MULTIPLE CHEMICAL SENSITIVITY

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MULTIPLE CHEMICAL SENSITIVITY

Allergies occur when the body's defenses react against substances it does not

tolerate well. These substances may be natural or an added part of food, in

air, in water, or in things that we touch.

The term environmental sensitivity is used to describe allergic reactions and

allergy-like disorders. These reactions usually involve the immune system but

can also affect other systems of the body.

Inhalants such as pollen, dust, mold and even pure foods have long been known

to cause allergies in some people. However, synthetic chemicals that are now

common around us, can also trigger symptoms in persons with no previous

history of allergy or other environmental sensitivity. In some cases the term

chemical allergy is appropriate.

Allergies are not hereditary but the tendency is. Children from families in

which there are allergies have a greater chance of becoming allergic. Family

history or not, anyone can become allergic.

But what about people with the syndrome of Multiple Chemical Sensitivity? Is

it the same as allergies. The answer is yes and no.

Multiple Chemical Sensitivity:

The medical 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 in diagnosing people with MCS are [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 such chemicals are removed). Along with a 6th criterion that

medical

researches now propose adding is that the 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 to 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 to 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. The recommendation is that MCS be formally

diagnosed,

in addition to any other disorders that may be present, in all cases in which

the 6 symptoms of the above mentioned 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.

In a statewide telephone survey of randomly selected adults, conducted by

health departments in California in 1995 and 1996 and New Mexico in 1997,

investigators found that 6% of adults in California' and 2% of adults in New

Mexico

indicated that they had already been diagnosed with MCS or Environmental

Illness, whereas 16% in both states said they were " unusually sensitive to

everyday

chemicals. " When randomly selected adults in other states were asked if they

were " especially sensitive " (instead of " unusually " sensitive), one-third

consistently maintained that they were .

MCS symptoms vary greatly among cases and over time. Some individuals are

totally disabled by severe symptoms suffered on a daily basis, for example,

whereas others are disabled only minimally by mild symptoms suffered

occasionally.

It was recommended that any clinical diagnosis of MCS be characterized and

followed over time. using quantitative and/or qualitative research studies of

life impact or disability (e.g., minimal, partial, total) ; symptom severity

(e.g., mild, moderate, severe); symptom frequency (e.g., daily, weekly,

monthly);

and sensory involvement (identification of which sensory pathways-olfactory,

trigeminal, gustatory auditory, visual and/or touch, including perception of

vibration, pain and heat or cold-show altered (+/-) sensitivity and/or tolerance

for normal levels of stimuli, either chronically or in response to particular

chemical exposures).

Exposures Precipitating Symptoms of MCS

Aerosol air freshener

Aerosol deodorant

After-shave lotion

Asphalt pavement

Cigar smoke

Cigarette smoke

Colognes, perfumes

Diesel exhaust

Diesel fuel

Dry-cleaning fluid

Floor cleaner

Furniture polish

Garage fumes

Gasoline exhaust

Hair spray

Insect repellent

Insecticide spray

Laundry detergent

Marking pens

Nail polish

Nail polish remover

Oil-based paint

Paint thinner

Perfumes in cosmetics

Public restroom deodorizers

Shampoo

Tar fumes from roof or road

Tile cleaners

Varnish, shellac, lacquer

The above precipitants are not all inclusive.

Management

A huge array of treatment strategies for MCS have been proposed, including

antifungal therapies, diets rotated to avoid the offending agents and the

" radical separatist avoidance approach, " which is an attempt to avoid all

exposures

to man-made chemicals.

Principles of Management of MCS Syndrome

First and foremost establish a respectful and empathetic physician-patient

relationship

Principle goals of physician management of symptoms.

Maximize rehabilitation

Control (not cure) symptoms

Treat concomitant psychiatric and physical illness

Encourage the following:

Activity as tolerated

Desensitization to symptom-producing situations

Relaxation exercises

Understanding that autonomic symptoms are not dangerous

Avoid the following:

Unproven therapies such as antifungal medication (for " chronic candidiasis "

{yeast})

Rotating diets

Extreme avoidance of chemicals

Isolation, social withdrawal

Nutritional supplements not recommended by your physician.

***As a licensed practitioner it is my obligation to inform you that dietary

and nutritional supplements are not regulation by the FDA. There is no way to

tell the exact amount of the active ingredient present or to know if the

supplement is contraindicated with medications you may be taken, either by

prescription or over the counter.

What you can do if you suspect that you have MCS

If consultation is desired, contact an occupational and environmental health

physician or the Association of Occupational and Environmental Clinics

(telephone: 202-347-4976).

For more information on this illness write to

K. Magill, M.D., Department of Family and Preventive Medicine,

University of Utah School of Medicine, 50 N. Medical Dr., 1C26SOM, Salt Lake

City,

UT 84132.

References

Eisenberg J. Report to Congress on Research on Multiple Chemical Exposures

and Veterans with Gulf War Illnesses. Washington DC: US Department of Health and

Human Services, Office of Public Health and Science. 15 January 1998.

Henneberger PK. Patients with multiple chemical sensitivities in an

occupational health clinic: presentation and follow-up. Arch Environ Health

1995;

50:425-31.

Kreutzer R, Neutra R, Lashuay N. The prevalence of people reporting

sensitivities to chemicals in a population-based survey. Am I Epidemiol (in

press).

Voorhees RE. Memorandum from New Mexico Deputy State Epidemiologist to Joe

, Special Counsel, Office of the Governor; 13 March 1998.