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PubMed1996

Sensitive skin and stratum corneum reactivity to household cleaning products.

Products intended for individuals with sensitive skin are being increasingly developed by formulators of household cleaning products. However, there is currently no consensus about the definition and recognition of the biological basis of sensitive skin. We sought to determine the relation between the nature of environmental threat perceived as aggressive by panelists, and the stratum corneum reactivity to household cleaning products as measured by the corneosurfametry test. Results indicate substantial differences in irritancy potential between proprietary products. Corneosurfametry data show significant differences in stratum corneum reactivity between, on the one hand, individuals with either non-sensitive skin or skin sensitive to climate/fabrics, and, on the other hand, individuals with detergent-sensitive skin. It is concluded that sensitive skin is not one single condition. Sound information in rating detergent-sensitive skin may be gained by corneosurfametry.

Adult↗
PubMedDate not supplied

Neuropsychiatric and somatic characteristics of young adults with and without self-reported chemical odor intolerance and chemical sensitivity.

The psychological, neuropsychiatric, and somatic characteristics of young adults who have different degrees of cacosmia (i.e., feeling "ill" from the odor of xenobiotic chemicals) and who have self-described "chemical sensitivity" were examined. A total of 800 college students completed the following: a self-rating scale for frequency of odor intolerance for 10 common substances, Simon Environmental Illness Symptom Survey, the SCL-90-R, Barsky Amplification Scale, Pearlin-Schooler Mastery Scale, Cheek-Buss and Kagan Shyness scales, Marlowe-Crowne Social Desirability Scale, and a health-symptom and physician-diagnosed checklist. Two pairs of groups were compared: (1) subjects in the top 16% (i.e., cacosmics) and bottom 15% (noncacosmics) of the sample with respect to odor intolerance scale scores; and (2) subjects from the entire sample who did (28%) or did not (72%) consider themselves to be "especially sensitive to certain chemicals.¿ Cacosmics and the chemically sensitive subjects scored significantly higher on measures of psychological distress and amplification of somatic symptoms, but there was little evidence of lifestyle change, as assessed by the Simon Survey. Compared with their respective comparison groups, cacosmic and chemically sensitive groups had significantly higher incidences of illnesses associated with chemicals, alcohol intake, opiate drug use, and caffeine use, even after controlling for the psychological measures and histories of atopic allergy. Subjects with and without neuropsychiatric symptoms were differentiated with respect to chemical odor intolerance, but subjects with and without atopic allergies and possible autoimmune diseases were differentiated with respect to chemical sensitivity. Females were more cacosmic than males. Cacosmia is defined by a population subset, with or without occupational xenobiotic exposures or disability, that has distress and symptom amplification and neuropsychiatric and somatic symptoms, none of which are explained fully by psychological measures. Prospective clinical studies are possible with such individuals. The data are also consistent with a time-dependent sensitization model for illness from low-level chemical exposures.

Adolescent↗
PubMed1996

A case of drug eruption due to simultaneous sensitization with three different kinds of drugs.

We reported a case of drug eruption induced by combined treatment with three different kinds of drugs, amoxapine, mexiletine hydrochloride and cefaclor. A 63-year-old Japanese woman suffering from 11 years of standing reflex sympathetic dystrophy developed multiple erythematous papules on her trunk and extremities after taking 14 kinds of drugs. The provocation challenge produced positive reactions to amoxapine, mexiletine hydrochloride, and cefaclor, but was negative to the other drugs. We discussed the mechanism of simultaneous sensitization to three different kinds of drugs in our case.

Amoxapine↗
PubMed2000

Quality of life and capsaicin sensitivity in patients with sensory airway hyperreactivity.

BACKGROUND: A group of patients with asthma-like symptoms and sensitivity to chemical irritants has shown an increased cough sensitivity to inhaled capsaicin compared to patients with asthma and to healthy controls. The condition is called sensory hyperreactivity (SHR), and the patients often feel that they are socially handicapped because of the risk of exposure to chemical irritants in daily life. METHODS: Twenty-six patients with asthma-like symptoms after exposure to nonspecific irritating stimuli, but without IgE-mediated allergy or demonstrable bronchial obstruction, were selected for a study of the response to a capsaicin test and measurement of quality of life by a general health profile (the Nottingham Health Profile [NHP]). We also investigated whether there was a correlation between quality of life and sensitivity to capsaicin. RESULTS: The patients demonstrated a dose-dependent response to the capsaicin provocation, with coughing and respiratory and other symptoms, that significantly differed from 12 healthy controls. The health profile showed that patients with SHR had a significantly reduced quality of life compared to reference values, and there was a significant correlation between the health profile and sensitivity to capsaicin. CONCLUSIONS: Patients with asthma-like symptoms verified by the capsaicin inhalation test for sensory hyperreactivity have a poor quality of life. The correlation between quality of life and sensitivity to capsaicin objectively demonstrates the validity of this general health profile study.

Administration, Inhalation↗
PubMed2000

Reproducibility of the University of Toronto self-administered questionnaire used to assess environmental sensitivity.

Environmental sensitivity patients report symptoms provoked by low-level exposure to a wide range of substances. Features of published case definitions include nature of onset, chronicity, symptom provocation by multiple substances, symptom provocation by an escalating number of exposures, involvement of multiple body systems including the nervous system, provocation by unrelated substances, and addictive behaviors. This study assessed the reproducibility of a Canadian self-administered questionnaire, the University of Toronto Health Survey, designed to determine the prevalence of the features described in these case definitions. A total of 191 eligible respondents aged 16-70 years who attended several types of medical practices in 1994 were invited to complete a second questionnaire 5-7 months after the first; 134 (70.2%) complied. Total agreement on whether patients satisfied each of seven case definitions ranged from 80% to 90%. After adjustment for chance, major agreement was observed for three of the seven case definitions (kappa = 0.69, 0.68, and 0.78). The survey achieved good reproducibility regarding self-report of symptoms described in published case definitions of environmental sensitivity.

Adolescent↗
PubMed2003

Idiopathic environmental intolerance: Part 2: A causation analysis applying Bradford Hill's criteria to the psychogenic theory.

Toxicogenic and psychogenic theories have been proposed to explain idiopathic environmental intolerance (IEI). Part 2 of this article is an evidence-based causality analysis of the psychogenic theory using an extended version of Bradford Hill's criteria. The psychogenic theory meets all of the criteria directly or indirectly and is characterised by a progressive research programme including double-blind, placebo-controlled provocation challenge studies. We conclude that IEI is a belief characterised by an overvalued idea of toxic attribution of symptoms and disability, fulfilling criteria for a somatoform disorder and a functional somatic syndrome. A neurobiological diathesis similar to anxiety, specifically panic disorder, is a neurobiologically plausible mechanism to explain triggered reactions to ambient doses of environmental agents, real or perceived. In addition, there is a cognitively mediated fear response mechanism characterised by vigilance for perceived exposures and bodily sensations that are subsequently amplified in the process of learned sensitivity. Implications for the assessment and treatment of patients are presented.

Animals↗
PubMed1998

Perioperative care of environmentally sensitive patients.

In today's complex environment, with an increasing number of chemicals and environmental contamination, some individuals have developed sensitivities to their surroundings. Surgical intervention for environmentally sensitive patients provides an opportunity to reach beyond the boundaries of the OR. These patients require highly individualized perioperative nursing assessments and care planning on a multidisciplinary level. Presbyterian Hospital of Dallas has developed a protocol to initiate collaborative planning for these patients and has had the opportunity to successfully care for these patients.

Environment, Controlled↗
PubMed1994

Neurasthenic fatigue, chemical sensitivity and GABAa receptor toxins.

Following observation of fatigue syndromes in people who have been occupationally exposed to pesticides and insecticides which exert their toxicity through the GABAa receptor, we have formulated the hypothesis that fatigue syndromes in general may be secondary to altered sensitivity of the GABAa receptor. We discuss the possible involvement of organochlorine compounds which are widespread in the environment. Organophosphate compounds may have similar toxic effects through damaged cholinergic input to the dentate gyrus of the hippocampus where cholinergic and GABAergic transmission are closely linked.

Adult↗
PubMedDate not supplied

White paper: Chemical sensitivity: history and phenomenology.

Nearly everyone has heard something about chemical sensitivity, either from personal experience with someone who has the condition or from the media. The television series Northern Exposure recently featured a chemically sensitive attorney who lived in a geodesic dome in Alaska, and L.A. Law depicted the struggles of a Persian Gulf veteran with chemical sensitivities who lost his case against the Veterans Administration, but may appeal later in the season. Television news programs and the printed media have showcased patients living spartan existences in remote areas or in aluminum foil-lined rooms. Our views of the illness no doubt are colored by our own personal experiences of it. While some discount or make jokes about chemical sensitivity or these patients, physicians who have seen a number of them are discovering that many appear to be credible individuals with prior good work records who say they became ill following an identifiable exposure to chemicals.

Government Agencies↗
PubMed2002

Short-term exposure to aged and diluted sidestream cigarette smoke enhances ozone-induced lung injury in B6C3F1 mice.

To determine the effects of aged and diluted sidestream cigarette smoke (ADSS) as a surrogate of environmental tobacco smoke (ETS) on ozone-induced lung injury, male B6C3F1 mice were exposed to (1) filtered air (FA), (2) ADSS, (3) ozone, or (4) ADSS followed by ozone (ADSS/ozone). Exposure to ADSS at 30 mg/m3 of total suspended particulates (TSP) for 6 h/day for 3 days, followed by exposure to ozone at 0.5 ppm for 24 h was associated with a significant increase in the number of cells recovered by bronchoalveolar lavage (BAL) compared with exposure to ADSS alone or ozone alone. The proportion of neutrophils and lymphocytes, as well as total protein level in BAL, was also significantly elevated following ADSS/ozone exposure, when compared with all other groups. Within the centriacinar regions of the lungs, the percentage of proliferating cells identified by bromodeoxyuridine (BrdU) labeling was unchanged from control, following exposure to ADSS alone, but was significantly elevated following exposure to ozone (280% of control) and further augmented in a statistically significant manner in mice exposed to ADSS/ozone (402% of control). Following exposure to ozone or ADSS/ozone, the ability of alveolar macrophages (AM) to release interleukin (IL)-6 under lipopolysaccharide (LPS) stimulation was significantly decreased, while exposure to ADSS or ADSS/ozone caused a significantly increased release of tumor necrosis factor alpha from AM under LPS stimulation. We conclude that ADSS exposure enhances the sensitivity of animals to ozone-induced lung injury.

Air Pollutants↗
PubMed2005

Changes in levels of nerve growth factor in nasal secretions after capsaicin inhalation in patients with airway symptoms from scents and chemicals.

Patients complaining of upper and lower airway symptoms caused by scents and chemicals have previously been shown to have increased cough sensitivity to inhaled capsaicin, but the precise mechanisms behind this reaction are unknown. Hypothesizing that a neurochemical alteration related to sensory hyperreactivity (SHR) of the airway mucosa occurs, we measured levels of nerve growth factor (NGF) in nasal lavage fluid (NAL) before and after capsaicin inhalation provocations and related the capsaicin cough sensitivity to the NGF levels. Thirteen patients with SHR and 14 control subjects were provoked with capsaicin inhalation at three different doses. We measured NGF in NAL before and after provocation and recorded cough and capsaicin-induced symptoms. All subjects demonstrated a dose-dependent cough response to capsaicin inhalation, with a more pronounced effect in patients than in controls. Basal levels of NGF were significantly lower in the patient group than in the control subjects (p < 0.01). After capsaicin provocation, the patients showed a significant increase in NGF (p < 0.01), which was related to capsaicin cough sensitivity. The findings demonstrate that, in patients with airway symptoms induced by scents and chemicals, SHR is real and measurable, demonstrating a pathophysiology in the airways of these patients compared to healthy subjects.

Administration, Inhalation↗
PubMedDate not supplied

Use of neuropsychological testing in idiopathic environmental testing.

Individuals with idiopathic environmental intolerance (IEI) report fatigue, headaches, weakness, malaise, decreased attention/concentration, memory loss, disorientation, confusion, and psychological disturbances. These neurobehavioral symptoms may be a sign of possible alterations in the central nervous system (CNS). The evaluation of neurobehavioral functioning using standardized testing provides a surrogate measure of integrity of the CNS. However, the interpretation of neuropsychological test results must be made cautiously since this technique is extremely sensitive, but not specific. Abnormal test results could be due to a neurological disorder, a medical disorder, or a neuropsychiatric disorder. Therefore, when evaluating patients who present with symptoms of IEI, abnormal neurobehavioral results should not be attributed routinely to environmental chemical exposure until other causes are systematically ruled out.

Brain Diseases↗
PubMed2002

Reported chemical sensitivities in a health survey of United Kingdom military personnel.

OBJECTIVE: To report the prevalence of self reported chemical sensitivities in three cohorts of United Kingdom service personnel. METHOD: Cross sectional postal survey of three cohorts of United Kingdom military personnel comprising Gulf veterans (n=3531), those who had served in Bosnia (n=2050), and those serving during the Gulf war but not deployed there (Era cohort, n=2614). RESULTS: Sensitivity to at least one everyday chemical was reported by a considerable proportion of all three cohorts, and particularly by veterans of the Gulf war (Era: 14%; Bosnia: 13%; Gulf: 28%). CONCLUSION: Reported chemical sensitivities were common in all three military cohorts. Our understanding of chemical sensitivities remains limited and objective evidence for a causal link between low level exposures to chemicals and reported symptoms is lacking. Given their frequency in the population, further work in this area is necessary.

Bosnia and Herzegovina↗
PubMed2000

Carbon dioxide inhalation challenges in idiopathic environmental intolerance.

BACKGROUND: Idiopathic environmental intolerance (IEI) is associated with unexplained physical symptoms, which overlap considerably with those of panic disorder (PD). OBJECTIVE: This study tested the hypothesis that patients with symptoms to suggest IEI exhibit features of PD in response to nonnoxious environmental stimuli. METHODS: A single-blind, case-control 35% carbon dioxide inhalation challenge was conducted at a university-based occupational health unit with the use of standardized psychologic questionnaires involving 36 patients with IEI and 37 healthy control subjects. The main outcome measures included panic attack symptoms and scores on the Anxiety Sensitivity Index, a measure of panic-related anxiety. RESULTS: Patients with IEI scored significantly higher on the Anxiety Sensitivity Index than control subjects did (P <.05). Significantly more patients with IEI (71%) than control subjects (26%) fulfilled panic attack criteria after carbon dioxide (P <.001). Physiologic responses to the challenge were not significantly different between groups. CONCLUSIONS: Results suggest that, similar to patients with PD, patients with IEI display high anxiety sensitivity and in response to carbon dioxide inhalation tend to experience heightened anxiety and panic attacks.

Administration, Inhalation↗
PubMedDate not supplied

Chemosensory function and response in idiopathic environmental intolerance.

This chapter reviews the current literature on the possible role of olfactory and trigeminal chemosensory function in idiopathic environmental intolerances (IEI). Two general points emerge from the review. First, studies of chemosensory function in IEI patients indicate that, despite their self-reported "heightened sensitivity" and enhanced responsivity to environmental odors, when compared to healthy controls they generally are found to be equally or even less sensitive to odors as measured by objective psychophysical and electrophysiological measures of olfactory function. These studies point towards alterations in the cognitive processing of olfactory information as the major characteristic of IEI. Second, studies of the role of sensitivity and bias in olfactory and trigeminal chemosensory functioning indicate that nonsensory factors (e.g., attention, bias, personality) can dramatically alter the self-reported impact of exposure to volatile chemicals. Together, these general points suggest a perspective on IEI that views many symptoms of the disorder to primarily reflect the influence of nonsensory, cognitive processes on responses to environmental odors.

Chemoreceptor Cells↗
PubMed2004

Relationship of airway symptoms from chemicals to capsaicin cough sensitivity in atopic subjects.

BACKGROUND: It is well known that some patients with allergy complain of airway symptoms from chemicals (ASCs) and strong odours. However, the importance of such information for the treatment of allergic disease is not known. Such symptoms in non-allergic patients have previously been shown to be related to increased sensory nerve reactivity, which is expressed as increased cough sensitivity to inhaled capsaicin. OBJECTIVE: The aim of this study was to examine ASC in atopic patients and relate it to cough reaction to capsaicin inhalation. MATERIALS AND METHODS: Fifty-seven consecutively chosen, skin prick-positive patients with symptoms of the upper and/or lower airways completed a questionnaire concerning ASC. The patients were then divided into two groups, those with and those without such symptoms. Both groups were provoked with inhaled capsaicin in three increments and compared with 73 healthy control subjects. RESULTS: Out of 57 atopic patients, 34 reported ASC agents and 23 did not. The patients with ASC were older (P<0.01) and coughed significantly more on capsaicin provocation (P<0.001), but did not differ from them with respect to the allergic disease or its treatment or to smoking habits. Patients with atopy but without ASC did not differ from healthy controls with regard to sensitivity to capsaicin inhalation. The scored degree of ASC was directly related to the number of coughs during the capsaicin provocation. CONCLUSION: ASC in atopic patients are related to increased airway sensory nerve reactivity. There is still no explanation for this in certain patients with atopy, but age may be a confounding factor.

Adolescent↗
PubMed1997

Chemical sensitivity: the scientific literature.

This article provides an overview of the scientific literature in which chemically sensitive patients have been directly evaluated. For that purpose, consideration of various case definitions is offered along with summaries of subjects' demographic profiles, exposure characteristics, and symptom profiles across studies. Controlled investigations of chemically sensitive subjects without other organic illnesses are reviewed. To date, psychiatric, personality, cognitive/neurologic, immunologic, and olfactory studies have been conducted comparing subjects with primary chemical sensitivity to various control groups. Thus far, the most consistent finding is that chemically sensitive patients have a higher rate of psychiatric disorders across studies and relative to diverse comparison groups. However, since these studies are cross-sectional, causality cannot be implied. Demonstrating the role of low-level chemical exposure in a controlled environment has yet to be undertaken with this patient group and is crucial to the understanding of this phenomenon.

Environmental Health↗
PubMed1995

Failure to assess psychopathology in patients presenting with chemical sensitivities.

Mediating processes can be inferred from self-report data only if it can be assumed that the patient has a valid capacity for introspection. That assumption is invalid when beliefs can be shown to influence sensory perception and symptom reports. Another serious limitation of self-reporting is that the individual has only a limited awareness of his or her psychological state. Also, we cannot ignore the observations that come from the psychodynamic tradition, that unconscious or subconscious ideas also can affect and distort self-reporting. The lack of validity of self-reports is summarized by Brewin: "[T]he value of self-reports would appear to be more in their relation to intentional future actions than in any insight they might provide into complex feeling states or into the contingencies governing past behavior." A more objective procedure for obtaining information about EI/MCS patients' beliefs is clearly needed before their symptom reports can be taken at face value.

Female↗