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PubMed2001

The influence of health beliefs on the presentation and consultation outcome in patients with chemical sensitivities.

OBJECTIVE: This study was carried out to investigate the impact of the physical effects of a chemical exposure, health and chemical beliefs, and chemical sensitivities treatment preferences on the consultation outcome at a tertiary liaison clinic. METHOD: Eighty-five patients exposed to a range of chemicals were assessed at a joint medical toxicology and psychiatric clinic. Patient's beliefs about chemicals and health, chemical sensitivities and their treatment preferences were assessed using a 23-item questionnaire. RESULTS: Fifty-seven patients (69%) had suffered from a range of initial or delayed symptoms that were probably a clear physical consequence of the exposure (Group A), whereas 26 patients (31%) had not (Group B). There were no significant differences found between groups A and B in terms of their diagnosis and their beliefs about health, food, chemicals and chemical sensitivities treatment preferences. However, patients in Group A were significantly more likely to report moderate to severe symptoms in comparison to Group B. Consultation outcome too did not differ between the two groups. The only predictors of consultation outcome were the patients' chemical sensitivities treatment preferences. Patients who at the outset thought that their treatment should comprise of complete avoidance to chemicals, regular monitoring and the use of alternative rather than conventional medicine were significantly less likely to achieve a favourable consultation outcome. Patients' chemical sensitivities treatment preferences were related to the more general beliefs on health, food and the harmful nature of chemicals and were not related to the chemical exposure variables. CONCLUSION: These findings suggest that addressing patients' treatment preferences and the general beliefs on chemicals, food and health may enhance outcome and perhaps ought to be the target for intervention in context of such a liaison clinic.

Adult↗
PubMed2004

Environmental odor intolerance in pregnant women.

Previous findings indicating that pregnant women experience a shift in odor sensitivity and hedonics raise the question of whether these changes evoke adverse reactions to odorous and pungent environmental substances in daily activities, to a larger extent in pregnant than in nonpregnant women. Forty-four women in pregnancy weeks 21-23 and 44 nonpregnant women were therefore compared with respect to affective reactions to and behavioral disruptions by odorous/pungent daily environments by means of the questionnaire-based, 21-item Chemical Sensitivity Scale (CSS). This scale refers to neurasthenic and sensory/somatic symptoms and includes the 11 items of the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR). This latter scale refers predominantly to sensory/somatic symptoms. To investigate whether there is a general environmental hypersensitivity during pregnancy, the Noise Sensitivity Scale (NSS) was used that is analogous to the CSS (including 11 NSS items corresponding to those of the CSS-SHR; "NSS-SHR"). Results show that the two groups were similar with respect to scores on both the CSS and NSS, whereas the pregnant women had higher scores than the nonpregnant women on the CSS-SHR, but not on the "NSS-SHR". These results suggest that pregnant women to a larger extent than nonpregnant women manifest an odor intolerance that affects their daily activities, with predominantly sensory/somatic symptoms, which appears not to be due to a general environmental hypersensitivity. This behavior may have embryo- and maternal-protective functions.

Adult↗
PubMed2006

Drug intolerance in patients with idiopathic environmental intolerance syndrome.

The increasing rate of the idiopathic environmental intolerance (IEI) has been observed for the last decade. The aim of this report was to analyse the allergic component of the disease in particular relation to drug intolerance. Six patients with diagnosed IEI showed a positive skin test reaction to several commonly used antibiotics, nonsteroidal anti-inflammatory drugs, myorelaxants, verapamil, etc. In three cases, the thorough diagnosis of sensitivity to anaesthetic agents enabled to perform necessary surgical treatment, in others - facilitated the proper treatment of headaches and hypertension. Symptoms related to allergy contributed to the deterioration of IEI. Thus, a consultation of IEI patients by an allergologist seems to be of a substantial importance.

Aged↗
PubMed1997

Psychoneuroimmunology.

This paper develops hypotheses regarding the interactions among stress, immunity, and chemical sensitivities and gives an overview of the questions and hypotheses generated by a working group exploring the application of psychoneuroimmunology to chemical sensitivities. Consideration is given to prospective longitudinal studies designed to find cases among at-risk exposed populations. Relevant immune parameters to be measured longitudinally and in challenge studies for patients with MCS are discussed. Immune system changes in response to the chronic stress of having MCS and as primary responses to chemical exposure also are considered.

Environment, Controlled↗
PubMedDate not supplied

Psychological bases of symptom reporting: perceptual and emotional aspects of chemical sensitivity.

The reporting of physical symptoms is influenced to a large degree by psychological processes. Individuals are more likely to notice subtle sensations in environments lacking in stimulation than those demanding external attention. The beliefs or schemas that people hold dictate where and how they attend to their bodies as well. These normal perceptual processes help explain why people are often poor at accurately detecting internal physiological activity. Several individual differences are also related to the symptom reporting process. Females are more likely to base their symptom reports on external situational cues than are males. In addition, individuals with chronic anxiety--those high in Negative Affectivity (NA)--report more symptoms than those low in NA. Finally, individuals, who have had traumatic experiences, either in childhood or within 1-6 months prior to a major symptom reporting episode, tend to be high symptom reporters. Several recommendations are made to help researchers and clinicians distinguish between psychological or perceptual factors with presumed biological effects. One implication of this work is that MCS and allied syndromes should be viewed as both a mental and a physical health problem.

Attitude to Health↗
PubMed2004

A short Chemical Sensitivity Scale for assessment of airway sensory hyperreactivity.

OBJECTIVES: A short version of the 21-item Chemical Sensitivity Scale (CSS), called the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR), was developed and evaluated for the quantifying of self-reported affective reactions to and behavioral disruptions in daily activities by odorous/pungent substances among patients with sensory hyperreactivity (SHR) for clinical and epidemiological studies. METHODS: Twenty-two patients with clinically diagnosed SHR and 124 control participants responded to the CSS and to additional questions about chemical sensitivity for the evaluation of the CSS-SHR. RESULTS: Eleven of the 21 items of the CSS were selected, on statistical grounds, to constitute the CSS-SHR, which was found to generate approximately normal distributions, have good test-retest reliability (r(xy)=0.87), satisfying internal consistency (r(alpha)=0.76-0.84) and predictive and concurrent validity, and to be uni-dimensional. The metric properties of the CSS-SHR were, despite its few items, comparable with those of the CSS. A proposed diagnostic cut-off score for SHR demonstrated a high correct classification rate (92%) for the CSS-SHR. CONCLUSIONS: The favorable metric properties of the CSS-SHR and its sensitivity/specificity suggests that it is useful for clinical diagnosis and epidemiological study of sensory hyperreactivity in combination with other diagnostic tools.

Bronchial Hyperreactivity↗
PubMed1997

Toxicant-induced loss of tolerance--an emerging theory of disease?

This paper attempts to clarify the nature of chemical sensitivity by proposing a theory of disease that unites the disparate clinical observations associated with the condition. Sensitivity to chemicals appears to be the consequence of a two-step process: loss of tolerance in susceptible persons following exposure to various toxicants, and subsequent triggering of symptoms by extremely small quantities of previously tolerated chemicals, drugs, foods, and food and drug combinations including caffeine and alcohol. Although chemical sensitivity may be the consequence of this process, a term that may more clearly describe the observed process is toxicant-induced loss of tolerance. Features of this yet-to-be-proven mechanism or theory of disease that affect the design of human exposure studies include the stimulatory and withdrawallike nature (resembling addiction) of symptoms reported by patients and masking. Masking, which may blunt or eliminate responses to chemical challenges, appears to have several components: apposition, which is the overlapping of the effects of closely timed exposures, acclimatization or habituation, and addiction. A number of human challenge studies in this area have concluded that there is no physiological basis for chemical sensitivity. However, these studies have failed to address the role of masking. To ensure reliable and reproducible responses to challenges, future studies in which subjects are evaluated in an environmental medical unit, a hospital-based facility in which background chemical exposures are reduced to the lowest levels practicable, may be necessary. A set of postulates is offered to determine whether there is a causal relationship between low-level chemical exposures and symptoms using an environmental medical unit.

Adaptation, Physiological↗
PubMed1998

[Poison and nocebo--2 aspects of toxicology].

BACKGROUND: Erroneously it is assumed that drugs promote health exclusively by interacting with the organism through chemical or physical forces. However, placebo phenomena are omnipresent in patients who believe in the value of a treatment, be it medical or paramedical. Conversely, nocebo phenomena originate from fear of detrimental effects attributed to a putative poison. Thus, both drugs and poisons release two different messages, the one being physicochemical, the other psychosocial. The latter is fostered by the public opinion, and man is a sensitive receiver. TYPICAL NOCEBO PHENOMENA: Here some epidemiological examples of nocebo phenomena will be presented. Each society selects the matching nocebos, today mainly as chemical exposures from oecological sources such as environment, buildings, emissions and industrial products. THERAPEUTICAL APPROACH: Suspicion of nocebo should not hamper the search for chemical poisons. Anxiety and fear furnish the neurobiological and evolutionary basis of the nocebo phenomena. Hence behavioural and conversational therapy, supported by antidepressants if needed, should be tried. Unfortunately, most patients expect their psychosocial problems instead to be declared as chemical.

Adult↗
PubMed1997

[Ecopathology of the kidneys and individual sensitivity to heavy metal salts].

Investigations performed in the region contaminated with heavy metal salts revealed high prevalence of renal diseases in children. The test for blood polymorphic proteins indicated signs of genetic predisposition to renal damage. Greater occurrence in the population with econephropathy of a rare allele of transferrin C3 may be the cause of enhanced oxidative-radical processes in renal cells. Individual sensitivity of children to heavy metal salts assessed by leukocytolysis and high incidence of somatic mutations to determine T-lymphocyte microclones deficient by HGPRT may help in specification of the affections detected in the regions contaminated with heavy metal salts.

Adolescent↗
PubMed1998

Detection of patients with multiple drug allergy syndrome by elective tolerance tests.

BACKGROUND: Multiple drug allergy syndrome (MDAS) caused by antibiotics is frequently observed in allergy departments; however, risk factors for such a condition as well as the means to detect patients prone to MDAS are poorly defined. OBJECTIVE: The identification of patients prone to MDAS and the detection of risk factors for multiple antibiotic sensitivity. METHODS: Two hundred fifty-three elective oral challenges with alternative antimicrobial drugs were performed in 120 patients with histories of recent allergic reactions to antibiotics. RESULTS: Twenty-three (19%) subjects reacted to at least one antibiotic class. All reactions were mild and easily controlled by conventional therapy. Female sex, history of multiple antibiotic reactions, and reactions to nonsteroidal antinflammatory drugs were the main risk factors for reactions to alternative antibiotics. To date, no patient has reported immediate adverse reactions to drugs negative on oral challenge tests but one had urticaria/angioedema on the fifth day of full dose treatment with ofloxacin. CONCLUSIONS: Elective oral challenges with alternative antibiotics are a sensitive, specific, and safe means to detect patients with MDAS, thus sparing them more severe adverse reactions caused by full dose therapies. The recommendation to perform oral challenge tests with antibiotics just before their therapeutic use seems unnecessary and should be reconsidered.

Administration, Oral↗
PubMed1995

Medical histories and psychological profiles of middle-aged women with and without self-reported illness from environmental chemicals.

BACKGROUND: Cacosmia, which is a predictor of cognitive deficits in industrial samples, is a core symptom of several controversial syndromes. Previous studies of cacosmic populations have considered only psychiatric but not medical or family histories of identified patients. METHOD: This questionnaire survey study examined subjective characteristics of illness from chemical odors, sensitivity to chemicals, psychological and stress profiles, and medical, psychiatric, and family health histories of 28 middle-aged women with cacosmia in self-reported poor health attributed to chemicals (MCS), 17 controls with cacosmia in good health, and 20 normal controls without cacosmia in good health. RESULTS: Those with MCS rated themselves in significantly poorer overall health with higher Pennebaker symptom scores, a larger number of chemical triggers, and greater frequency of illness from chemicals than the other two groups, even after controlling for variables on which the groups differed (i.e., education, Symptom Checklist-90 [revised] somatization, obsessive-compulsiveness, depression, anxiety, phobic anxiety, psychoticism, Barsky Somatic Symptom Amplification, and Cheek-Buss shyness). Despite increased levels of affective distress, those with MCS reported the greatest intolerance for alcohol and the lowest alcohol consumption. CONCLUSION: The data suggest that women with MCS report increased disability, multiple medical diagnoses including inflammatory and gynecologic dysfunctions, and psychological distress. The data are consistent descriptively with the phenomenology of somatization disorder. However, the persisting significance of group health rating differences after controlling for psychological variables, the lack of differences in life stress ratings between those with MCS and healthy cacosmics, the later age at onset (60% after age 30 years), and the lack of excess family psychiatric histories in this sample of women with MCS suggest a potential role for an organic factor in the evolution of poor health in certain cacosmics.

Adult↗
PubMedDate not supplied

Behavioral conditioning and idiopathic environmental intolerance.

Idiopathic environmental intolerance (IEI) is a poorly understood condition that may involve disturbances in immunologic, neurologic, endocrine, behavioral, emotional, and cognitive processes. This chapter reviews theories and evidence that behavioral conditioning processes, including pharmacologic sensitization, conditioned immunomodulation, and conditioned odor and taste aversions, may play a role in the development and maintenance of IEI. It also reviews the psychophysiologic concepts of individual response specificity and situational response stereotypy as potential explanations for the individual differences observed in specific responses to environmental stimuli in patients with IEI. Finally, the treatment implications of a conditioning account of IEI are discussed as part of a more comprehensive treatment approach that incorporates other behavioral and nonbehavioral strategies.

Animals↗
PubMed2000

Carbonless copy paper and workplace safety: a review.

Carbonless copy paper (CCP), introduced in 1954, is ubiquitous in the U.S. marketplace, and because of this, many workers come into contact with it. Its safety to workers who handle large amounts of CCP has been addressed in numerous studies and reports; and the National Institute for Occupational Safety and Health (NIOSH) on two occasions has sought to determine what, if any, hazards to health CCP might pose. This review encompasses the world's literature on CCP and provides a weight-of-evidence analysis of the safety of CCP to workers in the United States. CCP is systematically studied on large groups of humans using repeat insult patch tests. Consistently, CCP in U.S. commerce since 1987 (the focus of this review) has produced neither primary skin irritation nor skin sensitization under exaggerated test conditions, demonstrating that no irritation or sensitization is expected on contact with CCP under normal conditions of manufacture and use. Years after the introduction of CCP, the first case reports appeared in 1974 suggesting an association between CCP use and various generic symptoms. Most of the earliest reports occurred in Sweden in response to negative publicity concerning the product, and to date approximately half of all published articles originate in Scandinavia. Many early reports were questionnaire/interview studies which suffered from suggestive questions, biases, and lack of control for confounding factors. Few studies included a comparison group (i.e., people not exposed to CCP) making it impossible to estimate risk values. Later, sick building syndrome studies, accounting for many relevant factors in the office environment, found no association between CCP exposure and symptoms unexplained by other factors. Animal studies showed that compounds used to manufacture CCP do not have acute toxic potential and are not genotoxic. Finally, very few published complaints have come from the manufacturing sector where the closest and most voluminous contact occurs. A few reports of symptoms have emanated from printing facilities (with a multiplicity of other chemical exposures), but generally most symptoms are reported in the office setting where the exposure is lower than in the manufacturing or printing settings. Based on the weight of the evidence, CCP currently in commerce in the United States is shown not to be the causative agent for the reported general symptoms sometimes associated with it over the years. Recently NIOSH evaluated the literature as to possible hazards to health posed by CCP, and NIOSH is anticipated to conclude that CCP is not a hazard to workers and has only a small possibility of producing mild and transient skin irritation.

Air Pollution, Indoor↗
PubMedDate not supplied

pS2--a new cytosolic protein recognized by monoclonal antibodies as a marker of hormone sensitivity in breast cancer.

Using a new immunoradiometric assay (ELSA pS2 Cis-France), a total of 200 cytosols obtained from primary breast tumors were examined for pS2 content, which is an estrogen-regulated protein actually studied as a marker of hormone sensitivity and favorable prognostic factor in breast cancer. In our patient group, the median pS2 value corresponding to 5.3 ng/mg of cytosolic proteins was used as cutoff. pS2 content was not related to menopause status, tumor size, or nodal involvement, whereas a positive correlation was found between pS2 and ER/PgR status. Moreover, the association of pS2 with steroid receptors seems to identify subgroups of patients better than ER/PgR alone.

Adult↗
PubMed2001

Organochlorine pesticides and chlorinated hydrocarbon solvents in the blood of chemically sensitive patients [corrected]. A statistical comparison with therapeutic medication and natural hormones.

The blood levels of organochlorine pesticides and chlorinated hydrocarbon solvents were measured in 200 and 114 chemically sensitive patients respectively, and compared with blood concentrations of standard medication (non- chlorinated substances. Clonidine, Haloperidol) of comparable toxicity after therapeutically effective dosage, and with reference levels of highly potent chemicals in the blood such as hormones. It was shown that the average blood levels of the most toxic environmental pollutants are comparable with the therapeutic steady state average blood levels of medications which have similar toxicities in the animal model. In addition the toxicity levels of xenoestrogens are at least an order of magnitude higher than normal plasma estrogen or progesterone levels. These findings suggest the possibility of additive or synergistic effects of these chlorinated compounds and the aforementioned medications. Also, these findings suggest the possibility of hormone deregulation from exposure to the aforementioned toxic chlorinated compounds.

Adolescent↗
PubMedDate not supplied

Patient statement: chemical sensitivity--one victim's perspective.

Not a day goes by that I don't miss my old life and the old me. To illustrate how my life has changed, I have two brief stories. In 1982, I developed a lending procedure in conjunction with Banker's Life Insurance Company that enabled commercial real estate developers to secure permanent financing for property that had not yet been developed--in essence using a permanent loan in place of a construction loan. It fixed the interest rate, at a time when new construction rates were bankrupting many projects and it allowed the developer to invest the excess funds to offset interest expenses. I received national recognition for this loan. In 1989, the police found me wandering around in 15 inches of snow, in below zero weather with no shoes or coat. The officer took me to the hospital because I was obviously disoriented. I didn't even know my name or where I lived. These stories show the disparity between my life as a successful, independent business woman and my life as someone who is chemically disabled.

Female↗
PubMed2001

Allergenic (sensitization, skin and eye irritation) effects of freshwater cyanobacteria--experimental evidence.

Many studies have been published on the human health effects of cyanobacterial toxicity. As a public health concern, we have to mention that the development of contact dermatitis, asthmalike symptoms, and symptoms resembling hay fever during bathing in cyanobacterial blooms have been also described. Microcystis aeruginosa, Anabaena flos-aquae, Aphanizomenon flos-aquae, and Cylindrospermopsis raciborskii are the most common species found in Hungarian freshwaters. A sensitization test on albino guinea pigs, and intradermal reactivity, and occular irritation test on albino rabbits were carried out with freeze-dried algal suspension in physiological salt solution. The sensitivity of guinea pigs is similar to that of humans. Microcystis, Anabaena, Cylindrospermopsis, and Aphanizomenon bloom and strain samples were examined in sensitization and irritation tests and no correlation was found between the toxin content and the allergenic character. The most toxic one (Microcystis aeruginosa) was not the most allergenic sample, but the nontoxic Aphanizomenon was the most allergenic one. The axenic strains were not allergenic at all. The pure microcystin LR was only slightly allergenic even in high concentration (1.5 mg/ml). Water and lipid soluble fractions were obtained by water and chloroform extraction of lyophilized algal suspensions. The chloroform fraction was bound on C18 cartridges and eluted by methanol in nine fractions. Only one of the lipid soluble fractions was skin irritative whereas the strongest irritative effect was shown by the water soluble fraction.

Alkaloids↗
PubMed1997

Apparent poisoning by wood preservatives: an attributional syndrome.

Recent reports have pointed to an increased number of patients presenting with multisystem symptoms which they attribute to chemical exposures or to heightened chemical sensitivity. Twenty patients exposed to wood preservative products, who attended a joint toxicology and psychiatric clinic, were reviewed by a retrospective case note analysis. Thirteen patients attributed their symptoms to the wood preservative soon after the exposure, and seven patients developed the attribution only at a later date. Reported symptoms referred to all body systems, but there were few physical signs. Clinical findings suggest that the acute symptoms were consistent with the expected toxic effects, but the chronic symptoms could not be explained physically. Patient's beliefs about chemical poisoning could be understood as arising in the context of an attributional process, representing a sociopsychosomatic syndrome precipitated by wood preservative exposure. Patient management included a discussion of findings from assessments, published information, along with counseling where appropriate. Follow-up information from their general practitioners indicated a possible improvement in 50% of patients.

Adult↗