A localized vaginal allergic response in women with recurrent vaginitis

In women with recurring vaginitis, treatment of a vaginal Candida infection is not always accompanied by an alleviation of symptoms, and infection frequently reappears after termination of the chemotherapeutic agent. To determine whether an allergic reaction might be involved in symptom prolongation and susceptibility to reinfection, sera and vaginal washes from patients were examined for specific IgE antibodies. With RAST modified to ELISA, anti-Candida albicans IgE was identified in 18.8% of saline vaginal washes, but in only 6.1% of sera, obtained from 64 patients. Similarly, 25% of 16 patients were positive for vaginal fluid IgE, but only 6.3% had serum IgE to their partners' seminal fluid. The detection of specific IgE antibodies vaginally but not in the peripheral circulation suggested the occurrence of a localized vaginal hypersensitivity response. Vaginal fluid-derived IgE antibodies reactive with contraceptive spermicides or present in the particulate fraction of saline vaginal washes were also identified. Vaginal fluids with IgE antibodies also contained detectable levels of prostaglandin E2. A vaginal allergic response can predispose to recurrent Candida infection by inducing prostaglandin E2 synthesis that suppresses cell-mediated immune responses.