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PubMed2002

[Indoor air and human health--sick house syndrome and multiple chemical sensitivity].

The number of complaints about the quality of indoor air has increased during the past two decades. These complaints have been frequent enough that the term "Sick House Syndrome or Sick Building Syndrome" and "Multiple Chemical Sensitivity" has been coined. Complaints are likely related to the increased use of synthetic organic materials in house, furnishing, and consumer products; and the buildings, furnishings, and consumer products; and the decreased ventilation for energy conservation in homes. Approximately thousand volatile chemicals have been identified in indoor air. The main sources of these chemicals are house materials, combustion fumes, cleaning compounds, and paints or stains. Exposure to high levels of these emissions and to others, coupled with the fact that most people spend more time indoors than outdoors, raises the possibility that the risk to human health from indoor air pollution may be potentially greater than the risk posed from outdoor pollutants. The complaints most frequently voiced with respect to Sick House Syndrome are irritations of the eye, nose, and throat; cough and hoarseness of voice; headache and mental fatigue. The syndrome of multiple chemical sensitivities is controversial subject with increasing impact on the field of indoor air quality. The controversy surrounding Multiple Chemical Sensitivity includes its definition, theories of etiology and pathogenesis, diagnostic, and life style. Multiple Chemical Sensitivity is considered the hypothesis that is a disease caused by exposure to many chemically distinct environmental substances at very low.

Air Pollution, Indoor↗
PubMed1993

Multiple chemical sensitivity: controlled scientific studies as proof of causation.

Multiple chemical sensitivity is an environmental illness that demands exacting methods of diagnosis. Proposed associations between symptoms and specific substances, whether to one substance or to multiple chemicals, need to be critically examined through adequately designed scientific studies. Appropriate methods for controlled scientific study of adverse reactions to chemicals are discussed as well as the Food and Drug Administration's (FDA's) experience with aspartame as an example of the need for controlled scientific studies to refute or confirm anecdotal evidence. Since 1986 the FDA has received reports of 265 cases of epileptic seizures temporally associated with the ingestion of aspartame. Information obtained from the complainants' medical records as well as data on consumption patterns, temporal relationships, and challenge tests do not support the claim that the occurrences of the seizures are linked to consumption of aspartame. In addition, two double-blind, placebo-controlled crossover studies failed to demonstrate an association between epileptic seizures in children and adults and the ingestion of aspartame.

Adult↗
PubMed1996

Sensitization induced by kindling and kindling-related phenomena as a model for multiple chemical sensitivity.

It has been suggested that the neurobehavioral dysfunction observed in persons presenting with symptoms of Multiple Chemical Sensitivity (MCS) syndrome involves sensitization of neural circuits. Two hypotheses for the route of exposure in induction of neural sensitization in MCS are: (a) direct chemical stimulation of olfactory processes, or (b) general systemic response to inhaled chemicals. In either case, the mechanism of action may involve chemical kindling or kindling-related phenomena. A neural sensitization mechanism based on kindling or kindling-related phenomena is attractive and has been previously demonstrated in both in vitro and in vivo animal models. Without a testable animal model for chemically mediated induction of MCS, however, any argument that MCS is mediated by kindling or kindling-related phenomena is reduced to the circular argument "the mechanism of sensitization is sensitization." The present survey provides an overview of the experimental paradigms that result in sensitization, differentiated on the basis of probable neurophysiological and neurochemical mechanisms. Neurophysiological potentiation, electrical kindling, chemical kindling and behavioral sensitization are evaluated and discussed in relationship to MCS.

Animals↗
PubMed2000

Multiple chemical sensitivity: a review of the theoretical and research literature.

Multiple chemical sensitivity (MCS) is a term used to describe a disorder characterized by a vast array of somatic, cognitive, and affective symptoms, the cause of which is attributed to exposure to extremely low levels of a variety of chemicals. Upon examination of the patient with a diagnosis of MCS, objective physical findings and consistent laboratory abnormalities are typically nonexistent. The concept of MCS has ignited considerable controversy in the fields of toxicology, immunology, allergy, psychology, and neuropsychology. Central to the controversy is the disagreement over the extent to which the manifestation of MCS is mediated by psychological factors. Because of the large number of neuropsychological symptoms associated with a diagnosis of MCS, neuropsychologists are increasingly receiving referrats for the assessment of these patients. It is important, therefore, that neuropsychologists become aware of the variety of clinical issues that must be taken into account when assessing an individual with a diagnosis of MCS. The theoretical and research literature on individuals with a diagnosis of MCS is reviewed here.

Diagnosis, Differential↗
PubMed1994

Behavioral treatment of phobic avoidance in multiple chemical sensitivity.

The clinical ecology model of environmental illness, or multiple chemical sensitivity (MCS), and particularly the theoretical assumptions, diagnostic procedures, and therapeutic recommendations promulgated by clinical ecologists are reviewed. No scientific evidence is found for their claims. MCS is conceptualized, instead, as a phobic disorder explicable in terms of the two-factor model of avoidance. Three cases of MCS are discussed in light of this model, and a comprehensive behavioral treatment package that includes biofeedback-assisted in vivo desensitization and cognitive restructuring is proposed.

Adult↗
PubMed1999

A review of multiple chemical sensitivity.

OBJECTIVE: To review critically the scientific literature on multiple chemical sensitivity (MCS). Definitions of MCS vary but, for this review, a broad definition of MCS was adopted as symptoms in more than one organ system elicited by various unrelated chemicals at very low levels of exposure. METHODS: A systematic literature search identified several hundred references from which key papers were selected. Two questions are considered, does MCS exist and what causes MCS. RESULTS AND CONCLUSIONS: Despite extensive literature on the existence of MCS, there is no unequivocal epidemiological evidence; quantitative exposure data are singularly lacking; and qualitative exposure data are, at best, patchy. There is also some evidence to suggest that MCS is sometimes used as an indiscriminate diagnosis for undiagnosed disorders. Despite this, the collated evidence suggests that MCS does exist although its prevalence generally seems to be exaggerated. Many causal mechanisms have been proposed, some suggesting a physical origin--such as MCS reflecting an immunological overload (total body load)--others favouring a psychological basis--such as MCS symptoms being evoked as part of a conditioned response to previous trauma. The available evidence seems most strongly to support a physical mechanism involving sensitisation of part of the midbrain known as the limbic system. However, it is increasingly being recognised that the psychological milieu of a person can considerably influence physical illness, either through generating a predisposition to disease or in the subsequent prognosis. Work is needed to establish the prevalence of MCS and to confirm or refute selected causal mechanisms.

Environmental Exposure↗
PubMed2004

Communication problems with environment-related health disorders as illustrated by a multiple chemical sensitivity (MCS) chatroom.

The problem of communication in treating multiple chemical sensitivity (MCS) was analysed and evaluated using the documentation of an MCS chatroom which was set up in April 2001 following the TV programme Gesundheitsmagazin Praxis (Health Magazine: Practice). Approaches were developed for solving communication problems in the chatroom. A total of 490 cases were evaluated, most of which (355) were directly or indirectly affected, 76 came from self-help groups and 10 were from 4 guest experts invited by ZDF (Zweites Deutsches Fernsehen, Second German TV channel). Of these 4 experts, 2 were environmental medicine specialists, 1 psychosomatics expert and 1 psychiatrist. Fourty-nine of the cases included a petition for chatroom participants to join a class-action law. Aside from exchanging basic information on MCS, frequent topics of discussion on the air were the assessment of physicians, clinics, self-help groups and experts. The participants also expressed their views on problems with society, politics, the economy, science and social security. Another common topic was communication in the chatroom itself, which for the most part consisted of sarcasm and insults, which were cause for conflicts in the chatroom. These communication problems led to the conclusion that a chatroom is not the best medium for discussing MCS. If a chatroom is to be used profitably to this end, it is imperative to have a well-defined organisational framework which allows the exchange of current, scientifically accurate information while keeping discussions from escalating and degenerating into arguments.

Attitude to Health↗
PubMed2003

Annoyance and performance during the experimental chemical challenge of subjects with multiple chemical sensitivity.

OBJECTIVES: This study explored the subjective reactions and psychological test performance of smell-intolerant subjects during consecutive challenges to chemicals with contrasting neurotoxic properties. METHODS: Women with symptoms compatible with multiple chemical sensitivity (N=10) and healthy referents (N=20) were individually challenged in an exposure chamber. All the subjects attended two separate 2-hour sessions of exposure to n-butyl acetate and toluene, in counterbalanced sequence. After an initial phase without exposure, air concentrations were increased in steps ranging from 3.6 to 57 mg/m3 for n-butyl acetate and from 11 to 180 mg/m3 for toluene. The response measures comprised ratings of annoyance and smell intensity and also neurobehavioral test performance. RESULTS: Both groups showed an increase in annoyance ratings and a decrease in test performance in the initial unexposed chamber phase and also in the first phase of the chemical exposure, these results indicating slight immediate expectancy or "suggestion" effects. During the six chamber phases, the ratings of mucous membrane irritation and fatigue showed a steeper increase in the group with multiple chemical sensitivity than among the referents, while the ratings of smell intensity and smell annoyance were similar in the two groups. A reduction in test performance was observed during the chamber phases, particularly in the group with multiple chemical sensitivity. No relation was found between the ratings or performance and chemical substance. CONCLUSIONS: Stronger immediate expectancy or "suggestion" reactions than normal did not characterize the group with multiple chemical sensitivity. This group showed a stronger than normal gradual build-up of fatigue, mucous membrane irritation, and reduced performance during chemical exposure. The results offer the most support to an irritative basis for multiple chemical sensitivity.

Acetates↗
PubMed1997

Pavlovian conditioning and multiple chemical sensitivity.

Pavlovian conditioning processes may contribute to some symptoms of multiple chemical sensitivity (MCS). This review summarizes the potential relevance of the literature on conditional taste and olfactory aversions, conditional sensitization, and conditional immunomodulation to understanding MCS. A conditioning-based perspective on MCS suggests novel research and treatment strategies.

Animals↗
PubMed1997

A behavior-genetic approach to multiple chemical sensitivity.

This report emphasizes the application of behavior-genetic designs to the study of sensitivity to toxic chemicals, and features of multiple chemical sensitivity and substance abuse that are polar opposites. The implications of these issues for future research are discussed in relation to twin, adoption, and sibling pair studies, as well as in relation to the degree to which genetically selected lines of rodents that have been developed in the alcoholism field are applicable to multiple chemical sensitivity.

Adoption↗
PubMedDate not supplied

Symptom profile of multiple chemical sensitivity in actual life.

OBJECTIVE: This study was conducted to confirm the definition of multiple chemical sensitivity (MCS) in actual life: that multiple symptoms are provoked in multiple organs by exposure to, and ameliorated by avoidance of, multiple chemicals at low levels. We used the Ecological Momentary Assessment to monitor everyday symptoms and the active sampling and passive sampling methods to measure environmental chemical exposure. METHODS: Eighteen patients with MCS, diagnosed according to the 1999 consensus criteria, and 12 healthy controls participated in this study. Fourteen patients and 12 controls underwent 1-week measurement of physical and psychologic symptoms and of the levels of exposure to various chemicals. Linear mixed models were used to test the hypotheses regarding the symptom profile of MCS patients. RESULTS: Some causative chemicals were detected in 11 of 14 MCS patients. Two other patients did not report any hypersensitivity episodes, whereas passive sampling showed far less exposure to chemicals than control subjects. Another subject reported episodic symptoms but was excluded from the following analyses because no possible chemical was detected. Eleven of the 17 physical symptoms and all four mood subscales examined were significantly aggravated in the interview based on "patient-initiated symptom prompts." On the other hand, there were no differences in physical symptoms or mood subscales between MCS patients and control subjects in the interview based on "random prompts." CONCLUSIONS: MCS patients do not have either somatic or psychologic symptoms under chemical-free conditions, and symptoms may be provoked only when exposed to chemicals.

Adult↗
PubMed2002

Psychophysiological functions of subjects with self-reported multiple chemical sensitivity (sMCS) during experimental solvent exposure.

The study examined the assumption of a higher sensitivity of autonomic functions of subjects with self-reported multiple chemical sensitivity (sMCS) during environmental exposure. The hypothesis was tested in a laboratory study with standardized exposures. Twelve healthy male subjects (26.4 +/- 5.4 y) with and 12 male control subjects (25.7 +/- 3.8 y) without self-reported multiple chemical sensitivity (sMCS), selected by a questionnaire, were included in the experimental study. At four different days the subjects were exposed in a random order to solvents for four hours: 10 ppm or 98 ppm ethyl benzene, 10 ppm or 189 ppm 2-butanone. Heart rate and breathing rate were analysed for two 30-minutes periods of vigilance testing at the beginning and end of exposure. In sMCS-subjects both functions were elevated at the beginning of the testing periods with a tendency to decrease over the 30-minutes periods. Control subjects revealed a relatively constant level (breathing rate) and a small increase (heart rate) during the periods. These group differences were obvious for all experimental conditions across substances and levels of exposures. Furthermore, the mean of the breathing rate of sMCS-subjects was generally higher compared to the control subjects. While the assumption of a generally altered sensitivity of autonomic functions of sMCS-subjects to environmental changes seems to be supported, no specific reactions to the type or level of the chemical exposure were found.

Adult↗
PubMed2005

Disability-induced identity changes in persons with multiple chemical sensitivity.

In this qualitative study, the authors asked respondents with multiple chemical sensitivity (MCS) in an open-ended question how having the condition affected their identities. Authors then examined responses for themes, which they discuss within the framework of critical theory. Emergent themes included loss of a stable, familiar personality, loss of self-positioning, emotional suppression to meet others' expectations, redesigning the planned life, forced growth, struggling with support, discovering the spiritual self, and identity reconsolidation. The authors compare findings with published works on adjustment to chronic illness and other delegitimized illnesses, find them to be fairly congruent, and then discuss problems regarding cultural acceptance of MCS as a condition caused by chemical exposure.

Chronic Disease↗
PubMed2006

MMPI-2 profiles of persons with multiple chemical sensitivity.

We compared the MMPI-2 profiles of adults with multiple chemical sensitivity (MCS), epileptic seizures (ES), and nonepileptic seizures (NES). Both NES and MCS are medically unexplained conditions. In previous studies profiles associated with NES were elevated on scales Hs and Hy, compared with profiles associated with ES. We predicted that profiles associated with MCS would be elevated on Hs and Hy compared with the ES group. Patients with ES and NES were diagnosed after intensive EEG monitoring using published criteria. MCS was diagnosed if there was a complaint of illness in response to multiple common odors at levels that are not noxious to most people. All the MCS cases had legal claims for injury related to chemical exposures. The results showed that on MMPI-2 scales Hs, D, and Hy the MCS group had means significantly higher than both the ES and NES groups. Fake Bad Scale scores were elevated in 11 MCS cases, and regression-based estimates of Fake Bad Scale scores showed elevation in the MCS group compared with both seizure groups. We conclude that MMPI-2 data, obtained from people seeking financial compensation, indicate that there is a strong psychological component to MCS symptoms.

Adult↗
PubMed2000

Multiple chemical sensitivity (MCS)--differential diagnosis in clinical neurotoxicology: a German perspective.

The multiple chemical sensitivity syndrome (MCS) is a new cluster of environmental symptoms which have been described and commented on for more than 15 years now in the USA. In the meantime it has also been observed in European countries. The main features of this syndrome are: multiple symptoms in multiple organ systems, precipitated by a variety of chemical substances with relapses and exacerbation under certain conditions when exposed to very low levels which do not affect the population at large. There are no lab markers or specific investigative findings. In our view, MCS is not a separate clinical syndrome but a collective term. A very small part of the patients in question may actually exhibit a somatic or psychosomatic response to low levels of a variety of chemicals in the environment. For another part, even if the MCS symptoms are induced by chemical substances in the environment, the basic hypersensitivity is a psychological stress reaction. In the third and largest group, the patients have been misdiagnosed, i.e. a somatic or psychiatric disease has been overlooked. There is a fourth group of patients in whom there is no evidence of any exposure at all but instead a belief system installed by certain physicians, the media and other groups in society. This paper tries to describe the neurological and neurotoxic aspects of MCS problems and to illustrate it with examples of an alleged outbreak of chronic neurotoxic disease caused by pyrethroids in Germany. Research strategy should establish clearly determined diagnostic criteria, agreement on the use of specific questionnaires as well as clinical and technical diagnostic procedures, prospective clinical studies of MCS patients and comparative groups as well as experimental approaches.

Adolescent↗
PubMedDate not supplied

A controlled comparison of multiple chemical sensitivities and chronic fatigue syndrome.

The present study had two objectives: 1) to determine the characteristics that differentiated subjects with multiple chemical sensitivities (MCS), chemical sensitivities (CS), and chronic fatigue syndrome (CFS); and 2) to evaluate the psychiatric and neuropsychological complaints of these groups relative to normal controls. A cross-sectional comparison was made of the following groups matched for age, sex, and education: 1) patients whose sensitivities to multiple low level chemical exposures began with a defined exposure (MCS; N = 23); 2) patients with sensitivities to multiple chemicals without a clear date of onset (CS; N = 13); 3) patients meeting CDC criteria for Chronic Fatigue Syndrome (CFS; N = 18); and 4) normal controls (N = 18). Subjects with sensitivities to chemicals (MCS and CS) reported significantly more lifestyle changes due to chemical sensitivities and significantly more chemical substances that made them ill compared with chronic fatigue and normal controls. MCS, CS, and CFS patients had significantly higher rates of current psychiatric disorders than normal controls and reported significantly more physical symptoms with no medical explanation. Seventy-four percent of MCS and 61% of CFS did not qualify for any current Axis I psychiatric diagnosis. Chemically sensitive subjects without a defined date of onset (CS) had the highest rate of Axis I psychiatric disorders (69%). On the MMPI-2, 44% of MCS, 42% of CS, 53% of CFS, and none of the controls achieved clinically significant elevations on scales associated with somatoform disorders. With the exception of one complex test of visual memory, no significant differences were noted among the groups on tests of neuropsychological function. Standardized measures of psychiatric and neuropsychological function did not differentiate subjects with sensitivities to chemicals from those with chronic fatigue. Subjects with sensitivities to chemicals and no clear date of onset had the highest rate of psychiatric morbidity. Standardized neuropsychological tests did not substantiate the cognitive impairment reported symptomatically. Cognitive deficits may become apparent under controlled exposure conditions.

Adult↗
PubMed1996

Multiple chemical sensitivity: state of the art symposium. The role of chemical allergens.

Multiple chemical sensitivity (MCS) has been defined as "an acquired disorder of recurrent symptoms, referable to multiple organ systems, occurring in response to chemically unrelated compounds at doses far below those established in the general population to cause harmful effects" [Cullen, State Art Rev. Occup. Med. 2, 655 (1987)]. The pathophysiologic basis for the MCS syndrome has not been clearly defined. However, allergic reactions to specific chemicals encountered in the environment are much better understood.

Allergens↗
PubMedDate not supplied

Psychiatric inferences from data on psychologic/psychiatric symptoms in multiple chemical sensitivities syndrome.

When abnormal psychologic/psychiatric symptom data are obtained on personality tests or psychiatric interviews administered to patients who report symptoms of Multiple Chemical Sensitivities Syndrome, investigators typically attribute these to either psychiatric traits or to psychogenic origins of illness. The primary purpose of these studies was the evaluation of the plausibility of nonpsychiatric explanations of psychologic/psychiatric symptom data. In Study 1, patients with Multiple Chemical Sensitivities Syndrome used the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) to describe which items had changed after they developed the condition. In Study 2, three diverse groups of professionals predicted which items on the MMPI-2 might change after a mentally healthy person developed the Syndrome or a condition resembling it. In Study 3, a second sample of Multiple Chemical Sensitivities Syndrome patients completed the MMPI-2 and other questionnaires by mail, which allowed the authors to ascertain whether these patients showed more or different psychopathology than was described by patients and hypothesized by professionals. Data from Study 1 patient informants indicated that developing the syndrome might result in a psychopathological MMPI-2 profile, characterized by abnormal Hypochondriasis and Hysteria scale scores. Professionals in Study 2 showed a consensus about hypothesized MMPI-2 changes following the development of the syndrome. These changes likely elevated the Hypochondriasis, Hysteria, Psychasthenia, Depression, and Schizophrenia scale scores. In Study 3, the patients taking the MMPI-2 showed elevations on the Hypochondriasis, Hysteria, Depression (women only), and Schizophrenia scales. Abnormal scores were associated closely with greater severity of illness and greater adjustment to illness. The strategy of administering psychometric tests to ill populations for the purposes of evaluating psychiatric illness or traits, and/or psychogenic origins of illness was shown to be potentially misleading.

Adult↗