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PubMedDate not supplied

Multiple chemical sensitivity: a 1999 consensus.

Consensus criteria for the definition of multiple chemical sensitivity (MCS) were first identified in a 1989 multidisciplinary survey of 89 clinicians and researchers with extensive experience in, but widely differing views of, MCS. A decade later, their top 5 consensus criteria (i.e., defining MCS as [1] a chronic condition [2] with symptoms that recur reproducibly [3] in response to low levels of exposure [4] to multiple unrelated chemicals and [5] improve or resolve when incitants are removed) are still unrefuted in published literature. Along with a 6th criterion that we now propose adding (i.e., requiring that symptoms occur in multiple organ systems), these criteria are all commonly encompassed by research definitions of MCS. Nonetheless, their standardized use in clinical settings is still lacking, long overdue, and greatly needed--especially in light of government studies in the United States, United Kingdom, and Canada that revealed 2-4 times as many cases of chemical sensitivity among Gulf War veterans than undeployed controls. In addition, state health department surveys of civilians in New Mexico and California showed that 2-6%, respectively, already had been diagnosed with MCS and that 16% of the civilians reported an "unusual sensitivity" to common everyday chemicals. Given this high prevalence, as well as the 1994 consensus of the American Lung Association, American Medical Association, U.S. Environmental Protection Agency, and the U.S. Consumer Product Safety Commission that "complaints [of MCS] should not be dismissed as psychogenic, and a thorough workup is essential," we recommend that MCS be formally diagnosed--in addition to any other disorders that may be present--in all cases in which the 6 aforementioned consensus criteria are met and no single other organic disorder (e.g., mastocytosis) can account for all the signs and symptoms associated with chemical exposure. The millions of civilians and tens of thousands of Gulf War veterans who suffer from chemical sensitivity should not be kept waiting any longer for a standardized diagnosis while medical research continues to investigate the etiology of their signs and symptoms.

California↗
PubMedDate not supplied

Psychogenic origins of multiple chemical sensitivities syndrome: a critical review of the research literature.

The purpose of this review was to critically evaluate research on the psychogenic origins of multiple chemical sensitivities (MCS) syndrome. Using as keywords environmental illness, multiple chemical sensitivities, and clinical ecology, two databases--PsychLit and Medline--were searched by computer; reference lists of all articles located were also searched manually. Ten articles meeting three criteria were selected for review. Five sample selection problems, seven measurement problems, and three study design problems were common in all but one of the articles reviewed. Current studies investigating psychogenic hypotheses of MCS syndrome are methodologically problematic and their conclusions questionable. Studies of psychiatric profiles observed in MCS syndrome need to be designed to differentiate between competing psychogenic and biogenic hypotheses.

Databases, Bibliographic↗
PubMed2005

Multiple chemical sensitivity syndrome (MCS)--suggestions for an extension of the U.S. MCS-case definition.

PURPOSE: To validate and extend the US case definition for the Multiple Chemical Sensitivity Syndrome (MCS) from 1999 by a systematic literature-review. DATA SOURCE: MEDLINE-research from 1997 to August 2003, research in the Cochrane-Library in August 2003, earlier reviews since 1997. STUDY SELECTION: Headings and abstracts were screened by one reviewer. All references dealing with multiple chemical sensitivities (MCS) which covered topics of interest such as symptom-profiles, differential diagnostic procedures, etc. were included in the analysis. DATA EXTRACTION AND SYNTHESIS: Topic-specific data extraction and synthesis was done by one reviewer. Data interpretation was discussed by all other authors. RESULTS: Out of 1429 references 36 publications proved to be suitable for the review. The results can be summarized as follows: exposure-related symptoms associated with self-reported multiple chemical sensitivities can be divided into non-specific complaints of the central nervous system--CNS (main characteristics) and functional disturbances in other organ systems (optional complaints). There is a significant overlap of MCS, CFS and fibromyalgie. At present no standards for a diagnostic procedure based on the criteria outlined above are existing CONCLUSIONS: MCS should only be diagnosed in patients who are mainly suffering from exposure-related non-specific complaints of the Central nervous system. The suggested diagnostic procedure follows the guidelines for CFS which are extended by diagnostic clarification of functional disturbances in other organ systems.

Data Collection↗
PubMed1993

Multiple chemical sensitivities: a symposium on the state of the science.

Multiple chemical sensitivities (MCS) defies diagnostic categorization because of its pansystemic manifestations, its lack of consistent symptomatology, and its absence of specific, measurable endpoints, either physical stigmata or laboratory findings. Controlled studies have been few and difficult to perform. Moreover, the phenomenon resists systematic investigation for two reasons. First, it has coalesced into a movement championed by zealous proponents and organized adherents. Second, it has gained support in the courts, the legislatures, and the regulatory agencies which have provided special protection and monetary awards to this phenomenon before science and medicine have defined it as a medical disorder. One hotly contested issue in the MCS debate is the relative role of organic versus psychological contribution to the symptoms of MCS patients. This is a critical issue most importantly because it determines approaches to treatment, secondarily because it affects regulatory action, disability determination, and compensability. The interest of the ISRTP in this phenomenon derives from the significant regulatory impact of this diagnosis on OSHA standards, EPA regulations, and FDA standards. The symposium was convened to explore the quality of the science underlying MCS with respect to diagnosis, and, particularly, to cause. The general objective of the symposium was to discuss the state of the science regarding MCS and its implications in regulatory toxicology and public health. The panel of speakers represented a variety of disciplines including toxicology, immunology, occupational medicine, psychiatry, psychology, epidemiology, and public health. The symposium was attended by a diverse audience representing the medical, scientific, business, legal, and regulatory communities. The majority of speakers critically questioned the characterization of MCS as a clinical entity, in light of historical comparisons to earlier false diagnoses, toxicological implausibility, and clinical inconsistencies.

Environmental Pollutants↗
PubMed1994

Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities.

BACKGROUND: Chronic fatigue syndrome (CFS), fibromyalgia (FM), and multiple chemical sensitivities (MCS) are conditions associated with fatigue and a variety of other symptoms that appear to share many clinical and demographic features. Our objectives were to describe the similarities and differences among patients with CFS, FM, and MCS. Additional objectives were to determine how frequently patients with MCS and FM met the criteria for CFS and if they differed in their health locus of control. METHODS: Demographic, clinical, and psychosocial measures were prospectively collected in 90 patients, 30 each with CFS, FM, and MCS. Patients were recruited from a university-based referral clinic devoted to the evaluation and treatment of chronic fatigue and three private practices. Variables included demographic features, symptoms characteristic of each condition, psychological complaints, a measure of health locus of control, and information on health care use. RESULTS: Overall, the three patient groups were remarkably similar in demographic characteristics and the presence of specific symptoms. Patients with CFS and FM frequently reported symptoms compatible with MCS. Likewise, 70% of patients with FM and 30% of those with MCS met the criteria for CFS. Health care use was substantial among patients with CFS, FM, and MCS, with an average of 22.1, 39.7, and 23.3 visits, respectively, to a medical provider during the prior year. Health locus of control did not differ among the three populations. CONCLUSIONS: In general, demographic and clinical factors and health locus of control do not clearly distinguish patients with CFS, FM, and MCS. Symptoms typical of each disorder are prevalent in the other two conditions.

Adult↗
PubMed2001

We are the canaries: self-care in multiple chemical sensitivity sufferers.

This ethnographic study investigates the experiences of living with multiple chemical sensitivity (MCS), a condition increasing in prevalence but medically contested, on which very little qualitative research has been done. Participant observation included two treatment centers, a support organization, an Internet chat room, and conversations with MCS sufferers, activists, and educators. Semistructured interviews were conducted with 33 people with MCS, recruited to reflect a broad demographic range and severity of illness variation. This article describes several methodological issues associated with doing "peer research" and then describes self-care for symptom management. With no known cure, MCS sufferers manage their symptoms through three main avenues: prevention/avoidance, detoxification, and emotional self-care. Implications include education of health care providers and a warning from those who have MCS: "We are the canaries in the coal mine; what has happened to us will happen to many others unless we clean up our environment."

Adult↗
PubMed2005

[Multiple chemical sensitivity (MCS) -- a case series].

BACKGROUND AND OBJECTIVE: The phenomenon of Multiple Chemical Sensitivity which generally cannot be explained organically is frequently associated with psychic impairment. This case series deals with the question if in addition to a standardized interview a routine psychiatric-psychosomatic examination alters the classification if a patient suffers from symptoms compatible with MCS or not. METHODS: Nine consecutive outpatients (m = 3, f = 6, mean age 44 yrs) of the environmental medicine centre were investigated. Somatic diseases were evaluated by standard medical procedures and emotional disturbances were assessed by the Munich Composite International Diagnostic Interview (M-CIDI) and a psychiatric-psychosomatic examination. RESULTS: In all but one patients emotional disturbances (F-codes of the ICD-10) were diagnosed by the M-CIDI and the psychiatric-psychosomatic examination. The diagnoses of the M-CIDI and the psychiatric-psychosomatic examination often did not match. MCS was ruled out in seven patients. CONCLUSIONS: According to the criteria defined by Cullen (5), emotional disturbances must be ruled out before MCS is diagnosed. Therefore, an examination by a specialist in psychiatry or psychosomatics is mandatory because evaluation solely based on the M-CIDI is insufficient. Performing a routine psychiatric-psychosomatic examination, MCS could be ruled out much more often than previously.

Adult↗
PubMed1999

[Multiple chemical sensitivities: case definition, etiology and relations to allergy, poisoning, psychogenic illness etc].

Multiple Chemical Sensitivities (MCS) have been defined as an acquired disorder characterized by recurrent symptoms, referable to multiple organ systems, occurring in response to demonstrable exposure to many chemically unrelated compounds at doses far below those established in the general population to cause harmful effects; no single widely accepted test of physiologic function can be shown to correlate with symptoms (Cullen MR, 1987). The etiology of MCS is hypothesized as a toxicant-induced loss of tolerance to multiple chemicals with subsequent manifestation of multiple-organ symptoms triggered by low-level exposure to such chemicals. The involvement of multiple organs might be attributed to a neurogenic switching mechanism. The final diagnosis of MCS is to rely on provocation of symptoms in a exposure chamber by a double-blind method. Relations of MCS to allergy, poisoning, psychogenic illness, chemical sensitivity, idiopathic environmental intolerances etc. are discussed in terms of case definition and etiology of these disorders.

Diagnosis, Differential↗
PubMed1993

Immunologic, psychological, and neuropsychological factors in multiple chemical sensitivity. A controlled study.

OBJECTIVE: To examine the role of immunologic, psychological, and neuropsychological factors in multiple chemical sensitivity. DESIGN: Case-control comparison. SETTING: Community allergy practice (cases), university-based clinics for musculoskeletal injuries (controls). PARTICIPANTS: Forty-one patients with chemical sensitivity and 34 control patients with chronic musculoskeletal injuries. MAIN OUTCOME MEASURES: Immunologic measures included autoantibody titers, lymphocyte surface markers, and interleukin-1 generation by monocytes. Psychological evaluation included standardized measures of anxiety, depression, and somatization. RESULTS: Immunologic testing did not differentiate patients with chemical sensitivity from controls. The only difference noted (lower interleukin-1 generation among cases) appeared attributable to laboratory methods. Patients with chemical sensitivity reported greater prevalence of current anxiety or depressive disorder (44% versus 15%, P = 0.006). This difference, however, did not appear to precede the onset of chemical sensitivity, and 25% of chemically sensitive patients showed no significant current psychological disturbance. Cases reported significantly more "medically unexplained" physical symptoms before and after the onset of chemical sensitivity. When considering only symptoms that preceded chemical sensitivity, 25% of cases (and no controls) satisfied criteria for somatization disorder. Neuropsychological testing revealed no significant case-control differences. CONCLUSIONS: Immunologic testing failed to confirm findings from earlier uncontrolled studies, militating against proposed immunologic mechanisms. The decreased memory and concentration frequently described in multiple chemical sensitivity were not confirmed by brief neuropsychological testing. Psychological symptoms, although not necessarily etiologic, are a central component of chemical sensitivity.

Adult↗
PubMed1999

[Idiopathic environmental intolerance (IPI)--formerly multiple chemical sensitivity (MCS)--from the psychiatric perspective].

The term "idiopathic environmental intolerances" (IEI)/"multiple chemical sensitivities" (MCS) is used to describe a complex of heterogeneous somatic symptoms without a diagnosable organic disease. Symptoms are believed to be triggered by exposure to low levels of environmental chemicals that are usually well tolerated by the general population. There is no widely accepted definition for the phenomenon. A number of contradictory etiologic hypotheses and therapeutic concepts are discussed. One of the crucial questions is whether IEI/MCS should be understood as an own entity of disease. It has been demonstrated that a majority of patients with IEI/MCS meet diagnostic criteria for psychiatric diseases. Most frequently, somatoform, affective and anxiety disorders can be diagnosed. Therefore, psychiatric and psychotherapeutic therapy seems appropriate. The present paper provides a review of the different case definitions, etiologic and therapeutic concepts and of studies examining the frequency of psychiatric morbidity in patients with IEI/MCS. Additionally, a diagnostic algorithm and a concept of behavioral therapy for IEI/MCS patients with somatoform disorders are described.

Humans↗
PubMedDate not supplied

Immunologic parameters of multiple chemical sensitivity.

Immunologic abnormalities have long been advanced as a potential mechanism for multiple chemical sensitivity (MCS). An immunologic mechanism is supported in part by the systemic nature of the symptoms reported, the complex interactions known to exist between the immune system and other systems, and limited experimental evidence. However, there are both theoretical grounds for doubting an immunologic mechanism in MCS and methodological constraints in many of the studies that have been conducted in humans. The authors discuss the structure and function of the immune system as it potentially applies to MCS, the uses and limitations of immunologic testing, and the evidence for immunologic theories of MCS. They describe recent work to validate some of the immunologic tests used in MCS and consider opportunities for further research.

Humans↗
PubMed2004

Case-control study of multiple chemical sensitivity, comparing haematology, biochemistry, vitamins and serum volatile organic compound measures.

BACKGROUND: Multiple chemical sensitivity (MCS), although poorly understood, is associated with considerable morbidity. AIM: To investigate potential biological mechanisms underlying MCS in a case-control study. METHODS: Two hundred and twenty-three MCS cases and 194 controls (urban females, aged 30-64 years) fulfilled reproducible eligibility criteria with discriminant validity. Routine laboratory results and serum levels of volatile organic compounds (VOCs) were compared. Dose-response relationships, a criterion for causality, were examined linking exposures to likelihood of case status. RESULTS: Routine laboratory investigations revealed clinically unimportant case-control differences in means. Confounder-adjusted odds ratios (OR) showed MCS was negatively associated with lymphocyte count and total plasma homocysteine, positively associated with mean cell haemoglobin concentration, alanine aminotransferase and serum vitamin B6, and not associated with thyroid stimulating hormone, folate or serum vitamin B12. More cases than controls had detectable serum chloroform (P = 0.001) with the OR for detectability 2.78 (95% confidence interval = 1.73-4.48, P < 0.001). Chloroform levels were higher in cases. However, cases had significantly lower means of detectable serum levels of ethylbenzene, m&p-xylene, 3-methylpentane and hexane, and means of all serum levels of 1,3,5- and 1,2,3-trimethylbenzene, 2- and 3-methylpentane, and m&p-xylene. CONCLUSIONS: Our findings are inconsistent with proposals that MCS is associated with vitamin deficiency or thyroid dysfunction, but the association of lower lymphocyte counts with an increased likelihood of MCS is consistent with theories of immune dysfunction in MCS. Whether avoidance of exposures or different metabolic pathways in cases explain the observed lower VOC levels or the higher chloroform levels should be investigated.

Adult↗
PubMed1999

Olfaction and symptoms in the multiple chemical sensitivities syndrome.

Whereas most idiosyncratic environmental sensitivity complaints do not fit known diagnoses, the multiple chemical sensitivities syndrome (MCS) is an extreme presentation that has defined diagnostic criteria. MCS symptomatics claim that they acquired a sensitized state as the result of a chemical exposure, usually to a solvent or pesticide, but not to a fragrance. Before this exposure, they did not experience symptoms. Following sensitization, symptoms increasing in number and severity with time are attributed by the MCS symptomatic to various exposures that are innocuous to most individuals. Although phenomenological studies have provided no evidence that particular odors elicit MCS symptoms, low levels of fragrances and perfumes are frequently associated with the reporting of MCS symptoms. This evaluation examines proposed mechanisms by which odorants and fragrances might cause either sensitization or elicitation of MCS symptoms, including altered odor sensitivity, primary irritancy or irritancy-induced upper airway reactivity, neurogenic switching of trigeminal irritancy signals, time-dependent sensitization and limbic kindling, CNS toxicity, and various psychiatric conditions. In no case was there persuasive evidence that any olfactory mechanism involving fragrance underlies either induction of a sensitized state or the triggering of MCS symptoms. Fragrances and other odorants could, however, be associated with symptoms as claimed by MCS symptomatics, because they are recognizable stimuli, but fragrance has not been demonstrated to be causal in the usual sense.

Environmental Exposure↗
PubMed2000

Conversion disorder and multiple chemical sensitivity: a comparative study of psychological defense strategies.

This study compared psychological defensive strategies in two groups of patients with multiple chemical sensitivity (n = 10) and conversion disorder (n = 10) by means of the projective perceptual Defense Mechanism Test. We attempted to create a model for personality assessment based on the test data of prior patients, in which new patients could successively be tested. The overall results indicated that it was possible to separate the clinical groups significantly from a control group and from each other. In comparison to the controls, the clinical groups were characterized by patterns that were more nonemotionally adapted as well by a lateness of perception, but the ways in which the clinical groups maintained this difference were not the same. The multiple chemical sensitivity group was characterized above all by blocking maneuvers, while the main defensive strategy of the conversion disorder group was distortion of content.

Adult↗
PubMedDate not supplied

Neurobiological sensitization models of post-traumatic stress disorder: their possible relevance to multiple chemical sensitivity syndrome.

Neurological sensitization has been proposed as a model for post-traumatic stress disorder (PTSD) (Lipper et al., 1986; van der Kolk, 1987; Friedman, 1988; Post et al., 1988, 1994; Charney et al., 1993). Laboratory paradigms in which repeated exposure to a discrete stimulus is associated with progressive intensification of a neurophysiologic, behavioral, or pharmacologic response has many parallels with the sequence of events that precipitates PTSD. Investigators with other clinical interests have also been attracted to sensitization models. Specifically, Bell and associates (1992) have proposed that olfactory-limbic kindling is a very good model for understanding the etiology of multiple chemical sensitivity (MCS) syndrome. A number of articles in this volume have addressed the goodness-of-fit between this model and MCS. My major assignment is to review laboratory data and clinical observations pertinent to sensitization models of PTSD. I will show that although there are intriguing parallels between the two phenomena, one must have great respect for the complexity and polymorphism of both sensitization and PTSD before grasping for simplistic theoretical conclusions. Secondly, I will address the following question; if both PTSD and MCS can be understood as sensitization phenomena, are PTSD patients at greater risk to develop MCS and vice versa? This article is divided into four sections: a) a description of three distinct sensitization phenomena; b) a description of the symptoms of PTSD; c) a review of the applicability of sensitization models to the clinical phenomenology of PTSD; and d) a review of the hypothesis that PTSD patients might be more vulnerable to MCS.

Animals↗
PubMedDate not supplied

Developing a pesticide policy for individuals with multiple chemical sensitivity: considerations for institutions.

Institutions are increasingly being asked to accommodate individuals with multiple chemical sensitivity (MCS). Most establishments have chosen to provide such accommodations on a case-by-case basis only. This paper investigates feasible actions that may be taken by institutions to reduce exposure of MCS individuals as well as the general institutional population to pesticides and other substances. Emphasis is placed on procedures that can be instituted on a regular basis and may be combined with case-by-case management for better resolution of problems.

Environmental Exposure↗