allergic vaginitis
Introduction
Introduction to allergic vaginitis The vaginal mucosa can behave like an allergic reaction to the nose, eyes, lungs and skin. The vagina and vulva are important ways to cause local or even severe systemic allergic reactions into the body. The disease is rare in clinical practice. Vaginal sensitization pathways include direct or indirect contact with hands or fingers or clothing, sexual intercourse, oral intake (including medications and foods ingested by a sexual partner), or inhalation. The main symptom is the increase of vaginal secretions, which is a purulent leucorrhea, and there is rot tissue excretion and odor. basic knowledge The proportion of sickness: 0.2% Susceptible people: good for adult women Mode of infection: non-infectious Complications: vaginal trichomoniasis
Cause
Causes of allergic vaginitis
Inhalation (20%):
Allergic vaginitis reported before 1995 was caused by pollen. In 1998, Moraes reported a case of a child with nasal and vaginal symptoms due to house dust mites. In 1999, Chiu reported that an adult woman had inhaled latex. Caused by the occurrence of allergic vaginitis, reported vaginal smear eosinophilia, positive skin test positive for pollen, house dust mites and or latex or positive for allergen adsorption test, accompanied by other abnormalities The history of reactions and familial allergic reactions, in addition to direct inhalation exposure, can also be absorbed by the system after contact.
Food and medicine (15%):
Accumulation of food and drugs in the vagina causes allergic reactions in sensitive patients. This may occur after ingestion or after contact with a sexual partner. The semen's semen may contain food or pharmaceutical ingredients that cause allergies. In 1978, Haddad reported A woman who was allergic to walnuts developed allergic vaginitis after her sexual life with her husband. She then examined her husband's semen and confirmed the presence of walnut protein in the semen. A similar reaction may also occur after the husband took the drug. The drugs include diclofenac, vinblastine sulfate, mezlocillin, amoxicillin, etc., vaginal vulvar reactions caused by drugs or foods, in addition to type I allergies, there may be other mechanisms involved.
Semen (10%):
The diagnosis of semen allergy is rare, and the incidence of allergic reactions to semen is unclear. In 1958, Dutch gynecologist Specken first reported that 65-year-old woman developed systemic rubella with asthma after sexual intercourse, disappeared after 3 hours, and skin on human seminal plasma. Single thorn test was positive, and symptoms may be different after sexual intercourse. Bernstein divided the patients with allergic to seminal plasma into two groups according to their symptom characteristics: local reaction group and systemic reaction group. They found that 12% of women met humans through questionnaires. Standard for allergic reactions to seminal plasma.
In most patients, only the symptoms of vaginal vulva appear as chronic menstruation. There is no obvious cause. Local mild reactions may occur before systemic symptoms. The interval between the two may vary from several months to several years. Systemic symptoms may not be expressed. First, mild itching, severe hypotension shock, most patients with allergic to seminal plasma are 20 to 30 years old, 2/3 of patients are atopic, most of them are allergic to food, many patients are different male partners An allergic reaction occurs.
The systemic allergic reaction to human seminal plasma is mediated by IgE antibodies, usually type I allergic reactions, and type III and IV have also been reported. Clinical manifestations are post-intercourse arthritis, rash, hemorrhagic proctitis, macrofoam Mixed drug eruption, contact dermatitis, recurrent asthma after unprotected sexual intercourse, isoelectric protein gel filtration isoelectric focusing analysis found that the molecular weight is 12 ~ 75kD, considered to be from the prostate, although skin experiments become specific to patients with systemic reactions Sexual experiments, but for patients with vaginal localization can not be a reliable indicator, the final diagnosis of allergic reactions to seminal plasma is the use of condoms can be completely prevented, it is very important to exclude allergies caused by seminal plasma transport food allergens or drug metabolism. of.
Male factors that cause women's increased allergic effects on seminal plasma include vasectomy, chronic diseases and infections. Female factors that increase allergies are pregnancy, infection, gynaecological surgery and IUD, infected women and infected sexual partners have higher levels. HLA is also considered to be one of the factors that cause allergies.
Latex (10%):
Reports of allergies to natural rubber are common, ranging from mild allergic reactions to severe allergies. I or IV allergic reactions occur after exposure to latex. The routes of exposure include condoms, contraceptive films, gloves, diagnostics and surgical procedures. Condom contraception prevention of STD increases, the incidence of latex allergy is also increasing, inhalation of latex can also induce vaginal itching.
Semen plus latex (10%):
Some women can show a simultaneous allergy to semen and latex, and if there is no latex condom, it is more difficult to handle.
Candida albicans (5%):
The incidence of recurrent vaginal candidiasis in healthy women is 15%. There is increasing evidence that Candida albicans is a potent allergen, and the protein and carbohydrate fragments of fungi contain allergens against white rosary IgE antibodies from bacteria can cause direct positive skin tests, stimulate experimental and clinical allergic symptoms, which have been confirmed in the lungs, nose and skin.
In 1988 Witkin found specific IgE antibodies in vaginal douche, and a certain number of patients with relapsing vaginitis who were resistant to traditional treatment confirmed IgE against Candida albicans, pollen, spermicide and semen in their vaginal fluid. These studies suggest that there may be two types of allergic recurrent candida vaginitis, one is primary allergic to Candida, and the other is secondary to other types of vaginal allergens such as pollen, semen and latex. .
PGE2 caused by vaginal allergic reaction causes temporary local cellular immunosuppression, and the complete cellular immune system is necessary to prevent overgrowth of Candida. In 1994, Regulez was in the rinsing fluid of patients with acute candida vaginitis. The presence of IgE antibodies to Candida albicans has been confirmed, and allergic reactions may be an important cause of recurrent vaginal candidiasis.
Parasites (5%):
Parasites can produce several allergic reactions such as asthma and rubella, which are common parasitic diseases due to the infection of the nematode, which is especially in childhood.
Spermicide (10%):
The main component of the spermicide, nonoxynol-type IgE, can be found in vaginal washings of women with chronic vaginitis. Nonoxynol is toxic to lymphocytes and macrophages, and significantly inhibits their activity.
2. High risk factors for allergic vaginitis There are four risk factors associated with allergic vaginitis.
(1) Sexual intercourse: Recurrent vaginitis is closely related to sexual activity because sexual intercourse can cause microscopic abrasion of vaginal mucosa; high levels of PGIE2 and extracellular organelles in semen have immunosuppressive activity; caused by semen IgE-mediated disease; sexual intercourse changes the pH of the vagina; frustrated or unpleasant sexual intercourse.
(2) Exaggerated personal hygiene habits: Excessive vaginal washing or cleaning of the vulva leads to excessive use of chemicals, which is a significant risk factor for recurrent candidiasis.
(3) Type of clothing: Underwear with tight nylon or synthetic elastic fibers can cause an increase in the recurrence of Candida albicans, which produces a warmer and moister environment suitable for the growth of Candida albicans in the reproductive tract.
(4) Psychological factors: Women with recurrent vaginitis are likely to suffer from depression, dissatisfaction with life, lack of self-esteem, feeling stressed by life, dissatisfied with sexual life, and sexual pleasure are also very common, no doubt stress and itching often Whether these symptoms are chronic vaginal itching, difficulty in sexual intercourse and vaginal discharge is difficult to determine.
It can be caused by systemic or local allergic reactions, so allergic reactions are the main cause of allergic vaginitis.
Pathogenesis
Human vaginal mucosal blood flow characteristics may affect the concentration of various substances in the vagina, making these substances local or systemic allergens, semen components, drugs and foods taken by semen neutral partners, spermicides, soaps, Sanitary cotton, latex, intestinal parasites and Candida albicans may induce rapid allergic reactions. In addition, pollen, dust or food particles may be inadvertently brought into the vagina or even absorbed throughout the body. Many studies have shown that vaginal immune response Some patients have recurrent vaginitis. IgE antibodies against Candida albicans, semen components, pollen and contraceptive spermicides can be found in vaginal fluid. In most cases, eosinophils can be seen in vaginal smears, allergens. Selectively accumulate in the vaginal mucosa, transport antigen through the interstitial system of the mucosa, and make contact with the mast cells of the lamina propria, the two react with each other, the mast cells degranulate and release histamine and other inflammatory mediators, The appearance of allergic vaginitis, histamine is a potential inducer of macrophage prostaglandins, before induction Generation of prostaglandin E2, prostaglandin E2 and inhibition of the cellular immune response against fungal mechanism dependent on cell immunity, and therefore, as a result of Candida vaginitis occurring secondary to the primary allergic vaginitis.
Early studies found that peanut protein placed in the vagina can be measured in the blood circulation after 1-2 hours. Vaginal administration of penicillin, steroid hormones, and prostaglandins can be confirmed for many years. In 1990, sjoberg confirmed healthy women. The concentration of drug in the blood and saliva reached a peak 1.5 hours after oral administration of penicillin, and could not be detected in these fluids within 15 hours, while the concentration of penicillin in the vagina continued to increase for more than 15 hours, indicating that the substance absorbed by the oral cavity can be in the vagina. Internal accumulation, which may be due to the presence of reverse blood flow in the reproductive tract.
Methotrexate (MTX) used in anticancer therapy can cause ulceration of the systemic mucosa including vaginal mucosa. It can also cause vaginal mucosal burns due to excessive local drug concentration or chemical substances, rupture, secondary infection and vaginal ulcer. .
Prevention
Allergic vaginitis prevention
Women with any allergic vaginal inflammation should be educated to change their lifestyle, reduce the irritations of the vulva, stay away from all the items that cause the disease, and avoid all topical medications, deodorants, perfumes, alkaline or colored soaps. , bubble bath, chemical rinsing, depilatory, shaving milk, but also avoid excessive frequency cleaning habits, women should use odorless hygienic plugs, sanitary napkins, no wing sanitary napkins, because the wings of the glue and sweat mutual Mixing causes itching and sensitization, let the patient know that the vulva is a moist organ, the physiological secretion is normal, often apply the cushion to affect the local ventilation, which is conducive to the growth of Candida causing allergies, apply white odorless toilet paper, avoid Long-term semen vaginal retention, because semen has immunosuppressive effect and changes the pH of the vagina, do not rinse the vagina and vulva after sexual intercourse, reduce the stimulation of chemicals on these parts, control the surrounding environment of allergic inhalation, keep Optimistic and confident, timely counseling and illness for patients with psychological disorders and depression Treatment.
Complication
Allergic vaginitis complications Complications, vaginal trichomoniasis
1. Concurrent bacterial infection, causing increased vaginal discharge, pus septic leucorrhea, or bloody vaginal discharge; concurrent candidiasis, sputum-like leucorrhea or fermented leucorrhea; accompanied by itching, burning, pain and other symptoms.
2. Due to the combination of inflammatory infections, vaginal congestion, edema, pain and other factors lead to sexual difficulties.
3. Inflammation infection spreads, causing complications such as endometrial, accessory and pelvic infections.
Symptom
Allergic vaginitis symptoms common symptoms vaginal discharge increased vaginal sexual intercourse difficulties
1. The main symptom is the increase of vaginal secretions, which is a purulent leucorrhea, and there is rot tissue excretion and odor.
2. Vaginal examination can be seen vaginal mucosal erosion and ulcer formation, the long course of disease, the vagina can form a wide and hard scar adhesion, so that the vagina is narrow, and even locked.
3. If there is vaginal, uterine hemorrhage, empyema, anal examination can touch the swollen vagina and swollen uterus.
4. The occurrence of symptoms is significantly associated with systemic or topical medication.
Examine
Examination of allergic vaginitis
Laboratory inspection
1. Puncture and/or intradermal skin test: application of common possible allergic inhalations (house dust mites, pollen, animal epithelium, etc.), food, possible drugs, Candida albicans, pollen, latex, semen, Spermicides and enzymes.
2. Determination of serum total and allergen-specific IgE.
3. Determination of vaginal secretion allergen-specific IgE.
4. Determination of total eosinophil count in vaginal secretions.
5. Sensitive substance skin contact test in patients with contact dermatitis, common vulvar sensitizers are propylene glycol, antibiotics, fungicides, formalin, rosin, dyes, etc.
6. Vaginal evoked experiments on possible allergens This would be an ideal means of re-inducing vaginal allergic reactions, while detecting IgE and eosinophils, however patients often disagree with this diagnostic approach.
Auxiliary inspection
Histopathological examination.
Diagnosis
Diagnosis and diagnosis of allergic vaginitis
diagnosis
Diagnosis can be made based on medical history and clinical manifestations.
History
Detailed medical history is very important for the diagnosis of allergic vaginitis. Pay attention to the process of onset and previous treatment, and understand possible predisposing factors such as personal cleaning habits, dressing habits, mental state, etc. Family history, because most patients with allergies to inhalation, semen, and Candida albicans have a history of familial allergies and symptoms of other organ diseases such as rhinitis, asthma, conjunctivitis, children should also understand hygiene conditions and whether they are affected Sexual abuse.
2. Clinical manifestations
Symptoms of adult women often manifest as itching, genital burning, dyspareunia and vaginal discharge, vaginal secretions may be clear, combined with Candida albicans infection secretion like skim milk powder cheese, vaginal angioedema, presented Acute or chronic inflammatory changes.
Differential diagnosis
Identification by pathological examination of vaginal or tuberculosis similar to lesions, Trichomonas, Gardnerella, Mycoplasma, Chlamydia trachomatis, Herpes simplex virus, HPV, aerobic and anaerobic bacteria, AIDS and other common Sexually transmitted diseases are common pathogenic microorganisms of vaginal inflammation. Other skin scales, mosses, pemphigus, lupus, Behcets syndrome, Paget's disease can also have itching and burning sensation in children. To rule out poor hygiene, foreign bodies, sexual abuse.
