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PubMed2001

Common etiology of posttraumatic stress disorder, fibromyalgia, chronic fatigue syndrome and multiple chemical sensitivity via elevated nitric oxide/peroxynitrite.

Three types of overlap occur among the disease states chronic fatigue syndrome (CFS), fibromyalgia (FM), multiple chemical sensitivity (MCS) and posttraumatic stress disorder (PTSD). They share common symptoms. Many patients meet the criteria for diagnosis for two or more of these disorders and each disorder appears to be often induced by a relatively short-term stress which is followed by a chronic pathology, suggesting that the stress may act by inducing a self-perpetuating vicious cycle. Such a vicious cycle mechanism has been proposed to explain the etiology of CFS and MCS, based on elevated levels of nitric oxide and its potent oxidant product, peroxynitrite. Six positive feedback loops were proposed to act such that when peroxynitrite levels are elevated, they may remain elevated. The biochemistry involved is not highly tissue-specific, so that variation in symptoms may be explained by a variation in nitric oxide/peroxynitrite tissue distribution. The evidence for the same biochemical mechanism in the etiology of PTSD and FM is discussed here, and while less extensive than in the case of CFS and MCS, it is nevertheless suggestive. Evidence supporting the role of elevated nitric oxide/peroxynitrite in these four disease states is summarized, including induction of nitric oxide by common apparent inducers of these disease states, markers of elevated nitric oxide/peroxynitrite in patients and evidence for an inductive role of elevated nitric oxide in animal models. This theory appears to be the first to provide a mechanistic explanation for the multiple overlaps of these disease states and it also explains the origin of many of their common symptoms and similarity to both Gulf War syndrome and chronic sequelae of carbon monoxide toxicity. This theory suggests multiple studies that should be performed to further test this proposed mechanism. If this mechanism proves central to the etiology of these four conditions, it may also be involved in other conditions of currently obscure etiology and criteria are suggested for identifying such conditions.

Carbon Monoxide↗
PubMed1994

Some preliminary thoughts on the potential contribution of epidemiology to the question of multiple chemical sensitivity.

Epidemiology has played a role in clarifying mysterious symptom complexes such as AIDS, Chronic Fatigue Syndrome, and Psychiatric Disease. Is Multiple Chemical Sensitivity a new environmental disease or another in the parade of psychosomatic syndromes which have come and gone in history. It is proposed that epidemiology can: (1) Describe quantitatively the relative frequency of presenting symptoms and natural history. (2) Work with experimental psychologists to develop double-blind protocols for the "environmental unit" where chemical challenges are said to reveal chemical etiology. (3) Develop an epidemiological definition in a clinical series. (4) Develop an epidemiological definition in cohorts recently exposed to chemicals. (5) Apply the epidemiological definitions in descriptive studies and around hazardous waste sites.

Diagnosis, Differential↗
PubMed1993

Successful management of patients with "multiple chemical sensitivities" on an inpatient psychiatric unit.

BACKGROUND: Much controversy exists over the diagnosis, etiology, and treatment of "multiple chemical sensitivities" also known as "environmental illness." The experience of multiple nonspecific reactions to numerous environmental agents leads to these diagnoses. Due to skepticism surrounding the validity of these patients' complaints, they are often referred for psychiatric evaluations, but successful management on a psychiatric inpatient unit can be complicated because of their unique presentations. METHOD: The approach taken by a university psychiatric inpatient unit to the evaluations of three such patients is presented along with a literature review of etiologic theories and treatment recommendations. RESULTS: Each of the three patients presented with severe disability from their "sensitivities," but each improved significantly over the course of a 17-day hospitalization. CONCLUSION: These patients benefited greatly from a serious, nonjudgmental, comprehensive approach to the evaluation of their multiple complaints. Despite the absence of any positive organic findings, each felt that her experiences had been validated, and each subsequently improved. When evaluating similar patients, clinicians should be aware of useful, effective management strategies and should avoid overt skepticism and confrontation.

Adult↗
PubMed2002

Psychiatric and somatic disorders and multiple chemical sensitivity (MCS) in 264 'environmental patients'.

BACKGROUND: An increasing number of individuals with diverse health complaints are currently seeking help in the field of environmental medicine. Multiple chemical sensitivity (MCS) or idiopathic environmental intolerances (IEI) is defined as an acquired disorder with multiple recurrent symptoms associated with environmental chemicals in low concentrations that are well tolerated by the majority of people. Their symptoms are not explained by any known psychiatric or somatic disorder. METHOD: Within a 2-year period we examined 264 of 267 consecutive patients prospectively presenting to a university based out-patient department for environmental medicine. Patients underwent routine medical examination, toxicological analysis and the structured clinical interview for DSM-IV psychiatric disorders (SCID). RESULTS: Seventy-five per cent of the patients met DSM-IV criteria for at least one psychiatric disorder and 35% of all patients suffered from somatoform disorders. Other frequent diagnoses were affective and anxiety disorders, and dependence or substance abuse. In 39% a psychiatric disorder, in 23% a somatic condition and in 19% a combination of the two were considered to provide sufficient explanation of the symptoms. Toxic chemicals were regarded as the most probable cause in only five cases. The suspected diagnosis of MCS/IEI could not be sustained in the vast majority of cases. CONCLUSION: This investigation confirms previous findings that psychiatric morbidity is high in patients presenting to specialized centres for environmental medicine. Somatoform disorders are the leading diagnostic category, and there is reason to believe that certain 'environmental' or MCS patients form a special subgroup of somatoform disorders. In most cases, symptoms can be explained by well-defined psychiatric and medical conditions other than MCS, which need specific treatment. Further studies should focus on provocation testing in order to find positive criteria for MCS and on therapeutic approaches that consider psychiatric aspects.

Adolescent↗
PubMed2003

A review of a two-phase population study of multiple chemical sensitivities.

In this review we summarize the findings of a two-phase study of the prevalence, symptomatology, and etiology of multiple chemical sensitivities (MCS). We also explore possible triggers, the potential linkage between MCS and other disorders, and the lifestyle alterations produced by MCS. The first phase of the study consisted of a random sampling of 1,582 individuals from the Atlanta, Georgia, metropolitan area to determine the reported prevalence of a hypersensitivity to common chemicals. In this phase, 12.6% of the sample reported a hypersensitivity. Further questioning of individuals with a hypersensitivity indicated that 13.5% (1.8% of the entire sample) reported losing their jobs because of their hypersensitivity. The second phase was a follow-up questioning of the respondents who initially reported hypersensitivity. In this phase, we found that individuals with hypersensitivity experience a variety of symptoms and triggers. A significant percentage (27.5%) reported that their hypersensitivity was initiated by an exposure to pesticides, whereas an equal percentage (27.5%) attributed it to solvents. Only 1.4% had a history of prior emotional problems, but 37.7% developed these problems after the physical symptoms emerged. This suggests that MCS has a physiologic and not a psychologic etiology.

Environmental Exposure↗
PubMed2003

Multiple chemical sensitivity in male painters; a controlled provocation study.

The purpose of the present study was to examine whether male painters reporting multiple chemical sensitivity (MCS) differ from their matched controls (male painters without such sensitivity) during controlled chamber challenges to singular and mixtures of odorous chemicals with respect to: (1) Subjective rating of symptoms (i.e., symptoms related to central nervous system (CNS) and symptoms related to irritation) and sensations of smell elicited by low-level chemical exposures. (2) Changes in serum prolactin and cortisol levels, changes in nasal cavity and eye redness as a result of the various exposures. Moreover, background assessments were made regarding mental well-being, sense of coherence (SOC) as well as state of anxiety and depression in both groups. The MCS and control group consisted of 14 and 15 male painters respectively. Regarding background assessments of mental well-being, anxiety, depression and SOC, statistically significant differences were obtained between painters with MCS and their controls. During the controlled chamber challenges, neither difference regarding sensations of smell nor development of CNS related symptoms were seen between MCS and control group. In contrast, subjective rating of symptoms related to irritation (i.e., eyes, nose, throat, skin, and breathing difficulties) was significant higher in subjects with MCS. No differences between the groups as a result of the different exposures were seen concerning nasal cavity, eye redness and serum cortisol levels. However, a trend (P = 0.056) between the groups was measured regarding a decline of serum prolactin levels in the MCS group. This is a relatively small study with a limited number of volunteers; and no definitive conclusions can be drawn concerning the above findings. But it is the first controlled challenge study that incorporates similarly exposed groups (painters) recruited from a community rather than from a clinical population.

Adult↗
PubMed2001

Multiple chemical sensitivity and chronic fatigue syndrome in British Gulf War veterans.

The objective of this study was to measure the prevalence of multiple chemical sensitivity (MCS) and chronic fatigue syndrome (CFS) in British Gulf War veterans and to investigate their association with reported exposures and psychologic morbidity. In 1997--1998, the authors undertook a cross-sectional survey of three cohorts of British military personnel comprising Gulf veterans (n = 3,531), those who had served in Bosnia (n = 2,050), and those serving during the Gulf War but not deployed there (Era cohort, n = 2,614). MCS and CFS were defined according to operational criteria. The prevalence of MCS in the Gulf, Bosnia, and Era cohorts was 1.3%, 0.3%, and 0.2%, respectively. For CFS, the prevalence was 2.1% (Gulf cohort), 0.7% (Bosnia cohort), and 1.8% (Era cohort). In Gulf veterans, MCS was strongly associated with exposure to pesticides (adjusted odds ratio = 12.3, 95% confidence interval: 5.1, 30.0). Both syndromes were associated with high levels of psychologic morbidity. These findings suggest that CFS and MCS account for some of the medically unexplained illnesses reported by veterans after deployment to the Gulf. MCS was particularly associated with Gulf deployment and self-reported exposure to pesticides, findings that merit further exploration given the controversial status of this diagnosis and the potential for recall bias in a questionnaire survey.

Adult↗
PubMed1998

The credible forensic psychiatric evaluation in multiple chemical sensitivity litigation.

The forensic psychiatrist must be able to perform a credible psychiatric evaluation and render a competent psychiatric opinion in hotly contested multiple chemical sensitivity (MCS) litigation. Forensic psychiatrists are often requested to evaluate MCS claimants by third party payers, employers, lawyers, and government agencies regarding health care costs and disability payments, workers' compensation claims, unemployment benefits, workplace accommodation reimbursements for special housing and environmental needs, civil litigation, and other claims. The credible forensic psychiatric evaluation of MCS litigants is described using the multiaxial diagnostic system of DSM-IV. Forensic psychiatrists must avoid becoming polarized by the current MCS controversy. The ethical requirements of honesty and striving for objectivity can be met by keeping separate the roles of therapist and expert, staying abreast of the scientific literature regarding MCS, and understanding the role of the psychiatric expert in MCS litigation.

Ethics, Professional↗
PubMed2000

Occipital lobe meningioma in a patient with multiple chemical sensitivities.

BACKGROUND: The concurrent diagnosis of meningioma with increased intracranial pressure has not been reported previously in a patient who meets diagnostic criteria for multiple chemical sensitivities (MCS). METHODS: A patient who had been evaluated in an occupational medicine practice, and by several other physicians for sensitivity to chemical odors was found to have papilledema and a visual field deficit. The patient met the clinical criteria set forth by Cullen in 1987 for MCS. A magnetic resonance imaging (MRI) scan was performed. RESULTS: The MRI revealed a large occipital lobe meningioma, which was surgically resected. Removal of the meningioma had little effect on the patient's symptoms. She has been unable to return to her job as a custodian. DISCUSSION: The etiology of MCS has been disputed and is currently unresolved. Those who evaluate patients with MCS are reminded that meningiomas and other intracranial mass lesions can affect olfaction, and that patients with MCS can have treatable intracranial abnormalities.

Brain Neoplasms↗
PubMed2004

Effect of exposure to volatile organic compounds on plasma levels of neuropeptides, nerve growth factor and histamine in patients with self-reported multiple chemical sensitivity.

Plasma levels of substance P, vasoactive intestinal peptide and nerve growth factor, but not histamine, were elevated in patients with self-reported multiple chemical sensitivity (sMCS). Exposure to volatile organic compounds (VOC) increased plasma levels of all parameters in these patients, while it had no effect in normal subjects or patients with atopic eczema/dermatitis syndrome (AEDS). Exposure to VOC also enhanced skin wheal responses induced by histamine in patients with sMCS, while it failed to do so in normal or AEDS subjects. These results indicate that exposure to VOC may enhance neurogenic inflammation with concomitant enhancement of histamine-induced responses.

Adult↗
PubMed1996

Odor aversion of multiple chemical sensitivities: recommendation for a name change and description of successful behavioral medicine treatment.

Patients with odor-triggered symptoms, meeting the case definition of multiple chemical sensitivities (MCS), continue to be seen in our institution and other health science centers [Amundsen, Mayo Clinic Dept. Intern. Med. Newslett. 9(1) (1986)]. The term MCS, unfortunately, feeds the thesis that symptoms are allergic-immune system in origin, a theory that has not withstood scientific scrutiny [American College of Physicians, Ann. Intern. Med. 111, 168-178 (1989); Terr, Ann. Intern. Med. 119, 163-164 (1993)]. It has been proposed that some of these cases may be examples of classical (Pavlovian) conditioning: many MCS patients meet diagnostic criteria for psychiatric illnesses, especially mood, anxiety, and somatoform disorders. Attention is turning to the complex relationship between olfactory stimulation, memory, and mood (psyche) in an attempt to understand why some individuals develop odor aversion symptoms and how to best manage these, frequently, severely disabled patients. Two subjects with typical odor-triggered symptoms have been treated, using behavioral medicine techniques, with marked improvement in both cases. The term "odor aversion" is proposed rather than MCS to describe patients with these symptoms.

Behavior Therapy↗
PubMed1997

Multiple chemical sensitivity syndrome and porphyria. A note of caution and concern.

Growing numbers of patients suffering from many symptoms believe that they have a condition called multiple chemical sensitivity syndrome (MCSS). It has been suggested that this syndrome can be triggered by exposure to any of a large and usually incompletely defined number of natural and synthetic chemical substances. Major medical organizations, including the National Research Council and the American Medical Association, have not recognized MCSS as a clinical syndrome because of a lack of valid, well-controlled studies defining it and establishing pathogenesis or origin. Lately, some have proposed that many patients with MCSS suffer from hereditary coproporphyria. However, this purported association is based chiefly on results from a single reference laboratory of a fundamentally flawed assay for erythrocyte coproporphyrinogen oxidase. Although patients with MCSS may, at times, have modest increases in urinary coproporphyrin excretion, this is a common finding found in many asymptomatic subjects or patients with diverse other conditions (eg, diabetes mellitus, heavy alcohol use, liver disease, and many kinds of anemia). Such secondary coproporphyrinuria does not indicate the existence of coproporphyria. To our knowledge, there is no scientifically valid evidence to support an association between MCSS and coproporphyria, nor is there any unifying hypothesis for rationally linking these 2 disorders.

Adolescent↗
PubMedDate not supplied

Olfaction and multiple chemical sensitivity.

In this paper, a description of olfactory anatomy is presented, followed by a brief review of modern procedures for testing olfactory function. Information from the sole study which has quantitatively examined olfactory function in patients with apparent multiple chemical sensitivity (MCS) is presented. In essence, this study suggests that MCS is associated with increased nasal airflow resistance, respiration rate, heart rate, and scores on the Beck Depression Inventory, but not with significant changes in odor detection threshold sensitivity to phenyl ethyl alcohol and methyl ethyl ketone, the two target stimuli evaluated. Whether MCS patients evidence hypersensitivity to other chemicals is unknown.

Butanones↗
PubMed2002

Mechanisms of multiple chemical sensitivity.

Sensitivity to chemicals is a toxicological concept, contained in the dose-response relationship. Sensitivity also includes the concept of hypersensitivity, although controversy surrounds the nature of effects from very low exposures. The term multiple chemical sensitivity has been used to describe individuals with a debilitating, multi-organ sensitivity following chemical exposures. Many aspects of this condition extend the nature of sensitivity to low levels of exposure to chemicals, and is a designation with medical, immunological, neuropsychological and toxicological perspectives. The basis of MCS is still to be identified, although a large number of hypersensitivity, immunological, psychological, neurological and toxicological mechanisms have been suggested, including: allergy; autosuggestion; cacosomia; conditioned response; immunological; impairment of biochemical pathways involved in energy production; impairment of neurochemical pathways; illness belief system; limbic kindling; olfactory threshold sensitivity; panic disorder; psychosomatic condition; malingering; neurogenic inflammation; overload of biotransformation pathways (also linked with free radical production); psychological or psychiatric illness; airway reactivity; sensitisation of the neurological system; time dependent sensitisation, toxicant induced loss of tolerance. Most of these theories tend to break down into concepts involving: (1) disruption in immunological/allergy processes; (2) alteration in nervous system function; (3) changes in biochemical or biotransformation capacity; (4) changes in psychological/neurobehavioural function. Research into the possible mechanisms of MCS is far from complete. However, a number of promising avenues of investigation indicate that the possibility of alteration of the sensitivity of nervous system cells (neurogenic inflammation, limbic kindling, cacosomia, neurogenic switching) are a possible mechanism for MCS.

Dose-Response Relationship, Drug↗
PubMed1999

Hope in multiple chemical sensitivity: social support and attitude towards healthcare delivery as predictors of hope.

This paper examines hope, as measured by the Herth Hope Scale, and its predictors in a sample of 305 people self-identified with multiple chemical sensitivity. The sample had relatively low levels of hope with scores unrelated to gender, severity or length of illness, income loss as a result of illness, or reported iatrogenic harm. Hope scores were positively correlated with perceived social support, having found personal growth through illness, age, reported level of supportiveness from a partner, an improved course of illness and level of reported safety of the home environment in regard to chemical exposures. Negative correlations were found with attitude toward healthcare delivery, fatigue and reported abuse/ostracism from family members other than partner. Social support, Healthcare Orientation, growth through illness, fatigue and age predicted hope scores accounted for 55% of the variance. Implications and suggestions for future research are discussed.

Adaptation, Psychological↗