Q:

6/22/2017
A 26/F patient of mine with persistent vaginal pruritus and irritation, without persistent diagnosis of vaginal yeast infection (but treated empirically) poses the question of Allergic Vaginitis. I have not seen anything substantiated in the literature for diagnosis or management of this and would appreciate any thoughts or advise.

A:

There are allergic diseases that can present with vaginal involvement. Seminal fluid allergy and latex allergy from condoms come to mind. In my practice, I have occasionally seen women who had vaginal irritation that could be attributed to either and irritant or allergic contact dermatitis to various feminine hygiene products.

As to seasonal allergy causing “allergic vaginitis” I found the following reports on PubMed that suggesting season allergy may play a role:

Hypersensitivity to aeroallergens in patients with recurrent vulvovaginitis of undetermined etiology.
Ozturk S, Caliskaner Z, Karaayvaz M, Dede M, Gulec M.
J Obstet Gynaecol Res. 2007 Aug;33(4):496-500.

Vaginal itching as a manifestation of seasonal allergic disease.
Dhaliwal AK, Fink JN.
J Allergy Clin Immunol. 1995 Mar;95(3):780-2.

Seasonal Allergic Vulvovagintis Caused by Pollen.
Berman Ba.
Ann Allergy. 1964 Nov;22:594-7.

I could not find any data on PubMed about food allergens causing vaginitis. There was limited data in the literature that some women with recurrent candida vaginitis may develop sIgE to candida. There are even a few case series that used immunotherapy to candida in these patients with some success.

Allergy in chronic monilial vaginitis.
Kudelko NM.
Ann Allergy. 1971 May;29(5):266-7.

Candida albicans allergen immunotherapy in recurrent vaginal candidiasis.
Moraes PS, de Lima Goiaba S, Taketomi EA.
J Investig Allergol Clin Immunol. 2000 Sep-Oct;10(5):305-9.

Recurrent allergic vulvovaginitis: treatment with Candida albicans allergen immunotherapy.
Rigg D, Miller MM, Metzger WJ.
Am J Obstet Gynecol. 1990 Feb;162(2):332-6.

Recurrent allergic vulvovaginitis: treatment with Candida albicans allergen immunotherapy.
Rigg D, Miller MM, Metzger WJ.
Am J Obstet Gynecol. 1990 Feb;162(2):332-6.

I would interpret this data as very preliminary and appropriate clinical judgement should be used applying this to individual patients. I hope this has been helpful.

Andrew Murphy, MD, FAAAAI

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