What is MCS? [plus attachment]

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What is MCS?

_http://www.thecanaryreport.org/mcs-definition/_

(http://www.thecanaryreport.org/mcs-definition/)

What is Multiple Chemical Sensitivity?

by _Susie _ (http://www.thecanaryreport.org/about/editor/) , editor

at The Canary Report

People with an exquisite sensitivity to toxic chemicals are often called

**canaries.** The name comes from the old practice of miners who took

canaries with them into the mines; if the canary died from toxic air in the

shaft, the miners had time to escape with their lives. People with toxic

chemical sensitivities are the canaries of the modern world.

So how does a person develop chemical sensitivities?

In increasing numbers of the population, exposure to certain toxic

chemicals— a one-time mega exposure or a series of long-term micro

exposures—

initiates a chronic illness called Multiple Chemical Sensitivity (MCS), where

the person develops a hyper sensitivity to everyday toxic chemicals found

in consumer goods and the environment. _Current peer reviewed and published

research_ (http://thetenthparadigm.org/mcs09.htm) shows that MCS can be

initiated by seven classes of toxic chemicals. These toxic chemicals include

three classes of pesticides (organophosphorus and carbamate pesticides, the

organochlorine pesticides, and the pyrethroid pesticides) and the very

large class of organic solvents and related compounds. In addition, published

studies implicate mercury, hydrogen sulfide, and carbon monoxide as

initiators. (There also is evidence that MCS can be initiated by some types of

toxic mold, and although it’s not exactly clear through current research

which

mycotoxins are implicated, there is evidence that Stachybotrys molds may

be involved especially when present in **sick buildings.**) Once MCS is

initiated, the person develops hyper sensitivity to low levels of those same

toxic chemicals and others— ubiquitous in the home, work place and

environment

— which results in chronic ill health often becoming serious and

disabling.

Let’s see what the experts have to say about defining MCS. In 1999, a

consensus was reached among a large group of specialists in defining Multiple

Chemical Sensitivity (full document is below at the end of this post). The

abstract of their report reads:

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 defining 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 incitants are removed

[6] propose adding: 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.

In layman’s terms, people with MCS react unfavorably when exposed to any

amount, from minute to gross, of toxic chemicals from products such as

pesticides, cigarette smoke, paint fumes, wood preservatives, photocopier fumes,

perfumes and fragrances, laundry products, dryer sheets, air fresheners,

and epoxy, among many others. Symptoms vary from fleeting to severe and

might include rapid heart rate, shortness of breath, fatigue, flushing,

dizziness, nausea, coughing, difficulty concentrating, problems with memory,

migraine, or even life threatening seizures or respiratory distress. This

chemical sensitivity condition is not rare and the numbers of people who have

it

are growing.

But the truth is, it’s not just chemically sensitive people who are being

affected by a toxic environment. The general public is being _exposed to

tens of thousands of chemicals_

(http://www.greenpeace.org/raw/content/international/press/reports/fragile-our-r\

eproductive-heal.pdf) that didn’t even

exist until a few decades ago. Many of these chemicals, some found in

everyday household products like cleansers and cosmetics, are known to be or

are

suspected of causing cancer, reproductive problems, developmental

disabilities, and heart disease.

People around the world are now sounding the alarm about toxic household

cleansers, clothing and fabrics, electronics, cosmetics and personal care

items, perfumes and fragrances, deodorizers, cleansers and soaps, all the

products about which people with MCS have been alarmed for decades. But now

trends are finally catching up, consumers are making smarter choices with

non-toxic paints and building materials, organic gardens and foods, natural

cleansers and fabrics, and electronics free from flame retardant. Until

government and industry catch up with these progressive trends, the best course

of action is to limit exposure and lead the healthiest life possible.

For more information about Multiple Chemical Sensitivity

Click here to visit The Canary Report _blog_

(http://www.thecanaryreport.org/blog) .

Click here to visit The Canary Report online _social network_

(http://thecanaryreport.ning.com/) .

For a list of citations for peer-reviewed journal articles that support a

physiological basis for MCS, go to _Research on Multiple Chemical

Sensitivity_

(http://www.thecanaryreport.org/2009/05/21/research-on-multiple-chemical-sensiti\

vity-mcs/) , compiled by Professor Anne C. Steinemann and Amy L.

at University of Washington.

Click here to learn more about the current scientific MCS research by

biochemist _ Pall, PhD_ (http://thetenthparadigm.org/mcs09.htm) .

Multiple Chemical Sensitivity is recognized as a disability by the United

States Social Security Administration, Department of Housing and Urban

Development, and the Americans with Disabilities Act, among other government

agencies. To learn more, click on the tags at right “_Disability Rights_

(http://www.thecanaryreport.org/category/law/disability-rights-law/) †and “

_Worker’s Rights_

(http://www.thecanaryreport.org/category/law/workers-rights/)

..â€

To learn more about safe housing, click on _Multiple Chemical Sensitivity

and Safe Housing_ (http://www.thecanaryreport.org/fyi/housing/) .

Click here for links to more _Resources_

(http://www.thecanaryreport.org/resources/) .

Click here to learn more about _Multiple Chemical Sensitivity_

(http://www.thecanaryreport.org/resources/mcs/) from websites around the

world.

Click on a specific category at the top menu bar or tab listed in the

right column for more information on a given topic.

Not finding what you need? Feel free to write me, Susie , editor at

The Canary Report, through the _Contact page_

(http://www.thecanaryreport.org/contact/) .

If you feel isolated or confused with your chemical sensitivities, take

heart. The Canary Report is here to give you trusted news, information and

inspiration!

~~~

MCS Definition

Multiple Chemical Sensitivity: A 1999 Consensus

Archives of Environmental Health v.54, n.3 May/Jun99

ABSTRACT

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 sensitivityâ€

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.

AS RESEARCHERS AND CLINICIANS with experience in the study, evaluation,

diagnosis, and/or care of adults and children with chemical sensitivity

disorders, we support the stated goal of the National Institutes of Health 1999

Atlanta Conference on the Health Impact of Chemical Exposures During the

Gulf War **to fully characterize the nature of multiple chemical exposures

within the Gulf War veteran population and to relate this characterization to

what is known about Multiple Chemical Sensitivity (MCS) and related

conditions and disorders within civilian populations.** (1) Based on research

conducted by state and federal government agencies, we already know that MCS

is one of the most commonly diagnosed chronic disorders in civilians and the

most common—but still largely undiagnosed—disorder of any kind in Gulf

War veterans of the United States.

In statewide telephone surveys 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(2) and 2% of adults in

New Mexico(3) 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.(4–6)

Among Gulf War era veterans, data from the largest random survey presented

by the U.S. Department of Veterans’ Affairs (VA) in 1998 (based on

questionnaires completed by 11 216 deployed to the Gulf and 9 761 nondeployed)

show that 5% reported chemical sensitivity among the nondeployed personnel and

15% reported the same among the deployed.(7) Other VA researchers report

much higher rates—but the same 3-fold difference—in a smaller random sample

of VA hospital outpatients: 86% of ill veterans deployed to the Gulf

complained of chemical sensitivity, compared with 30% of undeployed ill

veterans.(8) In the only study in which MCS was specifically assessed among

veterans selected randomly from the VA Registry, investigators found 36% of 1

004

met common research criteria for MCS.(9) Among randomly selected Department

of Defense (DOD) personnel who remain on active duty, two larger studies

by the Centers for Disease Control found slightly lower—but still significant

—2.1- and 2.5-fold increases in the prevalence of self-reported chemical

sensitivity among those deployed to the Gulf, compared with those who were

not deployed. In the **Iowa** study, in which the prevalence rates for

deployed and nondeployed individuals were 5.4% and 2.6%, respectively,

investigators used a detailed questionnaire to assess “probable MCS.â€(10) In

the

**Pennsylvania** study,(11) in which prevalence rates were 5% versus 2%,

respectively, only one “yes/no†question was asked about chemical

sensitivity. Canadian Gulf War veterans reported only approximately one-half

the

prevalence of MCS (2.4%), but nevertheless this was 4 times more than their

controls.(12) Even in the United Kingdom where MCS is little known, Gulf War

veterans report being diagnosed with MCS at 2.5 times the rate of military

controls.(13)

Clearly, there is a significant need for a standardized clinical

definition of MCS and a comprehensive clinical protocol that VA, DOD, and other

physicians can use to evaluate it. We recommend to our colleagues and the

sponsors of the Atlanta Conference—the Department of Health and Human

Services’

Office of Public Health and Science, the Centers for Disease Control and

Prevention, the National Institutes of Health, and the Agency for Toxic

Substances and Disease Registry—that MCS be formally defined for clinical

purposes by the top 5 **consensus criteria** identified in a 1989 survey of 89

clinicians and researchers who had extensive experience in MCS but who also

held widely divergent views about its etiology.(14) Included were 36

specialists in allergy, 23 in occupational medicine, 20 in **clinical

ecology,**

and 10 in internal medicine and otolaryngology. We would add only that

symptoms associated with chemical exposures must involve multiple organ

systems, thus distinguishing MCS from specific single-organ system disorders

(e.g., asthma, migraine) that also may meet the first 5 criteria.

Consensus Criteria for MCS

The following consensus criteria for the diagnosis of MCS were gleaned

from the study by Nethercott et al.(14) (funded in part by grants from US

NIOSH and US NIEHS):

1. “The symptoms are reproducible with [repeated chemical] exposure.â€

2. “The condition is chronic.â€

3. “Low levels of exposure [lower than previously or commonly

tolerated] result in manifestations of the syndrome.â€

4. “The symptoms improve or resolve when the incitants are removed.â€

5. “Responses occur to multiple chemically unrelated substances.â€

6. [Added in 1999]: Symptoms involve multiple organ systems.

Given the only other explicit consensus ever published on MCS—the 1994

statement of the American Lung Association, American Medical Association, U.S.

Environmental Protection Agency, and U.S. Consumer Product Safety

Commission, that “complaints [of MCS] should not be dismissed as psychogenic,

and a

thorough workup is essential†(ALA 1994)—we recommend that MCS be

diagnosed whenever all 6 of the consensus criteria are met, along with any

other

disorders that also may be present, such as asthma, allergy, migraine,

chronic fatigue syndrome (CFS), and fibromyalgia (FM). MCS should be excluded

only if a single other multi-organ disorder can account for both the entire

spectrum of signs and symptoms and their association with chemical exposures,

such as mastocytosis or porphyria, but not CFS or FM, which are not so

associated.

To assist physicians who are unfamiliar with the evaluation of MCS, we

recommend that clinical protocols include validated questionnaires for

screening and characterizing chemical sensitivity,(15,16) a list of overlapping

disorders to consider in the differential diagnosis of MCS, and a list of

signs and test abnormalities associated with MCS in the peer-reviewed

literature (summarized by Ashford and (17) and Donnay(18)). Although no

single test is yet considered diagnostic of MCS, those suggested by signs,

symptoms, or history may be helpful in treating and tracking the disorder.

The presentation of MCS may 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. We, therefore, recommend that any clinical

diagnosis of MCS be characterized and followed over time using quantitative

and/or

qualitative indices 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).

For research purposes that require greater homogeneity, we encourage

investigators to refine the consensus criteria for MCS with whatever additional

inclusion or exclusion criteria they believe are needed to test their

hypotheses. The indices and domains that are used to characterize and select

both cases and controls in MCS research should be fully reported so that

results from different studies can be compared and their broader applicability

assessed.

Given the significant overlap in clinic populations of MCS with both CFS

and FM, as well as the need to better understand the relationships between

these disorders,(19–21) we recommend that all **solicitations** and

**requests for applications** issued by federal agencies for human research

into

any one of CFS, FM, or MCS direct investigators to screen for all three

(regardless of their selection criteria, which need not be affected) and to

report their results in these terms. There is a precedent for this: the

National Institute of Arthritis and Musculoskeletal Disorders routinely

requires

that in studies of fibromyalgia investigators must screen for and report any

overlap with temporo-mandibular joint disorder. CFS, FM, and MCS research

could all benefit from greater collaboration, and so we welcome the

Congressional initiative of Senator Tom Harkin to earmark $3 million of the

DOD’s

1999 Gulf War illnesses research budget for multidisciplinary studies of

CFS, FM, and MCS together (solicitation 074 & & & -9902-0005 issued 2/12/99) to

better understand both their overlaps and differences. We recommend that

such three-way studies be solicited by all federal agencies funding CFS, FM or

MCS research.

References

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

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

2. Bell IR, Schwartz GE, Amend D, et al. Psychological

characteristics and subjective intolerance for xenobiotic agents of normal

young adults

with trait shyness and defensiveness. A Parkinsonian-like personality type?

J Nerv Ment Dis 1998; 182:367–74.

3. Bell IR, CS, Schwartz GE, et al. Neuropsychiatric and

somatic characteristics of young adults with and without self-reported chemical

odor intolerance and chemical sensitivity. Arch Environ Health 1996; 51:9–

21.

4. Meggs WJ, Dunn KA, Bloch RM, et al. Prevalence and nature of

allergy and chemical sensitivity in a general population. Arch Environ Health

1996; 51(4):275–82.

5. Kang HK, Mahan CM, Lee KY, et al. Prevalence of chronic fatigue

syndrome among US Gulf War veterans. Boston, MA: Fourth International AACFS

Conference on CFIDS, 10 October 1998 (abstract and presentation).

6. Bell IR., Warg-Damiani L, Baldwin CM, et al. Self-reported

chemical sensitivity and wartime chemical exposures in Gulf War veterans with

and

without decreased global health ratings. Mil Med 1998; 163:725–32.

7. Fiedler N, Kipen H, Natelson B. Civilian and veteran studies of

multiple chemical sensitivity. Boston, MA: 216th Annual Meeting of American

Chemical Society, Symposium on Multiple Chemical Sensitivity: Problems for

Scientists and Society, 26 August 1998 (abstract and presentation).

8. Black DW, Doebbing BN, Voelker MD, et al. Multiple Chemical

Sensitivity Syndrome: Symptom Prevalence and Risk Factors in a Military

Population. Atlanta, GA: The Health Impact of Chemical Exposures During the

Gulf War–

A Research Planning Conference. 28 February 1999 (presentation, manuscript

submitted).

9. Fukuda K, Nisenbaum R, et al. 1998. Chronic multisymptom illness

affecting Air Force veterans of the Gulf War. JAMA 1998; 280:981–88.

10. Canadian Department of National Defense (CDND). Health Study of

Canadian Forces Personnel Involved in the 1991 Conflict in the Persian Gulf.

Ottawa, Canada: Goss Gilroy; 20 April 1998. [Online at:

_http://www.DND.ca/menu/press/Reports/Health/health_study_e_vol1_TOC.htm_

(http://www.dnd.ca/menu/press/Reports/Health/health_study_e_vol1_TOC.htm) ]

11. Unwin C, Blatchley N, Coker W, et al. Health of UK servicemen who

served in the Persian Gulf War. Lancet 1999; 353:169–78.

12. Nethercott JR, off LL, Curbow B, et al. Multiple chemical

sensitivities syndrome: toward a working case definition. Arch Environ Health

1993; 48:19–26.

13. Szarek MJ, Bell IR, Schwartz GE. Validation of a brief screening

measure of environmental chemical sensitivity: the chemical odor intolerance

index. J Environ Psychol 1997; 17:345–51.

14. CS, Prihoda TJ. The Environmental Exposure and Sensitivity

Inventory (EESI): a standardized approach for quantifying symptoms and

intolerances for research and clinical applications. Toxicol Ind Health (in

press).

15. Ashford NA, CS. Chemical Exposures: Low Levels and High

Stakes (2nd ed). New York: Wiley, 1998.

16. Donnay A. A Resource Manual for Screening and Evaluating Multiple

Chemical Sensitivity. Baltimore MD: MCS Referral and Resources, 1999.

17. Buchwald D, Garrity D. Comparison of patients with chronic fatigue

syndrome, fibromyalgia, and multiple chemical sensitivities. Arch Int Med

1994; 154:2049–53.

18. Slotkoff AT, Radulovic DA, Clauw DJ. The relationship between

fibromyalgia and the multiple chemical sensitivity syndrome. Scand J Rheumatol

1997; 26:364–67.

19. Donnay A, Ziem G. Prevalence and overlap of chronic fatigue

syndrome and fibromyalgia syndrome among 100 new patients with multiple

chemical

sensitivity syndrome. J Chron Fatigue Syndrome 5(2):(in press).

Signatories to the 1999 Consensus on Multiple Chemical Sensitivity

Liliane Bartha, M.D.

Baumzweiger, M.D.

S. Buscher, M.D.

Callender, M.D., M.P.H.

a A. Dahl, M.D.

Ann off, Ph.D.

Albert Donnay, M.H.S.

B. Edelson, M.D., F.A.A.F.P., F.A.A.E.M.

Barry D. Elson, M.D.

a Elliott, M.D.

Donna P. Flayhan, Ph.D.

Gunnar Heuser, M.D., Ph.D., F.A.C.P.

Penelope M. Keyl, M.Sc., Ph.D.

Kaye H. Kilburn, M.D.

Pamela Gibson, Ph.D.

Leonard A. , Ph.D.

Jozef Krop, M.D.

D. Mazlen, M.D.

Ruth G. McGill, M.D.

McTamney, Ph.D.

J. Meggs, M.D., Ph.D., F.A.C.E.P.

Morton, M.D., Dr.P.H.

Meryl Nass, M.D.

L. Oliver, M.D., M.P.H., F.A.C.P.M.

Dilkhush D. Panjwani, M.D., D.P.M., F.R.C.P.C.

Lawrence A. Plumlee, M.D.

Doris Rapp, M.D., F.A.A.A., F.A.A.P., F.A.A.E.M.

Myra B. Shayevitz, M.D., F.C.C.P., F.A.C.P.

Janette Sherman, M.D.

M. Singer, Ph.D., A.B.P.N.

Anne , Ph.D., M.A.

Aristo Vodjani, Ph.D.

Joyce M. Woods, Ph.D., R.N.

Grace Ziem, M.D., Dr.P.H., M.P.H.