Allergic vaginitis

　　They can be triggered by systemic or local hypersensitivity, so hypersensitivity is the main cause of allergic vaginitis.

　　1. Allergens

　　1. Inhaled substances:Before 1995, allergic vaginitis reported were all caused by pollen. In 1998, Moraes reported a case of a child patient with symptoms of rhinitis and vaginitis induced by house dust mites. In 1999, Chiu reported a case of a young woman who developed allergic vaginitis due to the inhalation of latex. The patients reported had an increased number of eosinophils in the vaginal smear, and positive direct skin tests for pollen, house dust mites, and/or latex, as well as radioallergosorbent test positivity, accompanied by a history of other hypersensitivity and familial allergic reactions. In addition to direct inhalation contact, these allergens can also be absorbed systemically after contact.

　　2. Food and drugs:Food and drugs accumulating in the vagina can cause allergic reactions in sensitive patients. This may occur after ingestion or after contact with sexual partners, as the seminal fluid of sexual partners may contain food or drug components that can cause allergies. In 1978, Haddad reported a case of a woman allergic to walnuts who developed allergic vaginitis after one sexual encounter with her husband. Subsequent examination of her husband's seminal fluid confirmed the presence of walnut protein. Similar reactions can also occur after the husband takes medication, including dicloxacillin, vinblastine sulfate, meropenem, amoxicillin, and others. Vaginal and vulvar reactions caused by drugs or food may involve other mechanisms in addition to type I hypersensitivity.

　　3, Semen:The diagnosis of seminal plasma allergy is rare, and the incidence of seminal plasma allergy is unclear. In 1958, Dutch gynecologist Specken first reported a 65-year-old woman experiencing systemic measles with asthma after sexual intercourse, which disappeared 3 hours later, and a positive skin prick test for human seminal plasma. According to the different symptoms that can appear after sexual intercourse, Bernstein divided patients with seminal plasma allergy into two groups based on their symptom characteristics: local reaction group and systemic reaction group. They found that 12% of women met the criteria for human seminal plasma allergy through a questionnaire survey.

　　In most patients, only symptoms of the vulva and perineum appear, which manifest as a chronic course, with no obvious cause. Local mild reactions can occur before systemic symptoms, with intervals between the two ranging from several months to several years. Systemic symptoms can vary, with mild symptoms such as generalized itching and severe symptoms such as hypotensive shock. Most patients with seminal plasma allergy are between 20 and 30 years old, with 2/3 of the patients having hereditary allergies, and most of them are allergic to food. Many patients have allergic reactions to different male partners.

　　Systemic allergic reactions to human seminal plasma are mediated by IgE antibodies and are usually type I hypersensitivity, with type III and IV also reported. Clinical manifestations include post-coital arthritis, rash, hemorrhagic proctitis, bullous mixed drug eruptions, contact dermatitis, and recurrent asthma after unprotected sexual intercourse. Isoelectric focusing analysis of seminal plasma protein gel filtration found molecular weights of 12-75kD, believed to come from the prostate. Although skin tests have become a specific test for patients with systemic reactions, they cannot yet be reliable indicators for vaginal local patients. The final diagnostic standard for seminal plasma allergy is the complete prevention of allergy with the use of condoms. It is very important to exclude allergies caused by food allergens transported through seminal plasma or drug metabolism.

　　Male factors that can cause women to have an increased sensitivity to seminal plasma include vasectomy, chronic diseases, and infections. Factors that increase female sensitivity are pregnancy, infection, gynecological surgery, and IUD. Women with infections and their sexual partners have higher levels of HLA, which are also considered one of the factors that cause allergies.

　　4, Latex:Reports of allergies to natural rubber are quite common, ranging from mild allergic reaction symptoms to severe allergies. The main types of allergic reactions that occur after contact with latex include type I or IV hypersensitivity, with contact routes including condoms, contraceptive films, gloves, diagnostic and surgical procedures. With the increase in the use of condoms for the prevention of STDs, the incidence of latex allergy has also increased. Inhaling latex can also cause vaginal itching.

　　5. Semen plus latex:Some women may show simultaneous allergy to seminal fluid and latex, which can be difficult to deal with if there is no latex condom.

　　6. Candida albicans:The incidence of recurrent vulvovaginal candidiasis in healthy women is 15%, and more and more evidence shows that Candida albicans is an effective allergen, and the protein and carbohydrate fragments of the fungus contain allergens. IgE antibodies against Candida albicans can cause direct positive skin tests, challenge tests, and the occurrence of clinical allergic symptoms, which have been confirmed in the lungs, nose, and skin.

　　7. Parasites:Parasites can produce several allergic reactions such as asthma and measles. Due to the common infection of Enterobius vermicularis (pinworm), it is a common parasitic disease, especially in children.

　　8. Spermicides:The main component of spermicides, nonylphenol ether type IgE, can be found in the vaginal lavage fluid of women with chronic vaginitis. Nonylphenol ether is toxic to lymphocytes and macrophages, significantly inhibiting their activity.

　　Secondly, behaviors and habits that can easily lead to allergic vaginitis

　　1. Sexual intercourse:Recurrent vaginitis is closely related to sexual activity. The reason is that sexual intercourse can cause minor abrasions to the vaginal mucosa; seminal fluid contains high levels of PGIE2 and extracellular organelles that have immunosuppressive activity; diseases mediated by IgE induced by seminal fluid; sexual intercourse changes the vaginal pH; frustrated or unpleasant sexual intercourse.

　　2. Exaggerated personal hygiene habits:Excessive vaginal lavage or vulvar cleaning can lead to the use of excessive chemicals, which is a significant risk factor for recurrent candidiasis.

　　3. Clothing type:Wearing tight nylon or synthetic elastic fiber underwear can increase the recurrence of Candida albicans, as this type of tight underwear creates a relatively warm and moist environment in the reproductive tract, which is conducive to the growth of Candida albicans.

　　4. Psychological factors:Women with recurrent vaginitis are likely to suffer from depression, dissatisfaction with life, lack of self-esteem, and feeling the pressure of life. Dissatisfaction with sexual life and the absence of sexual pleasure are also very common. Undoubtedly, stress and itching are often related, and it is difficult to determine whether these symptoms are the result of chronic vaginal itching, difficulty with sexual intercourse, and vaginal discharge.

　　Allergic vaginitis often complicates with bacterial infection, causing increased leukorrhea, foul-smelling purulent leukorrhea, or bloody leukorrhea; and concurrent candidal infection, resulting in curd-like or mold-like leukorrhea, accompanied by symptoms such as itching, burning, and pain.

　　1. Symptoms

　　Increased vaginal discharge, which is purulent and bloody, with the discharge of necrotic tissue, and has an odor. The discharge from candidal infection may resemble powdered cheese.

　　There may be itching, a burning sensation in the vulva, and adult women may have difficulty with sexual intercourse.

　　2. Signs

　　Vaginal examination: The vaginal mucosa may be ulcerated, with the surface possibly forming ulcers. The vaginal vessels may be edematous, presenting acute or chronic inflammatory changes. With a longer course, the vagina may form extensive and hard adhesions, causing narrowing of the vagina and even leading to vaginal atresia.

　　If there is vaginal or uterine hematoma or abscess, rectal examination can feel the swollen vagina and enlarged uterus.

　　1. Avoid the long-term retention of semen in the vagina

　　Avoid the long-term retention of semen in the vagina, because semen has immunosuppressive effects and changes the vaginal pH value. Do not rinse the vagina or clean the vulva after sexual intercourse to reduce the irritation of chemical substances to these parts.

　　2. Use white odorless toilet paper

　　To reduce irritation or sensitivity, still use odorless hygiene products, avoid using sanitary napkins or toilet paper with added fragrances. In addition, do not use disinfectant water arbitrarily to clean the vagina, so as not to irritate the delicate skin and cause local skin damage or inflammation.

　　3. Wear less tight pants

　　Avoid wearing tight or close-fitting pants like jeans, in summer, it is better to wear skirts or loose pants, and also avoid wearing tight nylon underwear, choose cotton underwear instead, because the female lower body is dark and moist, tight pants make the lower body not dry, and the chance of women getting vaginitis will also increase.

　　4. Avoid frequent contact with chemicals

　　Avoid all local applications, deodorants, perfumes, alkaline or colored soaps, bubble baths, chemical rinses, depilatories, hair removal milk, and also avoid frequent cleaning habits.

　　5. Use odorless sanitary cotton, not winged sanitary napkins

　　Women should use odorless sanitary napkins and cotton, not winged sanitary napkins, because the glue on the wings mixes with sweat, causing itching and sensitization. Let patients know that the vulva is a moist organ, physiological secretion is normal, and frequent use of pads affects local ventilation, which is conducive to the growth of Candida and causes allergy.

　　6. Wipe the lower body from front to back

　　Pay attention to the cleanliness of the lower body, the underwear must be washed clean frequently, when cleaning the lower body with toilet paper after using the toilet, it should be wiped from front to back to avoid bringing bacteria from the anus into the vagina, causing inflammation.

　　I. Laboratory Examination

　　1. Prick test and/or intradermal skin test: Application of common possible allergic inhaled substances (dust mites, pollen, animal epidermis, etc.), food, possible drugs, Candida albicans, pollen, latex, semen, spermicides, and enzymes.

　　2. Determination of total and allergen-specific IgE in serum.

　　3. Determination of IgE specific to allergens in vaginal secretions.

　　4. Total eosinophil count in vaginal secretions.

　　5. Skin contact test for sensitive substances in contact dermatitis patients, common vulvar sensitizers are propylene glycol, antibiotics, antifungal agents, formaldehyde, rosin, dyes, etc.

　　6. Vaginal challenge test for possible allergens, which will be an ideal means to re-create vaginal allergic reactions, while detecting IgE and eosinophils, however, patients often disagree with this diagnostic method.

　　II. Auxiliary Examinations

　　Histopathological examination.

　　I. Appropriate Diet for Allergic Vaginitis

　　Diet should be light and healthy, pay attention to nutritional intake, enhance physical fitness, and expel evil externally.

　　Some light foods rich in vitamins and plant proteins, such as soybeans, brown rice, quinoa, soy products, chestnuts, carrots, bok choy, green peppers, apples, walnuts, and so on should be consumed more. It is also important to have a nutritionally rich diet in everyday life to enhance the body's immunity. In this way, allergic symptoms can also be reduced. Of course, if appropriate exercise and maintaining an optimistic attitude are combined, it will be very helpful for improving allergic constitution.

　　Secondly, dietary taboos for allergic vaginitis

　　1. Cold foods.

　　2. Greasy foods.

　　3. Avoid spicy and irritating foods to prevent the generation of damp-heat or consumption of Yin blood.

　　4. Salted cold foods such as shrimps and crabs.

　　Firstly, drug treatment

　　1. Antihistamines:The results of preventive treatment with antihistamines have been reported to be inconsistent, and there is a lack of open and double-blind studies on antihistamine treatment.

　　2. Cromolyn:In some women with allergic vaginitis, local treatment with mast cell stabilizers can also slow the onset of symptoms.

　　3. Corticosteroids:Reports indicate its use in patients who fail to respond to antihistamine treatment, but there are very few cases.

　　Secondly, other treatments

　　1. Immunotherapy:

　　(1) Inhalation therapy: A series of reports suggest that inhalation therapy is one of the immunotherapies for alleviating allergic vaginitis symptoms. It is mainly used for allergic reactions caused by pollen and house dust mites.

　　(2) Candida albicans: Patients with recurrent vulvovaginal candidiasis receive treatment with allergen-specific Candida albicans, all of whom have positive direct skin tests for candidiasis, and symptoms have been relieved.

　　(3) Human seminal plasma: Subcutaneous immunotherapy with whole seminal plasma or seminal fluid fragments.

　　2. Treatment for patients allergic to human seminal plasma and latex:The treatment of seminal plasma allergy includes condom contraception, administration of systemic antihistamines, and pretreatment with sodium cromoglycate via the vagina. Immunotherapy with allergen protein derived from the seminal plasma of the spouse can be considered. Immune therapy is not recommended for patients with local reactions. Some women are allergic to seminal fluid and latex at the same time and can use condoms made from sheep intestines. However, this condom cannot prevent HIV infection. Men should use double condoms, with the outer layer being a non-latex condom and the inner layer being a latex condom.