"I live in ______. Where can I find someone to do this procedure?"
For years this procedure has spread by word of mouth. It is hard to predict who will have heard of it or read our article. Fortunately it is very easy to do and takes no special training or equipment. We suggest that you print out the article and the "Learn the Procedure" page from this web site and take it to your local family doctor or dermatologist to see if they are willing to try it.
If this doesn't work, try a family practice or dermatology residency program. They may be more open to trying new things.
We are starting a list of injection providers. Let us know if you know of someone to add to the list.
"When I mentioned this treatment to the dermatologist I went to, she basically laughed me off."
Don't be too hard on your dermatologist. There are lots of strange remedies out there for warts. This one, however, has research to back it up. Although our study was not conclusive, there is another coming soon that is stronger, showing that injection of Candida antigen works.
I suggest that you go to our web site (www.altoonafp.org/wartstudy) and print out the vignette that was published in the Archives of Family Medicine, the full article and the "How to" page and send them to your dermatologist. If he or she is unwilling, try your family doctor. The procedure is simple and takes no special training.
"Can you give me a phone number or address of Allermed Labs?"
See their web site at www.allermed.com. Please note that others, including the upcoming randomized controlled trial, have used "generic" Candida. Unfortunately there are problems with standardization of some Candida antigen solutions. Please note that we receive no financial support from Allermed.
Where do you get the "generic" from?
We get ours from Hollister-Stier
Laboratories LLC, Spokane, WA 99207, 800-992-1120,
It comes in 5 ml bottles, labeled for intradermal use. I believe it is
about $40 a bottle.
"I read the article on the Archives of Dermatology website on the treatment of warts with Candida Antigen injection and I have placed a small piece with a link to the article on our website. I was wondering if you have come across this form of treatment for plantar warts and if so what success rate was achieved."
Unfortunately we did not break down our statistics by site of lesion. Our impression is that the technique is somewhat less effective for plantar warts, but this would be a great subject for a randomized controlled trial.
"Why did you dilute the Candida antigen with lidocaine? Lidocaine stings on injection, saline does not. In fact the benzyl alcohol preservative in multi-dose vials of saline is a short acting anesthetic."
Good question. The simple answer is that is how we were taught to do it. (A very common reason in medicine.) Using saline or no diluent may be superior. We are looking into a randomized controlled trial to refine our methods and using saline instead of lidocaine would be an option.
What are some alternative delivery methods people are trying?
Someone from Mexico e-mailed me that they are using candida antigen undiluted. Others are diluting more, depending on the source of the candida.
Dr. Pfenninger is now using the MedaJet to administer it. He considers it a great improvement with less pain. It is like a small BB gun (8"long) and it pulverizes the fluid into the tissues. Unfortunately there is a lot of waste with priming the "gun".
"You referenced an article on masoprocol cream. Unfortunately shortly after publication of the article, masoprocol cream became unavailable. It proved much better at causing allergic contact dermatitis than it was at destroying actinic keratoses."
We referenced masoprocol as an example of immunotherapy for warts. Fortunately, Candida is much better tolerated.
"I have a blue nevis mole (seborreic keratosis... hypertrophic scar... anything skin thing) Will the Candida treatment work for me?"
The theory is that as the body attacks the injected yeast, it gets tricked into attacking the wart virus. Therefore it should not work on other skin problems, only on warts.
Does this study prove that Candida antigen works?
Our study was designed to show whether the injection was safe and well accepted. It also provides some evidence that the method works, but can't prove it. Unfortunately there are many examples of techniques that seem to work but in the end are proven not to. Another study using a Randomized Controlled method, which we hope will be published soon, will give stronger evidence that it works. We also welcome more research into the method and would be glad to offer advice on research methods based on our experience.
How do you administer the scratch test prior to the injection of yeast for wart treatment and what response are looking for?
In one study (Johnson, et al.) the authors evaluated patients to see if their bodies reacted to the candida antigen before trying the treatment. We are not convinced this is necessary or helpful. The study did not directly look at whether this was useful. When the invasiveness of the skin test is very close to the invasiveness of the procedure itself, why not just inject the wart? If it works, it works. If it doesn't, one possible explanation is lack of sensitivity to Candida.
How do you bill for injection of candida for warts?
CPT for the injection is 11900 for 1-7 and 11901 for more
Don't forget to bill for the antigen itself.
I'd like to try it in my Dermatology practice. I purchased a couple of vials straight from the manufacturer but it's a bit costly just to absorb as an overhead expense. I wonder if you know a "j code" to use for it as is done with other intralesional injections?
There is no J code and insurances often won't pay since it's only listed as a screening prep as a control for TB testing.
One way to handle the cost is to use "generic" Candida. The standardized Candin may be superior, but I use the generic and it seems to work fine. See cautions with generics mentioned in the question above ("Can you give me a phone number...").
Another way is to give the first injection in the series from a stock vial. Give the patient a prescription for a vial to fill at a local pharmacy and bring in for the second shot if needed. (They may need to call the pharmacy ahead of time for it to be ordered.) Any left over from that patients treatments can be used as a stock vial for other patients.
The patient may need to fight with insurance companies to get payment.
We would be glad to list other billing approaches here.
What do patients think?
Here is an unsolicited letter. You should never trust testimonials because they don't really give evidence that something works, but this letter captures well the experience of a patient (received 4/13).
Thank you for the web page on the Candida antigen treatment. My doctor just ordered the Hollister-Steir medication and it was ~$40 a bottle recently if you want to update http://www.altoonafp.org/comments.htm .
This treatment is much less painful than cryotherapy, and I appreciate not having to go through that again if nothing else.
I had warts on my left index finger and right middle finger as well as my toe. My doctor told me she had never seen a patient as resistant to treatment as me.
I have been through: Canthradin application (didn't seem to do much of anything although my skin did blister) Cryotherapy (extremely painful and only partially worked) Laser wart removal (Yag laser) @ maximum number of Jules (Partially worked) Squaric acid (got a contact dermatitis reaction not at the application site and my doctor discontinued treatment immediately) Aldara (The skin is too thick to do much of anything)
So far it looks like one wart is down and there are a couple more to go, which are reacting more to this treatment than any other. If it were not for this web site, I would have probably had more difficulty getting my doctor to try this treatment. This treatment is superior in terms of long term pain to all but the laser wart removal. In terms of short term pain, it is less painful than cryotherapy but more than canthradin and aldara. It is also a lot less maintenance as opposed to the blistering methods.
This has made going to my dermatologists office a much less painful experience. Hopefully this will finish off the warts and she won't have to cryotherapy me ever again. Thanks again.
This research was mentioned in Newsweek magazine (November 6, 2000, p. 86) and the Reader's Digest ("Candida Can Do").
Send your comments. Email to truhl(at)altoonafp.org.