in the first year of treatment, he quit immunotherapy after two years because the symptoms returned."
Intralymphatic Immunotherapy With Autologous Semen in a Korean Man With Post-Orgasmic Illness Syndrome"The mechanism of ILIT is not sufficiently understood, but we propose that ILIT might be mediated by plasmablasts, plasma cells, and memory B cells that are activated by allergens injected into lymph nodes and produce allergen-specific IgE, IgG4, or other antibody isotypes with or without enhanced affinity."
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Table 3: Immunotherapy. The rush protocol is more effective than the conventional method (also increased risk for anaphalaxis):
Human seminal plasma allergy: a review of a rare phenomenon| Method | Attempted in | Successful in |
| Conventional | 14 | 9 (64%) |
| ‘Rush’ protocol | 11 | 11 (100%) |
| Subcutaneous | 6 | 6 (100%) |
| Intravaginal | 5 | 5 (100%) |
