ABSTRACT
BACKGROUND: Vulvitis that is refractory to all treatment remains a therapeutic challenge. Hypersensitivity to progesterone and estrogen has been recognized as a rare cause of premenstrual dermatoses. Such hypersensitivity seemed to be the cause of vulvitis in the patients described below. CASES: Nine women had treatment-resistant cyclic vulvitis and two patients had vulvitis develop after commencing hormone replacement therapy (HRT). These patients demonstrated delayed-type hypersensitivity responses by intradermal testing to endogenous estrogens, with two of the patients also reacting to intradermal testing with progesterone. A group of 19 healthy control subjects with no history of vulvar symptoms did not react to any test substance. Ten subjects with other vulvar dermatoses also did not react to any test substance. Of the nine patients with cyclic vulvitis, one recovered at menopause, and three responded to therapy aimed at lowering endogenous estrogen levels. One was able to control symptoms with a potent topical corticosteroid, and four elected not to be treated. Both patients with HRT-related vulvitis recovered when HRT was ceased. CONCLUSION: Hypersensitivity to estrogen appears to be implicated in chronic, cyclic vulvitis and vulvitis related to HRT in these patients. This is the first report of vulvitis due to estrogen hypersensitivity. The problem may not be rare and should be considered in patients with unexplained cyclic vulvitis unresponsive to standard therapy or in those developing noncandidal vulvitis on HRT. Specific therapy aimed at suppressing or antagonizing estrogen may be required in these patients.
Subject(s)
Drug Hypersensitivity/diagnosis , Estrogens/adverse effects , Hormone Replacement Therapy/adverse effects , Vulvitis/chemically induced , Adolescent , Adult , Child , Diagnosis, Differential , Female , Humans , Middle Aged , Patch Tests , Progesterone/adverse effectsSubject(s)
HIV Infections/diagnosis , HIV Infections/etiology , HIV-1 , Transfusion Reaction , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
OBJECTIVE: We undertook to determine whether adverse food reactions play a role in irritable bowel syndrome (IBS). METHODS: A systematic review of the literature using Medline (1980-1996), targeting IBS and adverse food reactions, was performed. All clinical trials whereby dietary exclusion was followed by food challenge were selected. Each study was reviewed using a structured format to examine methodological issues and study outcomes. RESULTS: Of the seven studies included, the positive response to an elimination diet ranged from 15% to 71%; double-blind placebo-controlled challenges identified problem foods in 6% to 58% of cases. Milk, wheat, and eggs were most frequently identified to cause symptom exacerbation; of the foods identified the most common trait was a high salicylate content. Foods high in amines were also identified. Studies of diarrhea-predominant IBS identified a higher percentage of adverse food reactions. However, all studies had major limitations in their trial designs, including inadequate patient selection, appropriateness of--and duration of--exclusion diets, and methods of food challenge. CONCLUSION: Whether adverse reactions to foods are a key factor in exacerbating IBS symptoms or whether dietary manipulation is a valid treatment option is unclear. Carefully designed controlled clinical trials are now needed to specifically test the potential role of adverse food reactions in diarrhea-predominant IBS.
Subject(s)
Colonic Diseases, Functional/etiology , Food Hypersensitivity/complications , Food/adverse effects , Clinical Trials as Topic , Double-Blind Method , Humans , Research DesignABSTRACT
Renal parenchymal and fluid and electrolyte abnormalities may complicate hospitalisation in 20% of patients. HIV-specific renal abnormalities are being defined, but most follow opportunistic infection or drug nephrotoxicity. Principles of treatment are largely the same as for patients without HIV.
