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Sensory irritation and multiple chemical sensitivity.

Many of the symptoms described in Sick Building Syndrome (SBS) and multiple chemical sensitivity (MCS) resemble the symptoms known to be elicited by airborne irritant chemicals. Irritation of the eye, nose, and throat is common to SBS, MCS, and sensory irritation (SI). Difficulty of breathing is often seen with SBS, MCS, and pulmonary irritation (PI). We therefore asked the question: can indoor air pollutants cause SI and/or PI? In laboratory testing in which mice breathed the dilute volatile emissions of air fresheners, fabric softeners, colognes, and mattresses for 1 h, we measured various combinations of SI and PI as well as airflow decreases (analogous to asthma attacks). Air samples taken from sites associated with repeated human complaints of poor air quality also caused SI, PI, and airflow limitation (AFL) in the mice. In previous publications, we have documented numerous behavior changes in mice (which we formally studied with a functional observational battery) after exposure to product emissions or complaint site air; neurological complaints are a prominent part of SBS and MCS. All together, these data suggest that many symptoms of SBS and MCS can be described as SI, PI, AFL, and neurotoxicity. All these problems can be caused by airborne irritant chemicals such as those emitted by common commercial products and found in polluted indoor air. With some chemical mixtures (e.g., emissions of some fabric softeners, disposable diapers, and vinyl mattress covers) but not others (e.g., emissions of a solid air freshener), the SI response became larger (2- to 4-fold) when we administered a series of two or three 1-h exposures over a 24-h period. Since with each exposure the intensity of the stimulus was constant yet the magnitude of the response increased, we concluded that there was a change in the sensitivity of the mice to these chemicals. The response was not a generalized stress response because it occurred with only some mixtures of irritants and not others; it is a specific response to certain mixtures of airborne chemicals. This is one of the few times in MCS research that one can actually measure both the intensity of the stimulus and the magnitude of the response and thus be allowed to discuss sensitivity changes. The changing SI response of the mice might serve as a model of how people develop increasing sensitivity to environmental pollutants. Intensive study of this system should teach us much about how people respond to and change sensitivity to airborne irritant chemicals.

Administration, Inhalation↗

Time-dependent sensitization in animals: a possible model of multiple chemical sensitivity in humans.

It often happens in science that clues to the nature of a problem under study come from a completely different, seemingly unrelated, line of investigation. This may be the case with MCS and Time-Dependent Sensitization (TDS), a phenomenon we discovered in rats in the late 1970s and later named. TDS refers to the ability of mild stressors--whether pharmacological or environmental--to induce physiological and behavioral effects which then progress, i.e., get stronger, entirely as a function of the passage of time since stressor presentation. This strengthening is revealed when the organism is later exposed to either the original or another stressor. The characteristics of TDS bear a remarkable resemblance to the features of MCS and that similarity is the subject of this manuscript.

Animals↗

Personality, mental distress, and risk perception in subjects with multiple chemical sensitivity and toxic encephalopathy.

Personality, mental distress, and risk perception were assessed in (a) cases of multiple chemical sensitivity (MCS; n = 17), (b) chemically intolerant toxic encephalopathy cases (TE), type 2A (n = 31) and 2B (n = 26), and (c) healthy referents (n = 200). MCS cases showed elevated mental distress scores on the Depression, Interpersonal Sensitivity, Global Severity Index, and Somatization scales in the Symptom Checklist 90 (SCL-90). In the Karolinska Scales of Personality (KSP) the MCS group showed an elevation only on the Psychasthenia scale. Both TE groups showed elevations across the KSP anxiety scales Muscular Tension, Psychasthenia, and Somatic Anxiety. TE type 2B subjects also showed elevations on the Irritability and Indirect Aggression scales. However, neither MCS nor TE groups showed deviating personality characteristics in the Meta Contrast Technique test. Similarly, none of the groups deviated from referents in a risk perception inventory.

Adult↗

Development of a brief questionnaire for screening for multiple chemical sensitivity syndrome.

The objective of this study was to identify a parsimonious set of questions that has high sensitivity and specificity for screening for individuals with multiple chemical sensitivity (MCS) syndrome. We performed a cross-sectional survey using a case-control design. Subjects were derived from patients seen at an academically based Occupational and Environmental Medicine Clinic. Cases consisted of patients who fulfilled the Cullen definition for MCS. Controls were patients who had diagnoses excluding MCS and asthma and who were matched to cases by age and sex. Cases and controls filled out a screening questionnaire that, among things, elicited responses as to whether and how subjects reacted to 122 different types of environmental exposures. Data from 44 pairs of cases and controls were available for analysis. The average age of cases was 50.2 years, and 91% was female. Among cases, the most common exposure that was purported to incite MCS was 'indoor air quality contaminants (unspecified)' (59%), followed by solvents (27.3%). After randomly excluding five cases and controls, a stepwise selection procedure for two-group discriminant analysis revealed that the main contributors to the discrimination of the remaining cases and controls were self-reported reactions to copy machine emissions, marking pens, aftershave, window cleaner, nylon fabric, pine-scented products, and rayon material. When a positive response to these factors was used as the sole method for discriminating cases from controls, only one of 41 cases was misclassified as a control while none of the controls was misclassified as a case. When the same method was applied to the five excluded cases and five excluded controls, only one of the five cases was misclassified while none of the five controls was misclassified as a case. Among patients with MCS defined by the Cullen criteria in this clinical setting, having a reaction to these seven common potential exposures comprised a parsimonious set of factors that discriminated between MCS patients and age- and sex-matched normal controls. These questions may have utility in screening for individuals with MCS in general population survey studies.

Air Pollution, Indoor↗

Psychophysiological hypotheses regarding multiple chemical sensitivity syndrome.

This paper proposes several hypotheses and research strategies for exploring possible psychological factors contributing to multiple chemical sensitivity (MCS). The hypotheses are based on concepts of individual response stereotypy, situational response specificity, classical conditioning of chemical-induced responses, and psychophysiological reactions to active and passive coping orientations. Hypotheses regarding hypersensitivity to perception and/or aversiveness of chemical stimulation also are presented. Strategies for evaluating these hypotheses are described based on experimental literature on psychophysiology and psychophysics.

Cognition↗

Possible models for multiple chemical sensitivity: conceptual issues and role of the limbic system.

Conceivably, chemicals contacting olfactory nerve projections in the nose could either be transported into or relay electrical signals to the limbic region, leading to a vast array of symptoms. Likewise, thought processes and mood states may trigger or interrupt pre-existing limbic activity. At present, however, no evidence suggests that limbic activity triggered by environmental exposures can be entirely overcome by psychologic interventions. One important ramification of a limbic hypothesis, if true, is that no convenient biologic marker for multiple chemical sensitivity may exist at the present time. Ten years from now, we may finally confirm the existence of multiple chemical sensitivities (by careful, blinded challenges) but still have no single mechanism to explain it; that is, after all avenues of biochemical and immunologic inquiry have been exhausted, no single cause or marker for this disorder may be apparent. The theory that adaptation plays a role in MCS is based on the observed responses of patients in a deadapted state who have been housed in an environmental unit. Although adaptation is only an observation at this time, not a mechanism, biologic limits might regulate how much an organism can adapt. Such limits could be highly individual and vary by orders of magnitude. Certainly adaptation occurs at all levels of biologic systems, from enzyme systems to cells, tissues, organs, and even behavior (Fregly, 1969). Theoretically, a major insult or the accumulation of lower-level injuries within these systems could lead to a kind of "overload" or "saturation" effect with respect to adaptive capacity. This might cause an individual to have environmental responses, which, instead of being flexible and fluid, would become fragile and overly responsive. Many MCS patients report that years, and in some cases decades, after the onset of their problems, they have recovered only a portion of their former energies and tolerance for their environment. Their descriptions seem to suggest the loss of an intangible capacity to adapt, parts of which may be temporary and recoverable and other parts of which may not. Perhaps our patients have been telling us the diagnosis.

Adult↗

Neuropsychological test performance of Swedish multiple chemical sensitivity patients--an exploratory study.

To address the hypothesis of brain dysfunction as a component of the multiple chemical sensitivity (MCS) syndrome, a neuropsychological battery comprising 8 tests was given to 17 Swedish MCS patients and 34 demographically matched controls. Across the 6 tests used as indicators of brain impairment, comprising a total of 17 test variables, the MCS group performed poorer only in a complex reaction time test (mean reaction time; p = 0.002; t test). Correction for self-ratings of mental distress and trait psychasthenia did not eliminate the deviation in the reaction time test. Because the results on most tests were within normal limits, brain impairment was not evidenced. However, the similar minor deviations in neurobehavioral tests observed in several studies of MCS patients indicate the need for a study on a larger sample of MCS cases.

Adult↗

Acquiring symptoms in response to odors: a learning perspective on multiple chemical sensitivity.

In this chapter, a learning account is discussed as a potential explanation for the symptoms in multiple chemical sensitivity. Clinical evidence is scarce and anecdotal. A laboratory model provides more convincing results. After a few breathing trials containing CO2-enriched air as an unconditioned stimulus in a compound with harmless odor substances as conditioned stimuli, subjective symptoms are elicited and respiratory behavior is altered by the odors only. Also, mental images can become conditioned stimuli to trigger subjective symptoms. The learning effects cannot be explained by a response bias or by conditioned arousal, and they appear to involve basic associative processes that do not overlap with aware cognition of the relationship between the odors and the CO2 inhalation. Learned symptoms generalize to new odors and they can be eliminated in a Pavlovian extinction procedure. In accordance with clinical findings, neurotic subjects and psychiatric cases are more vulnerable to learning subjective symptoms in response to odors. Consistent with a learning account, cognitive-behavioral treatment techniques appear to produce beneficial results in clinical cases. Several criticisms and unresolved questions regarding the potential role of learning mechanisms are discussed.

Administration, Inhalation↗

Multiple chemical sensitivities--new paradigm needed.

The current principles of toxicology, immunology and allergy do not provide a coherent explanation of a chemical sensitivity lacking reproducible and measurable physiologic or biochemical changes. A new paradigm is needed as a scientific model for multiple chemical sensitivities.

Humans↗

[Psychiatric disorders of environmental outpatients--results of the standardized psychiatric interview (CIDI) from the German multi-center study on Multiple Chemical Sensitivity (MCS)].

BACKGROUND: A nationwide, environmental outpatient-based multi-center two-phase study on Multiple Chemical Sensitivity (MCS) was conducted from 1999 until 2004. The aim of the study was to characterize more precisely the health-complaints relevant for the MCS-phenomenon. A standardized psychiatric interview (CIDI), used to identify frequency, character and duration of psychiatric disorders and their chronological relation to the environment-related health complaints of the patients, formed part of the extensive diagnostic procedure. METHOD: 251 (86.3%) of the 291 attendees of the environmental outpatient departments in Aachen, Berlin, Bredstedt, Freiburg, Giessen and Munich, were examined using the German version (M-CIDI/DIA-X) of the Composite International Diagnostic Interview. RESULTS: 83.7% (lifetime prevalence rate) fulfilled the diagnostic criteria of at least one psychiatric disorder, with the 12-month and 4-week prevalence rates being 76.5% and 64.5%, respectively. Environmental outpatients, in all prevalence periods, had significantly higher rates of psychiatric disorders than the comparable general population. Somatoform disorders were most frequently diagnosed, followed by depressive and phobic disorders. For 81.2% of the patients the psychiatric disorder started long before the environment-related health complaints (average 17 years). CONCLUSIONS: This study confirms the results of earlier studies, i.e. that patients with environment-related health complaints suffer from psychiatric disorders more frequently than the general population. The high environmental outpatients really suffer from psychosomatic complaints, but attribute the causes to the environment. Application of specific therapeutic regimen is recommended for those patients, whose psychiatric disorders are safeguarded diagnostically and for whom a relevant exposure is unlikely.

Adult↗

Workers with multiple chemical sensitivities: a psychiatric approach to diagnosis and treatment.

Individuals considered to suffer from multiple chemical sensitivities comprise a heterogeneous grouping. Regardless of the original etiology of symptoms, these individuals tend to amplify their symptoms and to develop the mistaken belief that these symptoms are indicative of severe disease. Cognitive processes and anxiety contribute to amplification of symptoms and disability, and cognitive and behavioral techniques appear to be clinically useful in alleviating symptoms and disability. Specific psychiatric disorders, in particular major depression, panic disorder, post-traumatic stress disorder, and somatization disorder, may be confused or associated with MCS. When present, specific treatment of these psychiatric disorders is essential.

Anxiety↗

Multiple chemical sensitivities following intolerance to azo dye in sweets in a 5-year-old girl.

BACKGROUND: Cases of multiple chemical sensitivities (MCS) have been reported predominantly in adult patients, but pediatric cases have rarely been reported. METHODS: We present a 5-year-old girl who suffered from recurrent reactions accompanied by urticaria, angioedema, headaches, dyspnea, loss of consciousness, and abdominal pain that were not eradicated, but were instead exacerbated, by various treatments with antihistamines and intravenous corticosteroids. Her diet diary revealed that symptoms occurred after ingestion of colorful sweets such as candies and jellybeans. Open challenge tests with food additives and nonsteroidal anti-inflammatory drugs (NSAIDs) were performed after elimination of these items. Skin prick tests using additives and NSAIDs, which were dissolved in saline, and prick- prick tests using candies and jellybeans, were carried out. RESULTS: Open challenge tests with Tartrazine, aspirin and acetaminophen were positive, whereas skin prick tests using additives and NSAIDs and prick-prick tests using candies and jellybeans were all negative. Consequently, intolerance to azo dyes and NSAIDs such as aspirin was diagnosed. However, she appeared to react to multiple chemical odors such as those of cigarette smoke, disinfectant, detergent, cleaning compounds, perfume, and hairdressing, all while avoiding additives and NSAIDs. On the basis of her history and the neuro-ophthalmological abnormalities, a diagnosis of severe MCS was made and she was prescribed multiple vitamins and glutathione. CONCLUSIONS: The present results suggest that in pediatric MCS, food and drug additives containing azo dyes might play important roles as elicitors.

Azo Compounds↗

[Multiple chemical sensitivity disorder in patients with neurotoxic illnesses].

The data of 466 subjects suffering from neurologic disorders which are suggested to be caused by neurotoxic agents in their environment retrospectively was evaluated and documented. Among these cases there were 151 subjects with symptoms of Multiple Chemical Sensitivity Disorder (MCSD). The relationship between the neurological health impairments and neurotoxic agents in the environment of these patients was characterised using five different categories (probable = A, possible = B, uncertain = C, unclarified = D, not probable = E). From the 466 patients 320 subjects (69%) could be assigned to the categories A and B, respectively. Within theses 320 cases with chronic neurotoxic health impairments 136 subjects (79 females and 57 males) showed signs of MCSD. Age and gender of cases as well as duration and character of exposure to neurotoxic substances retrospectively were assessed from the explicit files of the patients, which had been made anonymous for this purpose. Frequency of characteristic symptoms of neurotoxicity were analysed. Results are given for patients with neurotoxic health impairments with MCSD (n = 136) and without MCSD (n = 184). Neurotoxic substances which were used as indoor wood preservatives (mainly Pentachlorophenol and/or Lindane) were found to be the causative agents in 63% of the cases with neurotoxic health impairments and MCSD. Other important neurotoxic substances to which the patients were mainly exposed were organic solvents (25%), formaldehyde (15%), dental materials (15%), pyrethroides (13%), and other biocides (19%) (multiple exposures were possible). The time of exposure was calculated as being > or = 10 years for 55% of the patients with MCSD and for 50% of the group with neurotoxic health impairments but without MCSD. Out of the 184 cases with neurotoxic health impairments but without MCSD there were 22%, and out of the 136 cases with MCSD there were 39% who showed all symptoms of chronic fatigue syndrome. 53% of the cases with MCSD had an allergic disposition compared to only 20% of the cases without MCSD. This work is not a controlled epidemiological study but a retrospective documentation and evaluation of data related to environmental medicine. With the present documentation in this purely descriptive manner the proof of a causal relationship was not possible or intended. But because corresponding epidemiological studies are lacking, this documentation can give important information on characteristic features of Multiple Chemical Sensitivity Disorder and chronic neurotoxic health impairments. Such information is essential for planning and carrying out epidemiological studies urgently needed in this field.

Adolescent↗

The relationship between fibromyalgia and the multiple chemical sensitivity syndrome.

Fibromyalgia (FM) patients often report a high frequency of non-musculoskeletal symptoms, including those suggestive of multiple chemical sensitivity (MCS) syndrome. The objective of this pilot study was to determine the prevalence of MCS in FM patients from a university-based rheumatology practice. Self-report questionnaires were administered to determine the presence of MCS, utilizing the criteria from a recent study of the immunologic profile of patients with this disorder. Patients also responded "yes" or "no" to the presence of 48 FM-related symptoms. Thirty-three of 60 patients with FM met the criteria for MCS. Eleven of these patients also fulfilled more restrictive criteria, requiring a "higher degree" of chemical sensitivity. The symptoms and substances most frequently cited were similar to those reported in other studies of MCS. FM patients with and without MCS did not differ in other symptomatology. MCS may represent an additional symptom complex within the spectrum of FM.

Adult↗

Multiple chemical sensitivities: a practicing clinician's point of view. Clinical and immunologic research findings.

The multiple chemical sensitivities syndrome is a symptom complex characterized by emotional depression, short-term memory loss, acquired intolerance to environmental agents such as aerosolized petrochemicals and foods, and alteration in metabolic rate associated with increased body mass. This syndrome can be caused by multiple etiologic agents. With careful evaluation, it is rare that a causal agent can not be identified in this syndrome. Our treatment regimens include combinations of diet and environment control as well as antiviral, antifungal, and immune modulator therapy. We find that the majority of patients can, through time and appropriate treatment, be restored to a normal and productive lives.

Environmental Health↗

[Role of positron emission tomography (PET) and single photon emission tomography (SPECT) in so-called "multiple chemical sensitivity"].

Functional imaging with SPECT and PET is increasingly used to prove evidence for the existence of a syndrome "Multiple Chemical Sensitivity" (MCS) and plays a major role in legal trials to justify compensation for the exposure to solvents. This paper critically reviews the literature on the use of SPECT and PET for the determination of MCS. The authors come to the conclusion that the current data are not sufficient to justify the claim of the existence of such a syndrome. The low specificity of the observed PET and especially SPECT-findings makes it very difficult to establish a cause-result relationship and therefore makes the use of these methods in legal trials on this issue doubtful.

Humans↗

Multiple chemical sensitivity: a test of the olfactory-limbic model.

Thus far, no neuropsychological study has examined the cognitive profile of multiple chemical sensitivity (MCS) within the framework of Bell's Olfactory-Limbic Model. It predicts that cognitive weaknesses will be associated more with limbic (i.e., frontal and/or temporal lobe) than with non-limbic (i.e., posterior cortex) brain regions. Matched MCS, asthma, and healthy control groups (n = 63) were tested on cognitive measures with localizing value. Between-group comparisons found that the MCS group performed as well as controls on all cognitive tasks. Within-group comparisons found that both the MCS and asthma groups performed significantly more poorly on tasks that were sensitive to frontal and temporal regions than to posterior regions. Additional research is needed before concluding that the Olfactory-Limbic Model adequately describes the cognitive strengths and weaknesses of MCS. Confounding factors such as medication use and chronic illness need to be considered.

Asthma↗