Fungal derivatives as antigenic excitants of episodic vertigo

AbstractThirty cases of episodic vertigo of labyrinthine origin with the common denominator of a history of hypersensitivity to fungal derivatives are grouped for study. Verification of the history of specific intolerances to fungal ingestants was accomplished by performing provocative intracutaneous or challenge feeding tests for hypersensitivity to yeast. A positive test response was obtained in each instance. Sixteen of the 30 patients gave a history of hypersensitivity to penicillin and 21 reported an intolerance to ingested, fermented alcohol. An antigenic cross‐reactivity between penicillin, yeast and other fungi is suggested.Ten of the 30 cases qualified as classic Ménière's disease and 14 as vestibular Ménière's disease without auditory involvement. Six fell into the category of benign, positional vertigo.Therapy entailed correction of proven metabolic and endocrine dysfunctions, when present and complete elimination from the diet of all proven allergenic offenders. Hyposensitization therapy for inhalant allergens supplemented the program when indicated.Therapeutic results are classified according to the criteria set forth by the Subcommittee on Equilibrium and Its Management of the American Academy of Ophthalmology and Otolaryngology. Two of the 10 cases of classic Ménière's disease fell into the Class A category with absence of definitive spells of vertigo for the prescribed “10 times the average interval of spells before treatment” plus an improvement in hearing. Three cases fell into the Class B group, experiencing no definitive spells of vertigo but failing to show auditory improvement. Definitive spells persisted in the remaining 5 cases.Allergic management of the vestibular Méniére's group of 14 cases allowed for the classification of 7 as meeting the prescribed requirement of 10 times the average pretreatment interval between definitive attacks. Seven cases of vestibular Ménière's disease failed to obtain relief from definitive spells.Only 1 of 6 cases of benign positional vertigo experienced relief with allergic management. The high failure rate suggests other etiologic factors in this group.It is conceivable that the initial hypersensitization of the patient to penicillin in some instances may be responsible for the eventual antigenic excitation of a perverse labyrinthine response by commonly ingested fungi.Antigenic stimuli may excite episodic vertigo of labyrinthine origin. An acute episode of vertigo may be precipitated by the intracutaneous injection of a predetermined dilution and volume of a specific food antigen or by its ingestion, if the patient is hypersensitive to that food and the labyrinth is in a state of readiness to react.