Recurrent allergic vulvovaginitis: treatment with Candida albicans allergen immunotherapy

Recurrent vaginal candidiasis is a difficult problem for many women who do not respond to the usual antifungal agents. Normally these women have recurrent disease for many years before they are referred for evaluation of local vaginal hypersensitivity. We evaluated 18 women with recurrent vulvovaginal candidiasis that was unresponsive to all other modalities of therapy and who were skin-test positive to Candida albicans with a positive prick test or intradermal skin test. Three patients had late-phase skin test reactions only. Of the 18 study participants, 16 responded with significant improvement in the mean incidence of episodes of vaginitis per year from 17.2 +/- 2.0 to 4.3 +/- 1.8 (p less than 0.0004). Overall, there was approximately 79% improvement in these patients. More than half the women were also atopic but were not first seen with these allergic symptoms. These data suggest that certain women who have chronic vaginal candidiasis may have a local hypersensitivity response to Candida that may improve with allergy immunotherapy with C. albicans extract. A double-blind, placebo-controlled trial in a homogeneous group of women with standardized extract is needed to establish this as a recommended form of therapy in this subgroup of patients.