Identification of responsible volatile chemicals that induce hypersensitive reactions to multiple chemical sensitivity patients

Multiple Chemical Sensitivity: It's time to catch up to the science

Multiple chemical sensitivity (MCS) is a complex medical condition associated with low dose chemical exposures. MCS is characterized by diverse features and common comorbidities, including fibromyalgia, cough hypersensitivity, asthma, and migraine, and stress/anxiety, with which the syndrome shares numerous neurobiological processes and altered functioning within diverse brain regions. Predictive factors linked to MCS comprise genetic influences, gene-environment interactions, oxidative stress, systemic inflammation, cell dysfunction, and psychosocial influences. The development of MCS may be attributed to the sensitization of transient receptor potential (TRP) receptors, notably TRPV1 and TRPA1. Capsaicin inhalation challenge studies demonstrated that TRPV1 sensitization is manifested in MCS, and functional brain imaging studies revealed that TRPV1 and TRPA1 agonists promote brain-region specific neuronal variations. Unfortunately, MCS has often been inappropriately viewed as stemming exclusively from psychological disturbances, which has fostered patients being stigmatized and ostracized, and often being denied accommodation for their disability. Evidence-based education is essential to provide appropriate support and advocacy. Greater recognition of receptor-mediated biological mechanisms should be incorporated in laws, and regulation of environmental exposures.

PAS1-modified optical SIS sensor for highly sensitive and specific detection of toluene

We report on a novel solution immersed silicon (SIS) sensor modified with bio-receptor to detect toluene. To perform this approach, bio-receptor PAS1 which specifically interacts with toluene was chosen as a capture agent for SIS ellipsometric sensing. We constructed wild PAS1 and mutant PAS1 (F46A and F79Y) which are toluene binding-defective. Especially, we utilized an easily accessible capturing approach based on silica binding peptide (SBP) for direct immobilization of PAS1 on the SiO₂ surfaces. After the immobilization of SBP-tagged PAS1 to the sensing layers, PAS1-based SIS sensor was evaluated for its ability to recognize toluene. As a result, a significant up-shift in Psi (Ψ) was clearly observed with a low limit of detection (LOD) of 0.1 μM, when treated with toluene on wild PAS1-surface, but not on mutant PAS1-sensing layers, indicating the selective interactions between PAS1 and toluene molecule. The PAS1-SIS sensor showed no changes in Psi (Ψ), if any, negligible, when exposed to benzene, phenol, xylene and 4-nitrophenol as negative controls, thereby demonstrating the specificity of interaction between PAS1 and toluene. Taken together, our results strongly indicate that PAS1-modified ellipsometry sensor can provide a high fidelity system for the accurate and selective detection of toluene.

Spatial variation in risk for physician diagnosed environmental sensitivity

Multiple chemical sensitivity (MCS) is a chronic condition characterized by recurring and severe symptoms triggered by exposures to low levels of toxicants or anthropogenic pollution. This study investigated the spatial structure of MCS incidence and estimated the contribution of socio-economic deprivation to variations in rates of MCS at the community level in Nova Scotia, Canada. Patient data were used to calculate cumulative incidence rate ratios for treated multiple chemical sensitivities. Poisson regression with a spatially autoregressive random effect was employed to assess spatial variation in MCS. Odds of MSC incidence are greatest among patients from the highest socioeconomic category using the most socioeconomically deprived category as reference (OR: 1.94, CI [2.5-95%] 1.45-2.56). No discernable spatial pattern for MCS risk was evident after controlling for known risk factors. This is the first study to investigate spatial variations in cumulative incidence of multiple chemical sensitivities. The socioeconomic status of the community in which patients live has a significant influence on the geographic patterns of MCS. Future research will include a smartphone application to assess positional and temporal information on environmental exposures to further explain MCS prevalence.

Characterization of the variation of carbonyl compounds concentrations before, during, and after the renovation of an apartment at Niterói, Brazil

The present work reports the variation of 31 carbonyl compounds (CC) in an apartment located at Niterói City, Rio de Janeiro State, Brazil. Eight sampling campaigns were conducted through a 1-year period, and three areas (living room, kitchen, and bedroom) were evaluated before, during, and after the renovation activities and reoccupation of the apartment. Samples were collected using SEP-PAK cartridges impregnated with 2,4-dinitrophenylhydrazine, and the hydrazones were analyzed using rapid resolution liquid chromatography with UV detection. The lowest total concentration of CC (19.0 ± 1.5 μg m(-3)) was found before the renovation when the apartment was empty, but door varnishing resulted in highest contamination of the apartment (1386 ± 384 μg m(-3)); however, an important dispersion of CC was observed in the subsequent sampling (148 ± 1.8 μg m(-3)). After apartment reoccupation, the indoor contamination seemed to depend on the routine activities taken there, such as household product use and cooking activities, but apparently, local temperature increase favored the vaporization of the volatile CC from the building materials in the apartment. As far as we are concerned, this is the first study comparing the concentrations of 31 CC in residential areas before, during, and after renovation activities taken in Brazil.

The Role of Plant-Microbe Interactions and Their Exploitation for Phytoremediation of Air Pollutants

Since air pollution has been linked to a plethora of human health problems, strategies to improve air quality are indispensable. Despite the complexity in composition of air pollution, phytoremediation was shown to be effective in cleaning air. Plants are known to scavenge significant amounts of air pollutants on their aboveground plant parts. Leaf fall and runoff lead to transfer of (part of) the adsorbed pollutants to the soil and rhizosphere below. After uptake in the roots and leaves, plants can metabolize, sequestrate and/or excrete air pollutants. In addition, plant-associated microorganisms play an important role by degrading, detoxifying or sequestrating the pollutants and by promoting plant growth. In this review, an overview of the available knowledge about the role and potential of plant-microbe interactions to improve indoor and outdoor air quality is provided. Most importantly, common air pollutants (particulate matter, volatile organic compounds and inorganic air pollutants) and their toxicity are described. For each of these pollutant types, a concise overview of the specific contributions of the plant and its microbiome is presented. To conclude, the state of the art and its related future challenges are presented.

In-situ Real-Time Monitoring of Volatile Organic Compound Exposure and Heart Rate Variability for Patients with Multiple Chemical Sensitivity

In-situ real-time monitoring of volatile organic compound (VOC) exposure and heart rate variability (HRV) were conducted for eight multiple chemical sensitivity (MCS) patients using a VOC monitor, a Holter monitor, and a time-activity questionnaire for 24 h to identify the relationship between VOC exposure, biological effects, and subjective symptoms in actual life. The results revealed no significantly different parameters for averaged values such as VOC concentration, HF (high frequency), and LF (low frequency) to HF ratio compared with previous data from healthy subjects (Int. J. Environ. Res. Public Health2010, 7, 4127–4138). Significant negative correlations for four subjects were observed between HF and amounts of VOC change. These results suggest that some patients show inhibition of parasympathetic activities along with VOC exposure as observed in healthy subjects. Comparing the parameters during subjective symptoms and normal condition, VOC concentration and/or VOC change were high except for one subject. HF values were low for five subjects during subjective symptoms. Examining the time-series data for VOC exposure and HF of each subject showed that the subjective symptoms, VOC exposure, and HF seemed well related in some symptoms. Based on these characteristics, prevention measures of symptoms for each subject may be proposed.

Double-blind non-controlled chemical challenge with environmental toxicological assessment in a Multiple Chemical Sensitivity case

The report of a Multiple Chemical Sensitivity case highlights two original points. First, even if non-controlled, the reappearance of MCS symptoms after an accidental re-exposure to one scentless semi-volatile chemical (permethrin) of the initial toxic cocktail exposure can be considered as a double blind re-exposure study in situ. Second, environmental toxicology investigations were warrant for a correct treatment and prevention measures.

A novel methodology to evaluate health impacts caused by VOC exposures using real-time VOC and Holter monitors

While various volatile organic compounds (VOCs) are known to show neurotoxic effects, the detailed mechanisms of the action of VOCs on the autonomic nervous system are not fully understood, partially because objective and quantitative measures to indicate neural abnormalities are still under development. Nevertheless, heart rate variability (HRV) has been recently proposed as an indicative measure of the autonomic effects. In this study, we used HRV as an indicative measure of the autonomic effects to relate their values to the personal concentrations of VOCs measured by a real-time VOC monitor. The measurements were conducted for 24 hours on seven healthy subjects under usual daily life conditions. The results showed HF powers were significantly decreased for six subjects when the changes of total volatile organic compound (TVOC) concentrations were large, indicating a suppression of parasympathetic nervous activity induced by the exposure to VOCs. The present study indicated these real-time monitoring was useful to characterize the trends of VOC exposures and their effects on autonomic nervous system.

Modified perfluorocarbon tracer method for measuring effective multizone air exchange rates

A modified procedure was developed for the measurement of the effective air exchange rate, which represents the relationship between the pollutants emitted from indoor sources and the residents’ level of exposure, by placing the dosers of tracer gas at locations that resemble indoor emission sources. To measure the 24-h-average effective air exchange rates in future surveys based on this procedure, a low-cost, easy-to-use perfluorocarbon tracer (PFT) doser with a stable dosing rate was developed by using double glass vials, a needle, a polyethylene-sintered filter, and a diffusion tube. Carbon molecular sieve cartridges and carbon disulfide (CS₂) were used for passive sampling and extraction of the tracer gas, respectively. Recovery efficiencies, sampling rates, and lower detection limits for 24-h sampling of hexafluorobenzene, octafluorotoluene, and perfluoroallylbenzene were 40% ± 3%, 72% ± 5%, and 84% ± 6%; 10.5 ± 1.1, 14.4 ± 1.4, and 12.2 ± 0.49 mL min⁻¹; and 0.20, 0.17, and 0.26 μg m⁻³, respectively.

Formaldehyde removal from air by a biodegradation system

A biodegradation system was used for the treatment of formaldehyde-polluted air. Air pressure dropped 12 mm water in the trickling biofilter during the experiment of about 4 months. In the range 20-300 mg m(-3) influent formaldehyde, this biodegradation system obtained 4.0-40.0 mg h(-1) degradation capacity, with 100%-66.7% degradation efficiency. The amount of formaldehyde degraded by the trickling biofilter was more than that by the activated sludge bioreactor below 200 mg m(-3) influent gaseous formaldehyde while the amount by the trickling biofilter was less than that by the activated sludge bioreactor over 200 mg m(-3) influent gaseous formaldehyde.

A simple method for screening emission sources of carbonyl compounds in indoor air

Volatile organic compounds (VOCs) emitted from building and furnishing materials are frequently observed in high concentrations in indoor air. Nondestructive analytical methods that determine the main parameters influencing concentration of the chemical substances are necessary to screen for sources of VOC emissions. Toward this goal, we have developed a new flux sampler, referred to herein as an emission cell for simultaneous multi-sampling (ECSMS), that is used for screening indoor emission sources of VOCs and for determining the emission rates of these sources. Because the ECSMS is based on passive sampling, it can be easily used on-site at a low cost. Among VOCs, low-molecular-weight carbonyl compounds including formaldehyde are frequently detected at high concentrations in indoor environments. In this study, we determined the reliability of the ECSMS for the collection of formaldehyde and other carbonyl compounds emitted from wood-based composites of medium density fiberboards and particleboards. We then used emission rates determined by the ECSMS to predict airborne concentrations of formaldehyde emitted from a bookshelf in a large chamber, and these data were compared to formaldehyde concentrations that were acquired simultaneously by means of an active sampling method. The values obtained from the two methods were quite similar, suggesting that ECSMS measurement is an effective method for screening primary sources influencing indoor concentrations of formaldehyde.

Passive emission colorimetric sensor (PECS) for measuring emission rates of formaldehyde based on an enzymatic reaction and reflectance photometry

A coin-sized passive emission colorimetric sensor (PECS) based on an enzymatic reaction and a portable reflectance photometry device were developed to determine the emission rates of formaldehyde from building materials and other materials found indoors in only 30 minutes on-site. The color change of the PECS linearly correlated to the concentration of formaldehyde aqueous solutions up to 28 microg/mL. The correlation between the emission rates measured by using the PECS and those measured by using a desiccator method or by using a chamber method was fitted with a linear function and a power function, and the determination coefficients were more than 0.98. The reproducible results indicate that the emission rates could be obtained with the correlation equations from the data measured by using the PECS and the portable reflectance photometry device. Limits of detection (LODs) were 0.051 mg/L for the desiccator method and 3.1 microg/m2/h for the chamber method. Thus, it was confirmed that the emission rates of formaldehyde from the building materials classified as F four-star (< 0.3 mg/L (desiccator method) or < 5.0 microg/m2/h (chamber method)), based on Japanese Industrial Standards (JIS), could be measured with the PECS. The measurement with PECS was confirmed to be precise (RSD < 10%). Other chemicals emitted from indoor materials, such as methanol, ethanol, acetone, toluene, and xylene, interfered little with the measurement of formaldehyde emission rates by using the PECS.

Sequence variations in subjects with self-reported multiple chemical sensitivity (sMCS): a case-control study

Polymorphisms in several genes contribute to interindividual differences in the metabolism of xenobiotics, and may lead to toxicity and disease. The balance between activation and/or detoxification processes may influence an individual's susceptibility to disease. One postulated mechanism underlying multiple chemical sensitivity (MCS) is based on increased metabolism of xenobiotics. The aim of the present study was to determine such polymorphisms in cases with self-reported MCS (sMCS) and controls. sMCS cases (14 men, 45 women, mean age: 48 yr) and controls (14 men, 26 women, mean age: 44 yr) of the same anthroposphere were characterized using the MCS-questionnaire from Huppe and coworkers (2000) and a standardized questionnaire for living conditions and living factors. Allelic frequencies of genomic variations for 5HTT, NAT1, NAT2, PON1, PON2, and SOD2 were determined. The MCS questionnaire from Huppe et al. (2000) differentiated between cases and controls with 87.5% sensitivity and 90% specificity. Compared to controls the sMCS cases had lower exposures, especially to odorous factors, and worse social conditions. No significant differences of the allelic distribution of genetic polymorphisms in the genes for 5HTT, NAT1, NAT2, PON1, PON2, and SOD2 were found between cases and controls. The results are in contrast to the study of McKeown-Eyssen and coworkers (2004) but in accordance with the German MCS multicenter study. Although the MCS questionnaire from Huppe et al. (2000) allowed us to differentiate sMCS cases and controls, it was not strong enough for a discrimination based on sequence variations in genes for enzymes involved in xenobiotic metabolism. Therefore, further research needs to focus on a unique phenomenological characterization of MCS.

Multiple chemical sensitivity in the clinical setting

Multiple chemical sensitivity (MCS) is a condition in which people experience a broad array of symptoms in reaction to exposure to trace amounts of common chemicals. Symptoms are most often triggered by odors, typically affect many systems, and can range from a runny nose to difficulty breathing and heart palpitations. The cause of this condition is unclear and there is no universal consensus on how to diagnose or treat it. MCS afflicts millions of Americans, although its prevalence is difficult to establish reliably. Theories of causation include both the physical and the psychogenic. This article begins with a case study, describes the current research on MCS, and offers recommendations to guide nurses when treating these patients in the hospital.

Symptom profile of multiple chemical sensitivity in actual life

OBJECTIVE

This study was conducted to confirm the definition of multiple chemical sensitivity (MCS) in actual life: that multiple symptoms are provoked in multiple organs by exposure to, and ameliorated by avoidance of, multiple chemicals at low levels. We used the Ecological Momentary Assessment to monitor everyday symptoms and the active sampling and passive sampling methods to measure environmental chemical exposure.

METHODS

Eighteen patients with MCS, diagnosed according to the 1999 consensus criteria, and 12 healthy controls participated in this study. Fourteen patients and 12 controls underwent 1-week measurement of physical and psychologic symptoms and of the levels of exposure to various chemicals. Linear mixed models were used to test the hypotheses regarding the symptom profile of MCS patients.

RESULTS

Some causative chemicals were detected in 11 of 14 MCS patients. Two other patients did not report any hypersensitivity episodes, whereas passive sampling showed far less exposure to chemicals than control subjects. Another subject reported episodic symptoms but was excluded from the following analyses because no possible chemical was detected. Eleven of the 17 physical symptoms and all four mood subscales examined were significantly aggravated in the interview based on "patient-initiated symptom prompts." On the other hand, there were no differences in physical symptoms or mood subscales between MCS patients and control subjects in the interview based on "random prompts."

CONCLUSIONS

MCS patients do not have either somatic or psychologic symptoms under chemical-free conditions, and symptoms may be provoked only when exposed to chemicals.

Symptoms in relation to chemicals and dampness in newly built dwellings

OBJECTIVES

As the airtightness of dwellings has recently increased, problems associated with indoor air pollution and dampness have become important environmental health issues. The aim of this study was to clarify whether symptoms in residents living in newly built dwellings were related to chemicals and dampness.

METHODS

Symptoms of 317 residents were surveyed by standardized questionnaires, and the concentrations of formaldehyde, acetaldehyde, and 17 volatile organic compounds (VOCs) in their homes were measured. Dampness (condensation on window panes and/or walls, and mold growth) was identified by questionnaires given to the householders or their partners.

RESULTS

Some VOCs (toluene, butyl acetate, ethylbenzene, alpha-pinene, p-dichlorobenzene, nonanal, and xylene) were significantly related to the symptoms, and the sum of all VOCs (all identified VOCs) was significantly related to throat and respiratory symptoms [odds ratio (OR) for eye symptoms =2.4; 95% confidence interval (CI) 1.0-5.5], although the concentrations of VOCs were relatively low. As for the dampness index, condensation on window panes and/or walls was related to all symptoms, and mold growth was related to all symptoms except skin, throat and respiratory and general symptoms. As the number of dampness signs increased, the ORs increased for the symptoms except general symptoms (OR for nose symptoms = 4.4, 95% CI 1.6-11.9).

CONCLUSION

Both VOCs and dampness were significantly related to symptoms. We should take measures to reduce the concentrations of VOCs, dampness and microbial growth in dwellings.