The American Academy of Allergy, Asthma and Immunology has strongly criticized the concept of “candidiasis hypersensitivity syndrome” and the diagnostic and treatment approaches its proponents use. AAAAI’s position statement concludes: (1) the concept of candidiasis hypersensitivity is speculative and unproven; (2) its basic elements would apply to almost all sick patients at some time because its supposed symptoms are essentially universal; (3) overuse of oral antifungal agents could lead to the development of resistant germs that could menace others; (4) adverse effects of oral antifungal agents are rare, but some inevitably will occur; and (5) neither patients nor doctors can determine effectiveness (as opposed to coincidence) without controlled trials. Because allergic symptoms can be influenced by many factors, including emotions, experiments must be designed to separate the effects of the procedure being tested from the effects of other factors [5]. Several years ago, Crook told me that he had no intention of conducting a controlled test because he was “a clinician, not a researcher.”

The antifungal drug most often prescribed by proponents of “candidiasis hypersensitivity” is nystatin (Mycostatin, Nilstat), which seldom has significant side effects. However, they also prescribe ketoconazole (Nizoral), which has an incidence of liver toxicity (hepatitis) of about 1 in 10,000. The liver injury usually reverses when the drug is discontinued, but ketoconazole has been responsible for several deaths. For this reason it should be prescribed only for serious infections. Both of these drugs are expensive [6]. In a double-blind trial, the antifungal drug nystatin did no better than a placebo in relieving systemic or psychological symptoms of “candidiasis hypersensitivity syndrome.” [7] A study of 100 consecutive chronic fatigue patients found no differences in historical, physical, or laboratory findings among those who believed their problem was yeast-related and those who did not [8].

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