Transcript The Spectrum of Candida Related Disorders

The Spectrum of Candida
Related Disorders:
An Allergist’s 33 yr Perspective
George F Kroker MD
Allergy Associates of La Crosse
Case History
C.G., a 39 y/o R.N. from Duluth MN , is referred
from her gynecologist for allergy assessment
Chronic headaches, daily for 1 year
Exhaustion, fatigue on awakening in AM
Episodic migraine headaches,
– Require frequent ER treatment
– Variety of meds tried: lortabs, imitrex, etc.
Chronic rhinitis & sinus headaches--worse in fall
c/o chronic recurrent yeast vaginitis
– Increasing frequency for 1 year PTA
Premenstrual syndrome: bloating, fatigue, CNS
Case History (cont)
Recurrent antibiotic use thru childhood for
chronic pharyngitis
Antibiotics twice this year for respiratory
infections during fall season
Premenstrually c/o fatigue, cravings for
chocolate
Case History: Patient Goals
“Help my energy” “I want to feel normal”
“Help my headaches”
“I don’t want to keep having yeast
infections”
“I don’t want to be sick every fall”
“What’s going on with me?”
What’s wrong with this patient?
How do I approach her allergy
evaluation and treatment?
Candida-related Disorders
Infectious
– Cutaneous
intertriginous candidiasis
onychia/paronychia
candida granuloma
– Mucocutaneous
oral: thrush, glossitis, cheilitis, stomatitis
genital: vaginitis, balanitis
alimentary: esophagitis, enteric, perianal
– Systemic
urinary, cardiovascular, central nervous system, blood, etc.
Candida-related disorders
Is this the complete list of pathogenic
Candida disorders??
The Tomato Effect:
Rejection of Highly Efficacious Therapies Because They
“don’t make sense and we know they can’t be true”
Goodwin, JS & Goodwin JM, JAMA 251: 2387-2390, 1984
Candida Albicans
Candida is a heterogeneous genus
grouped with Fungi Imperfecti
80 species; 6 species pathogenic
Candida albicans polyantigenic
– two cell wall antigens: mannan & glucan
– 77 cytoplasmic antigens; 1 mycelial antigen
– each strain of Candida has 30-35 of these
antigens
Candida Albicans
Characterization of IgE-binding epitopes on Candida
albicans enolase
– Ito K, Ishiguro A, Kanbe T, Tanaka, T, Torri S
– Clin Exp Allergy 25:529-35, 1995
Detection of IgE antibody against Candida albicans
enolase and its crossreactivity to Saccharomyces
cerevisiae enolase
– Ito K, Ishiguro A, Kanbe T, Tanaka K, Torri S
– Clin Exp Allergy 25:522-8, 1995
Candida-related Disorders
Infectious
– Cutaneous
intertriginous candidiasis
onychia/paronychia
candida granuloma
– Mucocutaneous
oral: thrush, glossitis, cheilitis, stomatitis
genital: vaginitis, balanitis
alimentary: esophagitis, enteric, perianal
– Systemic
urinary, cardiovascular, central nervous system, blood, etc.
Candida-related Disorders: A
more complete list
Infectious
Infectious/immunologic
– Chronic mucocutaneous candidiasis
– Allergic Fungal Sinusitis
Sensitivity Disorders
– Localized Sensitvity
Urticaria
Irritable bowel Syndrome
Allergic vaginitis
– Generalized Sensitivity
Candida Sensitivity Syndrome
Candida Sensitivity Disorders
Localized Sensitivity
– urticaria
Candida & Chronic Urticaria
An assessment of the role of Candida
albicans and food yeasts in chronic
urticaria. James, J & Warin RP BR J
Dermatology 84:227-237, 1971.
– 100 pts with chronic urticaria
– 36% (36 pts) positive prick Candida
– 3/36 responded to medication (nystatin)
– 23/36 responded to med & yeast-free diet
Candida and Chronic Urticaria
Holti, G: Candida allergy. In: Winner HI,
Hurley R, eds. Symposium on Candida
infections. Edinburgh and London: E& S
Livingstone 1966; 74-81.
– 255 patients with chronic urticaria
– 49 (19%) had positive prick to Candida
– 27 (11%) had positive prick to food yeast
– Rx nystatin x3 weeks cured 27/49 patients
– 18 pts required med plus yeast-free diet
Candida and Chronic Urticaria:
Clinical Correlates
Patient on multiple antibiotics who
gradually develops longstanding urticaria
Patient with chronic urticaria who has
other signs of overt Candida overgrowth—
i.e., recurrent yeast vaginitis
Patient with chronic urticaria known to be
sensitive to yeast-containing foods or mold
Candida Sensitivity Disorders
Localized Sensitivity
– Urticaria
– Irritable bowel syndrome
Candida & Irritable Bowel Syndr
Santelmann, H & Howard, JM: Yeast metabolic products, yeast antigens, and
Yeasts as possible triggers for irritable bowel syndrome.
Eur J Gastgroenterol Hepatol 17: 21-26, 2005
Candida & Irritable Bowel Syndr
“At least 3 different Candida species are
able to produce proteases which can
degrade IgA1, IgA2, and SIgA. This
protease activity can induce polyclonal Bcell response and inflammation. An
infection of the intestinal mucosa with
Candia might lead to an inactivating of
SIgA and inflammation within subgroups of
patients with IBS symptoms.”
Candida & Irritable Bowel Syndr
“It was shown recently that there is a
potential cross reactivity with gluten
because of several amino acid sequences
(in the Candia cell wall) that are highly
homologous to alpha-gliadin and gamma
gliadin. Such a mechanism might lead to
wheat intolerance with its accompanying
symptoms and even trigger celiac disease
in genetically susceptible people.”
Candida & Irritable Bowel Syndr
“Candida can be cultured from faeces in
up to 80% of healthy adults ”
“Unfortunately, there is no accepted “gold
standard” for distinguishing between a
yeast sensitivity condition and a yeast
overgrowth in the gut…
Candida & Irritable Bowel Syndr
“Candida can produce alcohols and contains
glycoproteins which have the potential to
stimulate mast cells to release histamine and
apparently PGE2 inflammatory substances
which could cause IBS Ssx”
“…there is increasing evidence for yeasts being
able to cause IBS symptoms in sensitized
patients via Candida products, antigens, and
cross-antigens
Candida & Irritable Bowel:
Clinical Correlates
The celiac patient who still has symptoms
or persistently high TTG levels may have
Candida issues
The patient with known IBS who markedly
worsens following antibiotic use may have
Candida issues
The patient with IBS, and known wheat or
yeast intolerance may have Candida
issues
Candida Sensitivity Disorders
Localized Sensitivity
– Urticaria
– Irritable bowel syndrome
– Allergic Vaginitis
Candida and Allergic Vaginitis
There is a strong association between
atopy and recurrent vaginal candidiasis
A history of atopy (68%) and positive skin
testing to aeroallergens (42%) was higher
in recurrent vaginal candidiasis than in
patients with sporadic vaginal candidiasis
(p<.05)
– Neves, NA, De Oliveira, MA et al. J Exp
Immunol 142: 167-171, 2005.
Candida and Allergic Vaginitis
A significant number of women with
recalcitrant yeast vaginitis are found to
have IgE antibodies in their vaginal fluid
but not in their sera
Vaginal IgE sometimes directed against C.
albicans, perennial ryegrass, spermicides
– Witkin, S. Jeremias, AB, Ledger J. A localized
vaginal allergic response in women with
recurrent vaginitis. JACI 81: 412-416, 1988
Candida and Allergic Vaginitis
Allergic Vulvovaginitis
Moraes, Paula & Taketomi, Ernesto T
Annals of Allergy 85: 253-265, 2000.
Candida and Allergic Vaginitis
“Exposure to allergen in the vaginal lumen is
followed by the transport of this allergen through the
interepithelial channels and its interaction with mast
cell-bound specific IgE”
“Mast cell degranulation and the release of
histamine and other inflammatory mediators causing
symptoms of allergic vaginitis”
“Histamine is a potent inducer of PGE2 from
macrophages which suppresses cell-mediated
immune response…the resulting symptomatic
candidal vaginitis would be a secondary
consequence to a primary allergic vaginitis”
Candida and Allergic Vaginitis
Stress
Beta Endorphin
Allergen exposure
IgE mediated vaginal rxn
Histamine
Macrophage production of PgE2
Inhibition of IL-2 production
Impaired lymphocyte proliferation
Against Candida
Candida Vaginitis
Candida Allergy
Candida and Allergic Vaginitis
“Women with immediate hypersensitivity reactions to
medications, environmental allergens, or
microorganisms would be at increased risk for
candidal vaginitis as a consequence of the induction
of PGE2 production. Because of the existence of a
countercurrent vascular system supplying the genital
organs, potential allergens may accumulate
preferentially in the vagina”
– Witkin, S. Immunologic Factors Influencing Susceptibility
to Recurrent Candidal Vaginitis Clinical Obstetrics &
Gynecology 34: 662-668, 1991.
Candida and Allergic Vaginitis
“These data suggest that there are two kinds of
allergic recurrent Candida vaginitis:
– (1) primarily due to Candida hypersensitivity
– (2) secondary to other types of vaginal allergy, such
as pollen, semen, and latex
Moraes, P. Allergic Vulvovaginitis, Annals of Allergy 2000.
Candida and Allergic Vaginitis
Clinical Cases
Woman with recurrent yeast vaginitis, who has
chronic symptoms helped with zyrtec and singulair;
major flare-up in June. Found to be grass allergic.
Woman (biology teacher) mushroom picking with
class, and comes back from activity and has prompt,
severe vaginal itching and clear discharge
Woman with recurrent Christmas-time yeast
vaginitis, tracked down to clementine oranges.
Eating for 1 day: vaginal itching
Eating for 2 days: vaginal itching & clear discharge
Eating for 3 days: yeast vaginitis
Candida and Allergic Vaginitis
Immunotherapy
For allergic vulvovaginitis due to pollens or house
dust mites, a series of case reports shows important
Improvement of symptoms after immunotherapy for
vaginitis due to pollens or house dust mites
For allergic vaginitis due to primary Candida sensitivity,
there are five case reports and five open studies,
including 177 patients with recurrent vaginal candidiasis
who had been prescribed Candida albicans allergen
immunotherapy. Improvement rates from 65% to 80%.
Candida and Allergic Vaginitis
Important Points
Many patients with recurrent yeast vaginitis have
chronic, low grade vaginal itching and clear discharge
between episodes of infections
Patients with allergic vaginitis may note a predilection in
infections or vaginal symptoms during allergy seasons
Every allergy patient deserves a gynecological history,
with attention towards recurrent vaginal infections or
symptoms
Every woman with chronic vaginitis deserves to be
screened for allergic disease
What about Candida
Sensitization outside of
localized organs?
An Illness in Search of a Name
Candidiasis
Systemic Candidiasis
Candida sensitivity/hypersensitivity
“The Yeast Connection” (Crook)
Superficial Candidiasis Syndrome (Truss)
Chronic Candidiasis sensitivity syndrome
(Kroker)
Fungal-type Dysbiosis (Eaton)
Systemic Candida-Related Sensitization
Systemic Candida Sensitization
First described by C.
Orian Truss, MD in
J Ortho Psych 7:1737,1978
Later wrote “The
Missing Diagnosis”
Systemic Candida Sensitization
Concept broadened by
Crook, who wrote “The
Yeast Connection”
Systemic Candida Sensitization
Definition:
– The occurrence of a polysymptomatic
complex typically involving (among others)
fatigue, cognitive impairment, gastrointestinal
distress and sugar cravings coinciding with
signs and symptoms of significant Candida
colonization and often accompanied by a
sensitivity to molds and yeast related
products.
Systemic Candida Sensitization—
Clinical Presentation
Signs of excessive Candida colonization:
– recurrent yeast vaginitis
– thrush
– bloating, gas, intestinal upset
Signs of systemic illness:
–
–
–
–
–
–
chronic fatigue, cognitive dysfunction
aching, malaise
intense cravings for refined carbs, sugars
gastrointestinal complaints (irritable bowel syndrome)
increased sensitivity to molds and chemicals
reduced tolerance to alcoholic beverages
Systemic Candida Sensitization
Chronic Candidiasis and Allergy
In Food Allergy and Intolerance, Brostoff, Ed, 1st Edition
Systemic Candida Sensitization
Keith Eaton, Md
Definitive review of Candida related illness
2nd Edition: Food Allergy & Intolerance, Brostoff, ed 2002
Systemic Candida Sensitization
Medical Literature: 3 studies
Dismukes, WE et al: A randomized, double blind trial of
nystatin therapy for the candidiasis hypersensitivity
syndrome. N Engl J Med 323: 1717-1723, 1990.
Santelmann, H et al: Effectiveness of nystatin in
polysymptomatic patients. A randomized, double-blind
trial with nystatin versus placebo in general practice.
Fam Prac 18: 258-265, 2001.
Truss, CO et al: Generalized symptoms in women with
chronic yeast vaginitis: treatment with nystatin, diet, and
immunotherapy versus nystatin alone. J Advancement
Med 5: 139-175, 1992.
Systemic Candida Sensitization
Good Medical Literature Review
Crandall M. Allergic Predisposition in
Recurrent Vulvovaginal Candidiasis. J.
Adv. Med. 4:21-38, 1991
Crandall M. The Pathogenic Significance
of Intestinal Candida Colonization. Intl. J.
Hygiene Environ Health 207: 79-81 (letter
to editor)
Systemic Candida Sensitization
Criteria for developing illness
– Clinical conditions to permit excessive yeast
colonization:
Recurrent antibiotics
Recurrent high-dose steroids
Diet high in refined sugars
– Immune system predisposed to dysregulation
(i.e., over activity to chronic antigen
presentation)
Past history of classical allergic disease
Systemic Candida Sensitization
Patterns of Development
undiagnosed “simple” allergy
(i.e., dust, milk)
recurrent infections
frequent antibiotic use
increased Candida
colonization
increased sugar
ingestion
Candida
Sensitization
Target
Organ
Target
Organ
Target
Organ
Systemic Candida Sensitization
Common Presentation for ENT’s
History of significant
Mold allergy
recurrent infections
frequent antibiotic use
increased Candida
colonization
increased sugar
ingestion
Candida
Sensitization
Target
Organ
Target
Organ
Target
Organ
Systemic Candida Sensitization
Diagnosis
History of paramount importance
Crook Questionnaire
Developed by William Crook MD
Extensive, 70 question assessment
Very sensitive, but not specific
False positives often from food
sensitivities, or other allergies
False positives from other chronic
illnesses
Fungus Related Disease
Questionnaire (FRDQ-7)
In an open study of 380 undiagnosed
polysymptomatic subjects, Santelmann
compared the effect of diet and antifungal
treatment with the responses to the Crook
Questionnaire
He used discrimination analysis to identify
seven questions that were the most
strongly predictive of treatment response
Fungus Related Disease
Questionnaire (FRDQ-7)
Fungus Related Disease
Questionnaire (FRDQ-7)
Fungal Related Disease Questionnaire (FRDQ-7)
Candida History—3 Key points
Signs of excessive Candida colonization:
– recurrent yeast vaginitis, thrush, bloating & gas
Reasons in for excessive Candida colonization
--antibiotics, steroids, sugar
Manifestations of systemic illness:
–
–
–
–
chronic fatigue, aching, CNS, PMS, sugar cravings
Increased sensitivity to molds & chemicals
intense cravings for refined carbs, sugars
Sensitivity/intolerance to alcoholic beverages
Systemic Candida Sensitization
Diagnosis
History of paramount importance
Abnormal reactivity (immediate/delayed) to
intradermal Candida skin test
– Inappropriate immediate reactivity
– Inappropriate delayed reactivity
Candida Skin Test at 48 hours
Patient with Systemic Candida Sensitization
Systemic Candida Sensitization
Diagnosis
History of paramount importance
Abnormal reactivity (immediate/delayed) to
intradermal Candida skin test
– Inappropriate immediate reactivity
– Inappropriate delayed reactivity
Elevation in Serum IgG Candida
Elevation of Candida IgG Antibodies in Patients with
Medically Unexplained Symptoms
Lewith, G. et al
J of Alternative & Complementary Medicine
Vol 13:1129-1133, 2007
Compared IgG antibody measurements
between population with high FRDQ-7
scores and symptom-free controls
Systemic Candida Sensitization
Diagnosis
“Gold Standard”: Clinical response to a 24 week trial of sugar/yeast free diet and
antifungal medication
Systemic Candida Sensitization
Comorbid conditions often found
Mold allergy, food yeast allergy
Thyroiditis
Multiple food sensitivities secondary to
increased intestinal permeability
Nutritional deficiencies
– magnesium
– fatty acids
Systemic Candida Sensitization
The “Candida-Mold-Yeast Triad”
Candida Sensitivity
Mold Sensitivity
Food Yeast Sensitivity
Candida Sensitization and Mold
Allergy: The Connection
An intimate connection between Candida
sensitivity and mold sensitivity
“Everything Candida can do (symptomatically),
mold can do, and visa-versa”
Heavy mold exposure can trigger Candida
sensitization; heavy Candida colonization can
trigger mold sensitization
Candida Sensitization & Mold
Allergy: The Connection
Heavy Candida
Colonization & Sensitization
Mold Sensitization
Example: 31 yr old woman moves into musty home with overt mold
contamination. Has had pre-existing yeast vaginitis, gastrointestinal
bloating, and thrush. She rapidly becomes ill in the home with increasing
sinus congestion & headaches; no other family members affected
Heavy Mold
Colonization & sensitization
Candida Sensitization
Example: 24 yr old woman working in basement television studio
that flooded. Heavy mold exposure. Became sick, exhausted,
headachy. She and coworkers left jobsite and moved to another
building. All coworkers became well except for her
Role of Antibiotics & Fungal Microbiota
in Driving Pulmonary Allergic Responses
Noverr Et al. Infec & Immunity Sept 2004 pp 4996-5003
Mouse model of antibiotic-induced GI microbial
disruption with C. albicans excess; followed by
nasal challenge to mold
Mice easily developed T cell mediated allergic
airway response in lungs to subsequent nasal
mold exposure without previous systemic
antigen priming
Effect is absent in mice challenged with mold
not receiving chronic antibiotic administration
Role of Antibiotics & Fungal Microbiota in
Driving Pulmonary Allergic Responses
Noverr Et al. Infec & Immunity Sept 2004 pp 4996-5003
“These studies indicate that increased numbers
of yeast cells in the microbiota can be a
contributing factor in up-regulating Th2
responses to antigen exposure in the lungs. In
these studies, Candida was never isolated from
the lungs…these studies highlight the concept
that events in distal mucosal sites such as the
GI tract can play an important role in regulating
immune responses in the lungs”
“We have presented a model of a clinically
feasible, common scenario that occurs for a
number of humans: antibiotic treatment
followed by a non life-threatening low grade
increase in fungal microbiota…”
Systemic Candida Sensitization and
increased intestinal permeability
a fertile ground for food allergy development
Systemic Candida colonization promotes
sensitization against food antigens by affecting
the mucosal barrier in mice
– Yamaguchi N, et al. Gut 55: 954-60, 2006.
Gut permeability measured by polyethylene
glycol absorption in abnormal gut fermentation
as compared with food intolerance
– Eaton, K. et al J Roy Soc Med 68: 63-66,
1995
Candida Sensitization and
increased intestinal permeability
Candida sensitization (and food allergy) produced
identical increases in intestinal permeability
Increased Refined
Sugar Ingestion
Antibiotics
Allergic
Predisposition
Candida Colonization
Antigenic
Products
immune
reactions
types I, III, IV
oxylipin
metabolic
molecules
toxins
autoimmune
reactions
Pg E2
thyroiditis
Th2/Th1
intestinal
damage
acetaldehyde
ethanol, CO2
egress of
food antigens &
bacterial LPS
nutrient
deficiencies into circulation
B6, ZN, Mg
food sensitivities
Target Organ Symptoms
Candida Sensitization—
Endocrine disruptor?
Majority of female patients have a
“premenstrual variant”
Treatment may resolve premenstrual
symptoms, early peri-menopausal
symptoms, and amenorrhea
Progesterone binding protein in cytosol
Could Candida bind to hormones, altering
their shape to make them unable to fit their
target receptor?
Candida Sensitization-Treatment
Two-pronged strategy:
– 1. Down-regulate Candida sensitivity
– 2. Reduce Candida colonization
Treat co-morbid conditions:
– Intestinal permeability
– Mold/inhalant sensitivities
– Secondary food sensitivities,
Candida Sensitization Treatment:
Down regulation of sensitivity
Apply intradermal skin test to Candida
– read immediate reaction at 10 min
– read delayed reaction at 24, 48 hours
Look for abnormal immediate or delayed
reactivity
Rx sublingual immunotherapy (SLIT)
based upon immediate and delayed
reaction
Candida Sensitization Treatment:
Lowering Candida Colonization
Antifungal medication
– Azole medications preferred:
fluconazole, ketoconazole, itraconazole
– 14 day course, followed by 2/wk suppression
– “die off” effects can occur
– If drug interactions, liver toxicity a concern,
use nystatin tablets
Probiotic administration
– 10-25 billion units/day minimum
Low refined carbohydrate, low yeast diet
Candida Sensitization Treatment:
“Die Off”
“Die off” (Herxheimer) reaction
– Typically occurs in first several days of Rx
– Usually is exaggeration of preexisting ssx
– New symptoms (i.e., severe rash) suggest a
drug reaction and not “die off”
– Depending on severity, reduce dose & continue
– Seems worse on nystatin than azole Rx
Sugar cravings subside in 3-5 days
Treating Elevated Intestinal Permeability
Eliminate usage of NSAIDs, Alcohol
Eliminate primary food allergens
Eliminate Candida colonization
Utilization of probiotics
Utilization of L-glutamine, 3-4 gm bid
Note: a sign of improvement is
improvement in food allergies
What about the Candida patient who doesn’t
improve on antifungal Rx and diet?
Some Common Causes
Major indoor mold exposure at home/work
Allergic to another food in yeast/sugar free
diet
Other comorbid medical illness (lyme’s
disease, thyroiditis, heavy metal toxicity)
Intercurrent illness requiring antibiotics
Poor dietary compliance
Back to the case !
Case History
C.G., a 39 y/o R.N. from Duluth MN , is referred
from her gynecologist for allergy assessment
Chronic headaches, daily for 1 year
Exhaustion, fatigue in AM on awakening
Episodic migraine headaches,
– Require frequent ER treatment
– Variety of meds tried: lortabs, imitrex, etc.
Chronic rhinitis; headaches worse in fall mold
Chronic recurrent yeast vaginitis Candida
– Increasing frequency for 1 year PTA
Premenstrual syndrome: bloating, fatigue, CNS
Case History (cont)
Recurrent antibiotic use thru childhood for
chronic pharyngitis Preexisting allergies
Antibiotics twice this year for respiratory
infections during fall season Mold
Premenstrually c/o fatigue, cravings for
chocolate Candida
Case History (cont.)—Diet history
craves sugars, esp chocolate
Favorite foods: bagels, bread/rolls,
chocolate
Milk gives stomach upset
At risk for milk and wheat allergy due
To probable leaky gut from Candida
Case History--Environmental
Dusting causes sneezing
Headaches worse in Fall
3 cats at home
Musty odor in basement
Check out dust, cat, mold allergy
Working Hypothesis
Chronic childhood allergies
Occult allergens (?milk, cat, dust)
Recurrent resp infections/childhood
antibiotics
Increased Candida
Carriage
Candida sensitization
Yeast infections
Mold allergy
Intestinal permeability
Food sensitivities
(? Dairy, wheat)
Recurrent ENT Infections
Target organs
Case History—Intradermal Testing
Antigen Tested
Immediate Rxn
Delayed Rxn
Dust mite
+
++
Alternaria
+
+++
Cladosporium
+
+++
Aspergillus
+
+++
Spring Pollens
-
-
Fall Pollens
-
-
Cat
++
-
Case History—Food Testing
Antigen
Result
Milk challenge
Fatigue, aching
Wheat challenge
Nausea, cognition impaired
Yeast challenge
Fatigue, cognition impaired
Corn challenge
No reaction
Case History—Candida Testing
Test
Result
Intradermal Candida--immed
Negative
Intradermal Candida--delayed
++++
Serum IgG to Candida
60% elevated above neg
control
Case History
Allergy Reaction = Sensitivity x Load
Case History--Treatment
Reduce allergic sensitivity
– SLIT: dust, mold, cat
– SLIT: wheat, yeast, milk
Reduce allergic load
– Hypoallergenic diet—elim dairy, wheat, yeast,
refined sugar
– Diflucan 100 mg daily x 14 days
– probiotics
Case History
Patient returned to clinic 3 weeks later
Dramatic improvement in health
– No headaches
– No PMS
– Daily rhinitis, congestion better (but not gone)
– Less fatigue
Case History
Treated for 4 years with SLIT, then
discontinued after remission obtained
In remission and did well for next 7 years
Returned to clinic Oct 2007 for
reassessment
Candida sensitivity relapse following
heavy antibiotic usage for chronic dental
problems, stress, increasing carbohydrate
intake
Clinical Pearls
Every woman with mold allergy, and chronic antibiotic
use (sinusitis, UTI, etc.) who has chronic symptoms is
Candida sensitive until proven otherwise
In every patient with mold allergy, think about Candida
and food yeast sensitivity (“the yeast triad”)
In a patient with loss of food intolerance shortly after
antibiotic use, think about Candida
The Mystery of Candida Sensitivity:
Unanswered Questions
What is the exact pathogenesis behind local mucosal
Candida colonization causing ssx in distant organs?
Can we develop a test with high specificity and
sensitivity that can accurately diagnose the condition?
Can we develop prognostic indicators for long-term
improvement? I.E. is there a test we can follow with Rx?
Can we arrive at a consensus on the best diet for a
Candida patient?
"The most beautiful thing we can
experience is the mysterious. It is the
source of all true art and all science”
--Albert Einstein
The fairest thing we can experience is
the mysterious. It is the fundamental
emotion which stands at the cradle of
true science
--Hans Selye