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Arch Gynecol Obstet. 2016 Sep;294(3):541-8. doi: 10.1007/s00404-016-4081-2. Epub 2016 Apr 4.

Inhalant allergy compounding the chronic vaginitis syndrome: characterization of sensitization patterns, comorbidities and responses to sublingual immunotherapy.

Author information

1
Allergy Associates of La Crosse, 2727 Midwest Drive, Onalaska, WI, 54650, USA. dtheodoropoulos@allergy-solutions.com.
2
Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa, IA, USA.
3
Department of Health Education and Health Promotion, College of Science and Health, University of Wisconsin-La Crosse, La Crosse, WI, USA.
4
Allergy Associates of La Crosse, 2727 Midwest Drive, Onalaska, WI, 54650, USA.

Abstract

OBJECTIVE:

To characterize sensitization patterns, diagnoses and comorbidities, and to assess the response of lower genital tract symptoms to sublingual immunotherapy for airborne allergens in a select population of patients with chronic vaginitis.

METHODS:

Fifty-two patients referred for allergy evaluation over a 44 month period were studied. Charts were retrospectively reviewed to establish: (1) gynecological diagnoses, (2) allergic-immunological diagnoses, and (3) IgE-mediated sensitivity to airborne allergens on presentation. Patients were contacted at 9-50 months of treatment to assess response to sublingual immunotherapy based on a questionnaire addressing frequency and severity of symptoms and use of medication to control symptoms.

RESULTS:

Recurrent vulvovaginal candidiasis was identified in 34 (65 %); vulvar vestibulitis syndrome in 12 (23 %); and contact dermatitis in 10 (19 %) patients. Comorbidities included: non-reflux gastrointestinal complaints in 11 (21 %), gastroesophageal reflux in 5 (9 %), migraines in 9 (17 %), chronic non-migrainous headaches in 8 (17 %), and chronic sinusitis in 6 patients (11 %). Asthma was diagnosed in 8 patients (15 %). Oral allergy syndrome was present in 6 (11 %). Most frequent sensitivities were to: ragweed in 33 (63 %), molds in 26 (50 %), dust mites in 23 (44 %), and grass in 12 (23 %) patients. Mono-sensitization was demonstrated for ragweed in 7 (13 %), and for molds, dust mites and grass for 3 (5 %) patients each. Candida sensitization was identified in 15 patients with chronic vaginitis (28 %). Eleven patients with recurrent vulvovaginal diagnosis (32 %) showed Candida sensitization. Response to immunotherapy was generally favorable with pruritus/irritation being more responsive than visceral pain.

CONCLUSIONS:

In a Midwestern referral population, chronic vaginitis compounded by inhalant allergy showed: (1) high incidence rate of recurrent vulvo-vaginal candidiasis, (2) Candida IgE-mediated sensitization in less than one-third of patients with recurrent vulvovaginal candidiasis, (3) comorbid conditions not dissimilar to those of other allergic patients, and (4) allergen sensitization pattern typical for the Midwest.

KEYWORDS:

Allergic rhinitis; Candidiasis; Chronic vaginitis; Migraines; Neurogenic inflammation; Sublingual immunotherapy; Vulvodynia

PMID:
27040422
DOI:
10.1007/s00404-016-4081-2
[Indexed for MEDLINE]

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