title: Inhalant allergy compounding the chronic vaginitis syndrome: characterization of sensitization patterns, comorbidities and responses to sublingual immunotherapy.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Allergy Associates of La Crosse, 2727 Midwest Drive, Onalaska, WI, 54650, USA. dtheodoropoulos@allergy-solutions.com.
authors.forename: Demetrios S
authors.initials: DS
authors.lastname: Theodoropoulos
authors.affiliation: Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa, IA, USA.
authors.forename: Colleen K
authors.initials: CK
authors.lastname: Stockdale
authors.affiliation: Department of Health Education and Health Promotion, College of Science and Health, University of Wisconsin-La Crosse, La Crosse, WI, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Duquette
authors.affiliation: Allergy Associates of La Crosse, 2727 Midwest Drive, Onalaska, WI, 54650, USA.
authors.forename: Mary S
authors.initials: MS
authors.lastname: Morris
mesh_terms: D000328:Adult; D000485:Allergens / Q000276:immunology*; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D012189:Retrospective Studies; D063729:Sublingual Immunotherapy; D013577:Syndrome; D014627:Vaginitis / Q000209:etiology / Q000276:immunology*
chemical_list: D000485:Allergens; D007073:Immunoglobulin E
keywords: Allergic rhinitis; Candidiasis; Chronic vaginitis; Migraines; Neurogenic inflammation; Sublingual immunotherapy; Vulvodynia