Psychological Bases of Symptom Reporting: Perceptual and Emotional Aspects of Chemical Sensitivity

The reporting of physical symptoms is influenced to a large degree by psychological processes. Individuals are more likely to notice subtle sensations in environments lacking in stimulation than those demanding external attention. The beliefs or schemas that people hold dictate where and how they attend to their bodies as well. These normal perceptual processes help explain why people are of ten poor at accurately detecting internal physiological activity. Several individual differences are also related to the symptom reporting process. Females are more likely to base their symptom reports on external situational cues than are males. In addition, individuals with chronic anxiety those high in Negative Affectivity (NA) report more symptoms than those low in NA. Finally, individuals who have had traumatic experiences, either in childhood or within 16 months prior to a major symptom reporting episode, tend to be high symptom reporters. Several recommendations are made to help researchers and clinicians distinguish between psychological or perceptual factors with presumed biological effects. One implication of this work is that MCS and allied syndromes should be viewed as both a mental and a physical health problem.

Epidemiological association between multiple chemical sensitivity and birth by caesarean section: a nationwide case-control study

INTRODUCTION

Multiple chemical sensitivity (MCS) is characterized by recurrent nonspecific symptoms that are attributed to exposure to trace levels of environmental agents. Although the clinical symptoms of MCS have been described in several studies, the risk factors for this condition remain unclear. Our aim was to clarify the risk factors for MCS and the association between MCS and birth by caesarean section.

METHODS

We conducted a nationwide case-control study of Japanese individuals (aged 20-65 years) with physician-diagnosed MCS (183 cases) and without MCS (345 controls). The study participants were selected from among 150,000 people in a web-based research panel with approximately 1,000,000 registrants. They completed an online survey including questions on their sociodemographic characteristics, birth history (i.e., birth by caesarean section), and other potential risk factors for MCS. Multivariate logistic regression analysis was employed to determine the association between sociodemographic characteristics and the risk of MCS.

RESULTS

The proportions of case and control subjects who were born by caesarean section were 39.9 and 7.0%, respectively. The association between birth by caesarean section and MCS was significant even after adjusting for potential confounders (adjusted odds ratio: 6.15; 95% confidence interval: 3.13-12.1). A history of agricultural work, mouth breathing, ≥11 vaccinations in the past 10 years, and residing in a new home (< 1 year-old) ≥3 times were also significantly associated with MCS.

CONCLUSION

Our data indicate an epidemiological link between MCS and birth by caesarean section. Moreover, we show that factors other than chemical exposure may be associated with the development of MCS.

From individual coping strategies to illness codification: the reflection of gender in social science research on multiple chemical sensitivities (MCS)

INTRODUCTION

Emerging fields such as environmental health have been challenged, in recent years, to answer the growing methodological calls for a finer integration of sex and gender in health-related research and policy-making.

METHODS

Through a descriptive examination of 25 peer-reviewed social science papers published between 1996 and 2011, we explore, by examining methodological designs and theoretical standpoints, how the social sciences have integrated gender sensitivity in empirical work on Multiple Chemical Sensitivities (MCS). MCS is a "diagnosis" associated with sensitivities to chronic and low-dose chemical exposures, which remains contested in both the medical and institutional arenas, and is reported to disproportionately affect women.

RESULTS

We highlighted important differences between papers that did integrate a gender lens and those that did not. These included characteristics of the authorship, purposes, theoretical frameworks and methodological designs of the studies. Reviewed papers that integrated gender tended to focus on the gender roles and identity of women suffering from MCS, emphasizing personal strategies of adaptation. More generally, terminological confusions in the use of sex and gender language and concepts, such as a conflation of women and gender, were observed. Although some men were included in most of the study samples reviewed, specific data relating to men was undereported in results and only one paper discussed issues specifically experienced by men suffering from MCS. Papers that overlooked gender dimensions generally addressed more systemic social issues such as the dynamics of expertise and the medical codification of MCS, from more consistently outlined theoretical frameworks. Results highlight the place for a critical, systematic and reflexive problematization of gender and for the development of methodological and theoretical tools on how to integrate gender in research designs when looking at both micro and macro social dimensions of environmental health conditions.

CONCLUSIONS

This paper contributes to a discussion on the methodological and policy implications of taking sex and gender into account appropriately in order to contribute to better equity in health, especially where the critical social contexts of definition and medico-legal recognition play a major role such as in the case of MCS.

Acquired lightheadedness in response to odors after hyperventilation

OBJECTIVE

This study aimed to investigate whether lightheadedness in response to odors could be acquired through previous associations with hyperventilation-induced hypocapnia.

METHODS

Diluted ammonia and acetic acid served as conditional odor cues (CSs) in a differential associative learning paradigm. Hyperventilation-induced hypocapnia (unconditional stimulus [US]) was used to induce lightheadedness. In a training phase, participants (n = 28) performed three hypocapnic and three normocapnic overbreathing trials of 60 seconds each. One odor was consistently paired with the hypocapnic overbreathing (CS+); the other (control) odor was paired with normocapnic overbreathing (CS-). In the test phase, each odor was presented once during spontaneous breathing and once during normocapnic overventilation. Lightheadedness was assessed online during each breathing trial, which was followed by an extensive hyperventilation symptom checklist. Fractional end-tidal CO2, breathing frequency, and inspiratory volume were measured throughout the experiment.

RESULTS

In the test phase, participants experienced lightheadedness more quickly in response to the odor that had been paired with hypocapnic overbreathing compared with the control odor. They also scored higher on the symptom "feeling unreal."

CONCLUSION

Lightheadedness in response to odors can be acquired easily. The present results may help to elucidate the paradox that both avoidance and exposure to chemicals seem to be effective in reducing symptoms in idiopathic environmental illness.

Illnesses you have to fight to get: facts as forces in uncertain, emergent illnesses

Chronic fatigue syndrome and multiple chemical sensitivity are two clusters of illnesses that are pervaded by medical, social and political uncertainty. This article examines how facts are talked about and experienced in struggles over these emergent, contested illnesses in the US. Based principally on a large archive of internet newsgroup postings, and also on fieldwork and on published debates, it finds that (1) sufferers describe their experiences of being denied healthcare and legitimacy through bureaucratic categories of exclusion as dependent upon their lack of biological facts; (2) institutions manage these exclusions rhetorically through exploiting the open-endedness of science to deny efficacy to new facts; (3) collective patient action responds by archiving the systematic nature of these exclusions and developing counter-tactics. The result is the maintenance of these very expensive struggles for all involved.

The Problems of Multiple-Chemical Sensitivity Patients in Using Medicinal Drugs

Multiple-chemical sensitivity (MCS) patients are presumed to be compelled to lead inconvenient and difficult lives, because unpleasant and multiorgan symptoms are caused by very small amounts of various chemicals in the living environment. Therefore we conducted a questionnaire survey of MCS patients who are members of support groups to elucidate the problems of MCS patients in using medicinal drugs. In this report, we selected 205 persons who stated that they had been "diagnosed with MCS by a physician" or "a physician suspected a diagnosis of MCS" on the questionnaire as the reason they judged themselves to have MCS. The questionnaire results showed that about 60% of MCS patients have difficulty in using medicinal drugs and that the difficulties are more likely to occur in women, in people 40-59 years old, and in patients who developed MCS in reaction to pesticides or medicinal drugs. The prescribed drugs and OTC drugs noted as usable or unusable by patients in the questionnaire were analyzed from the viewpoint of their medicinal constituents. The results indicated that lidocaine is likely to be unusable by MCS patients. In addition, caffeine, aspirin, chlorphenylamine maleate, minocycline hydrochloride, levofloxacin, etc. were also likely to be unusable by MCS patients. Many patients who recorded drugs containing the above-mentioned remedies as unusable had a past history of allergy, suggesting that allergy is involved in the difficulties of MCS patients in using medicinal drugs.

Repeated low level formaldehyde exposure produces enhanced fear conditioning to odor in male, but not female, rats

Multiple chemical sensitivity (MCS) is an ill-defined disorder in humans attributed to exposure to volatile organic compounds. This study draws on apparent parallels between individuals with posttraumatic stress disorder (PTSD) and panic disorder and a subset of those reporting MCS, using a conditioned fear task in rats. Male and female Sprague-Dawley rats were given repeated exposure to 2 ppm formaldehyde (Form) (1 h/day x 5 days/week x 4 week) or air, and after 2-3 weeks, rats were trained on the conditioned fear task. One half of Air and Form rats were given odor (orange oil, the conditioned stimulus, CS) paired with footshock (PRD) and the other half was given the same stimuli in an unpaired manner (UNP). After 24 h, rats were placed into the same context without the CS or footshock. Male and female PRD groups demonstrated contextual freezing 5-15% of the time, while the UNP groups showed freezing 30-50% of the time, with no effect of Air or Form pretreatment. For the next 5 days, rats were placed into a novel context and tested for freezing in the absence or presence of the CS. In male rats, Form pretreatment produced a significantly greater freezing response in both UNP and PRD groups in the presence of the CS, with no differences in freezing in the absence of the CS. In female rats, no significant differences between Form pretreated rats and Air controls were observed in either the PRD or UNP groups. The increase in conditioned fear responding to the CS after Form exposure in males suggests that repeated low-level Form may act as a stressor to produce sensitized responding within olfactory/limbic pathways, and may help explain the panic-like responses observed in a subset of individuals reporting MCS. Furthermore, the male/female differences suggest a gonadal hormonal contribution to this behavior.

Sub-chronic exposure to toluene at 40ppm alters the monoamine biosynthesis rate in discrete brain areas

Effects of long-term exposure to a sub-toxic concentration of toluene (40 ppm, 104 h per week, 16 weeks) have been studied on monoamine biosynthesis rate in rat. The activities of the rate limiting enzymes in catecholamine and 5-hydroxytryptamine biosynthesis tyrosine and tryptophan hydroxylase, respectively, were estimated in vivo by measuring the accumulation of l-dihydroxyphenylalanine and 5-hydroxytryptophan after pharmacological blockade of l-aromatic acid decarboxylases by NSD-1015 (100 mg kg(-1) ip). The sub-chronic exposure to toluene led to a significant and gender dependent alteration in both catecholamine and 5-hydroxytryptamine biosynthesis rate in brainstem catecholaminergic cell groups and hypothalamus. In females exposed to toluene, changes in tryptophan hydroxylation were found in rostral subset of A2C2 (+41%) and in A1C1 (+41%) while a decrease in A5 (-44%) and an increase in A2C2 (+28%) were found in tyrosine hydroxylation. In males, an increase in tryptophane hydroxylation was observed in rostral subset of A2C2 (+35%) while a decrease was observed in ventro-median hypothalamus (-17%). These results suggest that toluene exposure to a dose generally recognized as sub-toxic (40 ppm, no observed adverse effect level) leads to adverse effects on monoaminergic systems. Therefore, the neurotoxicity of toluene should be carefully re-evaluated taking into account not only the exposure level but also the duration.

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

Multiple chemical sensitivity (MCS) has become a serious problem as a result of airtight techniques in modern construction. The mechanism of the MCS, however, has not been clarified. Responsible chemicals and their exposure levels for patient's hypersensitive reactions need to be identified. We measured the exposure of 15 MCS patients to both carbonyl compounds and volatile organic compounds (VOCs) that may induce hypersensitive reactions. The exposures of those not suffering from MCS (non-MCS individuals) were also measured at the same time. To characterize the chemicals responsible for MCS symptoms, we applied a new sampling strategy for the measurement of carbonyls and VOCs using active and passive sampling methods. The results of our study clearly demonstrated that the chemicals responsible for such hypersensitive reactions varied from patient to patient. Moreover, the concentrations during hypersensitive symptoms, which were apparent in some of the MCS patients, were far below both the WHO and the Japanese indoor guidelines. The average exposure levels of MCS patients within a 7-day period were lower than those of paired non-MCS individuals except for a few patients who were exposed to chemicals in their work places. This result indicates that the MCS patients try to keep away from exposures to the chemical compounds that cause some symptoms.

Are syndromes in environmental medicine variants of somatoform disorders?

To date, relatively little is known about the etiology, pathophysiology, diagnosis, therapy, prevention and prognosis of environment-related syndromes like multiple chemical sensitivity (MCS), idiopathic environmental intolerance (IEI), sick building syndrome (SBS), chronic fatigue syndrome (CFS), candida syndrome (CS) and burnout syndrome (BS). Part of the reason is that these syndromes have not been clearly defined and classified in scientific categories distinct from each other, and that they show clinical similarities to classified somatoform disorders. Furthermore, there are at least three possible explanations for the existence of these syndromes: (1) The syndromes may result from the interaction of environmental factors, individual susceptibility and psychological factors (i.e., how they are perceived and seen by the patient); (2) they may reflect socially and culturally accepted methods of expressing distress; and/or (3) they may be iatrogenic. Despite all the uncertainties in evaluation of environmental syndromes, physicians have the duty to take the affected person's problems seriously. A comprehensive systematic classification which better accounts for these complex clinical manifestations is long overdue. Until these syndromes are well defined, the terms used for them should definitely not be applied to connote a specific disease process.

Media warnings about environmental pollution facilitate the acquisition of symptoms in response to chemical substances

OBJECTIVE

Previous studies showed that somatic symptoms can be acquired in response to chemical substances using an associative learning paradigm, but only when the substance was foul smelling and not when it smelled pleasant. In this study, we investigated whether warnings about environmental pollution would facilitate acquiring symptoms, regardless of the pleasantness of the smell.

METHOD

One group received prior information framing the study in the context of the rapidly increasing chemical pollution of our environment. Another group received no prior information. Conditional odor stimuli (CS) were diluted ammonia (foul-smelling) and niaouli (neutral-positive smelling); the unconditional stimulus (UCS) was 10% CO2-enriched air. Each subject breathed one odor mixed with CO2 and a control odor mixed with air in 80-sec breathing trials. The type of odor mixed with CO2 was counterbalanced across participants. Next, the same breathing trials were administered without CO2. Breathing behavior was measured during each trial; subjective symptoms were assessed after each trial.

RESULTS

Only participants who had been given warnings about environmental pollution reported more symptoms to the odor that had previously been associated with CO2, compared with the control odor. This was so for both the foul- and the pleasant-smelling odor. Symptom learning did not occur in the group that did not receive warnings. The elevated symptom level could not be accounted for by altered respiratory behavior, nor by experimental demand effects.

CONCLUSIONS

Raising environmental awareness through warnings about chemical pollution facilitates learning of subjective health symptoms in response to chemical substances.

Multiple chemical sensitivity and idiopathic environmental intolerance (part two)

Multiple chemical sensitivity/idiopathic environmental intolerance (MCS/IEI) is a commonly used diagnostic term for a group of symptoms without apparent organic basis. The symptoms are characteristic of dysfunction in multiple organ systems. They wax and wane fluctuate according to exposure to low levels of chemical agents in the patient's environment, and sometimes begin after a distinct environmental change or injury such an industrial accident or chemical introduced after remodeling. Although traditional medical organizations have not agreed on a definition for this syndrome, it is being increasingly recognized and makes up an increasing percentage of the caseload at occupational/environmental medical clinics.Part two of this review article discusses diagnosis, clinical examination, long-term follow up of MCS/IEI, and the role of physicians, research on odor and treatment, diseases with similar symptoms, and further research regarding MCS/IEI patients.

Multiple chemical sensitivity and idiopathic environmental intolerance (part one)

Multiple chemical sensitivity/idiopathic environmental intolerance (MCS/IEI) is a commonly used diagnostic term for a group of symptoms. These symptoms have been described and commented on for more than 15 years in the USA. Recently, it has also been observed in Japan. The main features of this syndrome are multiple symptoms involving in multiple organ systems that are precipitated by a variety of chemical substances with relapses and exacerbation under certain conditions when exposed to very low levels which do not affect the population at large. There are no laboratory markers or specific investigative findings. Although traditional medical organizations have not agreed on a definition for this syndrome due to the lack of obvious evidence to demonstrate the existence of these symptoms, it is being increasingly recognized. It constitutes an increasing percentage of the caseload at occupational/environmental medical clinics.Part one of this review article discusses pathophysiological theories, substances which cause symptoms, prevalence in the general and specific populations, past history and family history, and clinical symptoms of MCS/IEI patients.

Symptomatology and etiology of multiple chemical sensitivities in the southeastern United States

A questionnaire was administered to individuals who had reported a hypersensitivity to common chemical products in an earlier epidemiological study in the Atlanta, Georgia, metropolitan area. The questionnaire investigated the nature of the symptoms and factors that potentially initiated hypersensitivity and subsequently triggered reactions. Also examined were associated lifestyle modifications and the relationships of hypersensitivity with other illnesses. The authors found that a majority of hypersensitive individuals (52.2%) experienced either "severe" or "somewhat severe" symptoms. The most common triggers of symptoms were cleaning products (88.4%), tobacco smoke (82.6%), perfume (81.2%), pesticides (81.2%), and car exhaust (72.5%). Only 1.4% of the subjects had a prior history of emotional problems, whereas 37.7% developed such problems after the emergence of their hypersensitivity. Lifestyle modifications varied; 76.8% changed their household cleaning/personal hygiene products, 47.8% began using water and/or air filtration systems, and 13% found it necessary to change residence. Although hypersensitivity was more common in females than males, the condition affects individuals in all categories of race/ethnicity, age, household income, and educational level.

Sensitization as a mechanism for multiple chemical sensitivity: relationship to evolutionary theory

Multiple chemical sensitivity (MCS) is a disorder in humans attributed to prior chemical exposure. Sensitization is an amplification of neuronal responsiveness that elicits increased behavioral responding to stimuli, and occurs in a recently developed rat model of MCS. Rats were exposed to repeated formaldehyde (Form) and their response in three behavioral tests, including locomotor activity after a cocaine challenge, conditioned fear, and behavioral avoidance of Form, was assessed. In all three tests, rats demonstrated sensitized behaviors, implicating amplified responding within specific limbic brain regions. Evolutionary theory in the context of MCS specifies how the behavioral strategies of those with MCS are consistent with the notion that their self-perceived sense of survival and reproductive fitness may be threatened by chemical exposures. This behavior may be mediated by the same limbic brain regions that become sensitized after repeated chemical exposure in animals.

Learning subjective health complaints

Symptom episodes often show a spatio-temporal structure, that is, they occur in a specific context for a certain duration. Repeated experiences may therefore be construed as associative learning trials, in which context elements are turned into predictive cues, triggering anticipatory processes conducive to subjective health complaints. A series of experiments, using inhalations of air enriched with CO2 and external (odors) or internal (mental images) stimuli as cues, is discussed to show that subjective health complaints may occur upon presenting the cue alone. Learned symptoms may be unrelated to bodily responses and easily generalize to new related cues. Better learning occurs to cues with a negative affective valence and in participants scoring high for negative affectivity. Our findings are relevant to the understanding of medically unexplained ("functional") syndromes and the poor relationship between objective and subjective health indicators in general.

A multiple center study of multiple chemical sensitivity syndrome

The lack of widely accepted, standardized, clinical and epidemiologic criteria for Multiple Chemical Sensitivity syndrome has led to confusion about the identification of the condition and has slowed pertinent research. In this article, the authors evaluated the psychometric properties of 2 sets of clinical/epidemiologic criteria for Multiple Chemical Sensitivity syndrome. In this cross-sectional survey of 1,166 patients who visited outpatient occupational, otolaryngology, allergy, and clinical ecological clinics, the authors used the aforementioned sets of criteria to (a) estimate the prevalence of the syndrome in these varied samples and (b) compare the current diagnostic practices of traditional physician specialists with those of clinical ecologists. The authors used a patient-completed questionnaire to assess the medical, psychosocial, and psychological status of patients who reported multiple chemical sensitivities. This approach enabled the formulation of 6 domains, which represented commonly observed characteristics of the syndrome. The authors used a physician-completed questionnaire to collect diagnoses of Multiple Chemical Sensitivity syndrome and other medical conditions. Domains, which were operationalized by the questionnaire and comprised the 2 sets of criteria for identification of the Multiple Chemical Sensitivity syndrome, had test-retest reliabilities that exceeded .75 and estimates of internal consistency that ranged between .59 and .94. Evidence of construct and face validity was considered acceptable. The overall clinic-based prevalences of Multiple Chemical Sensitivity syndrome, based on 6 and 4 domains, were 7% and 23%, respectively. Regardless of the identifying set of criteria used, physicians' diagnoses had relatively low sensitivities (range = 6-50%) and relatively high specificities (range = 82-99%). The study data suggested that the domains operationalized by the questionnaire had reasonable psychometric characteristics. Study data also support the fact that Multiple Chemical Sensitivity syndrome is often overlooked--even by those physicians who treat it most frequently--and that use of both sets of objective criteria for identifying the syndrome would greatly improve the sensitivity of physician diagnoses.

Exposure to repeated low-level formaldehyde in rats increases basal corticosterone levels and enhances the corticosterone response to subsequent formaldehyde

Low-level exposure to volatile organic compounds may produce symptoms in humans reporting multiple chemical sensitivity (MCS) through altered hypothalamic-pituitary-adrenal (HPA) axis functioning. We determined whether repeated formaldehyde (Form) exposure would alter corticosterone (CORT) levels in a rat model of MCS. Male Sprague-Dawley rats were given acute chamber exposures to Air or Form (0.7 or 2.4 ppm), and trunk blood was collected 20 or 60 min later. All groups showed increased CORT levels above naïve basal levels at 20 min and a return to baseline by 60 min, with no differences between treatment groups. The second experiment examined the effect of repeated Form exposure (1 h/day x 5 days/week x 2 or 4 weeks) on basal CORT levels and after a final challenge. Basal CORT was increased above naïve values after 2 week exposure to Air or 0.7 ppm Form. By 4 week, CORT levels in the Air group returned to naïve values, but remained elevated in the 0.7 ppm Form group. There were no differences in basal CORT levels among either 2.4 ppm exposed groups. After a final Air or Form challenge, the 2 and 4 week Air and 0.7 ppm Form groups had elevated CORT levels similar to their acute response, while the 2 and 4 week 2.4 ppm Form groups had elevated CORT levels compared to their acute response, indicating enhanced reactivity of the HPA axis to subsequent Form. These findings suggest that altered HPA axis functioning occurs after repeated low-level Form exposure, and may have implications for mechanisms mediating MCS in humans.

Repeated formaldehyde effects in an animal model for multiple chemical sensitivity

Chemical intolerance is a phenomenon observed in multiple chemical sensitivity (MCS) syndrome, an ill-defined disorder in humans attributed to exposure to volatile organic compounds. Amplification of symptoms in individuals with MCS resembles the phenomenon of psychostimulant- and stress-induced sensitization in rodents. We have recently tested in rats the hypothesis that repeated chemical exposure produces sensitization of central nervous system (CNS) circuitry. A rat model of MCS in our laboratory has employed several endpoints of CNS function after repeated formaldehyde (Form) exposure (1 h/day x 5 days/week x 4 weeks). Repeated Form exposure produced behavioral sensitization to later cocaine injection, suggesting altered dopaminergic sensitivity in mesolimbic pathways. Rats given repeated Form also demonstrated increased fear conditioning to odor paired with footshock, implicating amplification of neural circuitry guiding fear responding to a conditioned odor cue. Recent studies examining the effects of repeated Form on locomotor activity during each daily exposure showed a decrease in rearing activity after 12-15 days of Form exposure compared to air-exposed controls. EEG recordings taken 1 week after withdrawal from daily Form revealed altered sleep architecture. Some of the differences in sleep disappeared after subsequent brief (15 min) challenge with Form the next day. Overall, the findings indicate that repeated low-level chemical exposure produces behavioral changes that may be akin to those observed in individuals with MCS, such as greater sensitivity to chemicals manifest as increased anxiety upon chemical exposure and altered sleep and/or fatigue. Study of the underlying CNS changes will provide a basis for mechanistically based animal models for MCS.

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.

The compelling anomaly of chemical intolerance

In science, anomalies expose the limitations of existing paradigms and drive the search for new ones. In the late 1800s, physicians observed that certain illnesses spread from sick, feverish individuals to those contacting them, paving the way for the germ theory of disease. The germ theory served as a crude, but elegant formulation that explained dozens of seemingly unrelated illnesses affecting literally every organ system. Today, we are witnessing another medical anomaly-a unique pattern of illness involving chemically exposed groups in more than a dozen countries, who subsequently report multisystem symptoms and new-onset chemical, food, and drug intolerances. These intolerances may be the hallmark for a new disease process or paradigm, just as fever is a hallmark for infection. The fact that diverse demographic groups, sharing little in common except some initial chemical exposure event, develop these intolerances is a compelling anomaly pointing to a possible new theory of disease, one that has been referred to as "Toxicant-Induced Loss of Tolerance" ("TILT"). TILT has the potential to explain certain cases of asthma, migraine headaches, and depression, as well as chronic fatigue, fibromyalgia, and "Gulf War syndrome". It appears to evolve in two stages: (1) initiation, characterized by a profound breakdown in prior, natural tolerance resulting from either acute or chronic exposure to chemicals (pesticides, solvents, indoor air contaminants, etc.), followed by (2) triggering of symptoms by small quantities of previously tolerated chemicals (traffic exhaust, fragrances, gasoline), foods, drugs, and food/drug combinations (alcohol, caffeine). While the underlying dynamic remains an enigma, observations indicating that affected individuals respond to structurally unrelated drugs and experience cravings and withdrawal-like symptoms, paralleling drug addiction, suggest that multiple neurotransmitter pathways may be involved.

A nine-year follow-up of people diagnosed with multiple chemical sensitivities

The authors assessed self-reported health status and clinical symptoms in people reporting multiple chemical sensitivities (MCS) at a 9-year follow-up interview using structured and semistructured instruments and self-report questionnaires. Of the original sample, 18 people (69%) consented to an interview. By use of the best estimate diagnostic method, 15 subjects (83%) met DSM-IV criteria for a lifetime mood disorder, 10 (56%) for a lifetime anxiety disorder, and 10 (56%) for a lifetime somatoform disorder. None of the subjects met the criteria for a substance use disorder (current or lifetime). The Illness Behavior Questionnaire and the Symptom Check-list-90-Revised results showed little change from 1988 and remained significantly different from the control group on many subscales. The authors conclude that the subjects remain strongly committed to the diagnosis of MCS, and although improved since their original interview, many remain symptomatic and continue to report ongoing lifestyle changes.

Quality of life and health-services utilization in a population-based sample of military personnel reporting multiple chemical sensitivities

We sought to assess quality of life and health-services utilization variables in persons with symptoms suggestive of multiple chemical sensitivity/idiopathic environmental intolerance (MCS/IEI) among military personnel. We conducted a cross-sectional telephone survey of a population-based sample of Persian Gulf War (PGW) veterans from Iowa and a comparison group of PGW-era military personnel. A complex sample survey design was used, selecting subjects from four domains: PGW active duly, PGW National Guard/Reserve, non-PGW active duty, and non-PGW National Guard/Reserve. Each domain was substratified by age, gender, race, rank, and military branch. The criteria for MCS/IEI were developed by expert consensus and from the medical literature. In the total sample, 169 subjects (4.6%) of the 3695 who participated (76% of those eligible) met our criteria for MCS/IEI. Persons who met the criteria for MCS/IEI more often reported the following than did other subjects: more than 12 days in bed due to disability, Veteran's Affairs disability status, Veteran's Affairs disability compensation, medical disability, and unemployment. MCS/IEI cases also had higher outpatient rates of physician visits, emergency department visits, and inpatient hospital stays. Subjects who met the criteria for MCS/IEI more often reported impaired functioning on each Medical Outcomes Study 36-Item Short Form subscale, compared with those who did not meet the criteria. We concluded that although the diagnosis of MCS/IEI remains controversial, the persons who met our criteria for the disorder are functionally impaired.

Functional somatic syndromes: one or many?

We review the concept and importance of functional somatic symptoms and syndromes such as irritable bowel syndrome and chronic fatigue syndrome. On the basis of a literature review, we conclude that a substantial overlap exists between the individual syndromes and that the similarities between them outweigh the differences. Similarities are apparent in case definition, reported symptoms, and in non-symptom association such as patients' sex, outlook, and response to treatment. We conclude that the existing definitions of these syndromes in terms of specific symptoms is of limited value; instead we believe a dimensional classification is likely to be more productive.

Acquisition and extinction of somatic symptoms in response to odours: a Pavlovian paradigm relevant to multiple chemical sensitivity

OBJECTIVES

Multiple chemical sensitivity is a poorly understood syndrome in which various symptoms are triggered by chemically unrelated, but often odorous substances, at doses below those known to be harmful. This study focuses on the process of pavlovian acquisition and extinction of somatic symptoms triggered by odours.

METHODS

Diluted ammonia and butyric acid were odorous conditioned stimuli (CS). The unconditioned stimulus (US) was 7.4% CO2 enriched air. One odour (CS+) was presented together with the US for 2 minutes (CS+ trial), and the other odour (CS-) was presented with air (CS-trial). Three CS+ and three CS-exposures were run in a semi-randomised order; this as the acquisition (conditioning) phase. To test the effect of the conditioning, each subject then had one CS+ only--that is, CS+ without CO2--and one CS- test exposure. Next, half the subjects (n = 32) received five additional CS+ only exposures (extinction group), while the other half received five exposures to breathing air (wait group). Finally, all subjects got one CS+ only test exposure to test the effect of the extinction. Ventilatory responses were measured during and somatic symptoms after each exposure.

RESULTS

More symptoms were reported upon exposure to CS+ only than to CS-odours, regardless of the odour type. Altered respiratory rate was only found when ammonia was CS+. Five extinction trials were sufficient to reduce the level of acquired symptoms.

CONCLUSION

Subjects can acquire somatic symptoms and altered respiratory behaviour in response to harmless, but odorous chemical substances, if these odours have been associated with a physiological challenge that originally had caused these symptoms. The conditioned symptoms can subsequently be reduced in an extinction procedure. The study further supports the plausibility of a pavlovian conditioning hypothesis to explain the pathogenesis of MCS.

Olfaction and symptoms in the multiple chemical sensitivities syndrome

Whereas most idiosyncratic environmental sensitivity complaints do not fit known diagnoses, the multiple chemical sensitivities syndrome (MCS) is an extreme presentation that has defined diagnostic criteria. MCS symptomatics claim that they acquired a sensitized state as the result of a chemical exposure, usually to a solvent or pesticide, but not to a fragrance. Before this exposure, they did not experience symptoms. Following sensitization, symptoms increasing in number and severity with time are attributed by the MCS symptomatic to various exposures that are innocuous to most individuals. Although phenomenological studies have provided no evidence that particular odors elicit MCS symptoms, low levels of fragrances and perfumes are frequently associated with the reporting of MCS symptoms. This evaluation examines proposed mechanisms by which odorants and fragrances might cause either sensitization or elicitation of MCS symptoms, including altered odor sensitivity, primary irritancy or irritancy-induced upper airway reactivity, neurogenic switching of trigeminal irritancy signals, time-dependent sensitization and limbic kindling, CNS toxicity, and various psychiatric conditions. In no case was there persuasive evidence that any olfactory mechanism involving fragrance underlies either induction of a sensitized state or the triggering of MCS symptoms. Fragrances and other odorants could, however, be associated with symptoms as claimed by MCS symptomatics, because they are recognizable stimuli, but fragrance has not been demonstrated to be causal in the usual sense.

EEG sensitization during chemical exposure in women with and without chemical sensitivity of unknown etiology

This study tested the sensitization model proposed by Bell et al. [Bell I.R., Miller C.S. and Schwartz G.E. An olfactory-limbic model of multiple chemical sensitivity syndrome: possible relationship to kindling and affective spectrum disorders. Biol. Psychiatry 1992: 32: 218-242] to study chemical sensitivity. The sensitization model indicates that a pharmacological stimulus or a traumatic event which elicits a strong response can sensitize limbic and/or mesolimbic pathways; and subsequent less intense trauma or stimuli, in the same or different modality, can elicit an amplified response. Three groups of subjects were tested: (1) women who reported chemical sensitivity and no sexual abuse (chemically sensitive, CS); (2) sexually abused (SA) women without chemical sensitivity; and (3) healthy women without chemical sensitivity or sexual abuse history (normal, N). All subjects were exposed to odorant and nonodorous control stimuli once a week for 3 weeks. Electroencephalographic activity was recorded while subjects sniffed the odorant and control stimuli. Results of the study revealed that both the CS and the SA group showed electroencephalogram (EEG) alpha sensitization across experimental sessions, while the N group showed little change over time. Additionally, EEG findings revealed that the CS group generated significantly greater alpha activity than the other two groups. Finally, while the groups were different on measures of psychological distress, these differences did not diminish the EEG findings. In summary, these findings suggest that intermittent exposure to chemicals elicits sensitization in CS and SA women without chemical sensitivity, supporting our expectations that chemical sensitivity is, in part, a manifestation of time-dependent sensitization (TDS). Additionally, these EEG findings indicate that CS women are unlike SA and healthy women in the amount of EEG alpha activity they generate. Finally, these findings indicate that psychological factors as assessed in this study do not explain electrophysiological differences between chemically and non-chemically-sensitive women.

Behavioral sensitization after repeated formaldehyde exposure in rats

Multiple chemical sensitivity (MCS) is a phenomenon whereby individuals report increased sensitivity to chemicals in the environment, and attribute their sensitivities to prior exposure to the same or often structurally unrelated chemicals. A leading hypothesis suggests that MCS is akin to behavioral sensitization observed in rodents after repeated exposure to drugs of abuse or environmental stressors. Sensitization occurring within limbic circuitry of the central nervous system (CNS) may explain the multisymptom complaints in individuals with MCS. The present studies represent the continuing development of an animal model for MCS, the basis of which is the CNS sensitization hypothesis. Three behaviors were assessed in rats repeatedly exposed to formaldehyde (Form) inhalation. In the first series of experiments, rats were given high-dose Form exposure (11 parts per million [ppm]; 1 h/day x 7 days) or low-dose Form exposure (1 ppm; either 1 h/day x 7 days or 1 h/day x 5 days/week x 4 weeks). Within a few days after discontinuing daily Form, cocaine-induced locomotor activity was elevated after high-dose Form or 20 days of low-dose Form inhalation. Approximately 1 month later, cocaine-induced locomotor activity remained significantly elevated in the 20-day Form-exposed rats. The second experiment assessed whether prior exposure to Form (20 days, as above) would alter the ability to condition to an odor (orange oil) paired with footshock. The results suggested a tendency to increase the conditioned fear response to the odor but not the context of the footshock box, and a decreased tendency to extinguish the conditioned fear response to odor. The third experiment examined whether CNS sensitization to daily cocaine or stress would alter subsequent avoidance responding to odor (Form). Daily cocaine significantly elevated approach responses to Form, while daily stress pretreatment produced a trend in the opposite direction, producing greater avoidance of Form. Preliminary studies indicated that repeated daily Form inhalation (20 days, as above) produced a greater avoidance to subsequent Form presentation, suggesting that daily Form inhalation may serve as a stressor. The results support the hypothesis that repeated chemical exposure in rats may produce CNS plasticity manifest as greater sensitivity to dopaminergic drugs, enhanced fear conditioning to odor paired with an aversive event, and greater avoidance of odors. Some of these behavioral changes observed in rats may provide a link with symptoms in a subset of individuals with MCS.

Low-level chemical sensitivity: implications for research and social policy

There is increasing evidence that human exposure to levels of chemicals once thought to be safe--or presenting insignificant risk--are, in fact, harmful. So-called low-level exposures are now known to be associated with adverse biological effects including cancer, endocrine disruption, and chemical sensitivity. This requires that we change both (1) the way we design research linking chemicals and health, and (2) the solutions we devise to address chemically caused injury. The new and emerging science of low-level exposure to chemicals requires appropriate social policy responses which include regulation of toxic substances, notification of those exposed, and compensation and reasonable accommodation to those affected. Research and social policy need to be focused towards two distinct groups: (1) those individuals who could become chemically intolerant as a result of an initiating exposure, and (2) those individuals who have already become chemically intolerant and are now sensitive to chemicals at low levels.

Neural sensitization model for multiple chemical sensitivity: overview of theory and empirical evidence

This paper summarizes theory and evidence for a neural sensitization model of hyperresponsivity to low-level chemical exposures in multiple chemical sensitivity (MCS). MCS is a chronic polysymptomatic condition in which patients report illness from low levels of many different, structurally unrelated environmental chemicals (chemical intolerance, CI). Neural sensitization is the progressive host amplification of a response over time from repeated, intermittent exposures to a stimulus. Drugs, chemicals, endogenous mediators, and exogenous stressors can all initiate sensitization and can exhibit cross-sensitization between different classes of stimuli. The properties of sensitization overlap much of the clinical phenomenology of MCS. Animal studies have demonstrated sensitization to toluene, formaldehyde, and certain pesticides, as well as cross-sensitization, e.g., formaldehyde and cocaine. Controlled human studies in persons with self-reported CI have shown heightened sensitizability in the laboratory to nonspecific experimental factors and to specific chemical exposures. Useful outcome measures include spectral electroencephalography, blood pressure, heart rate, and plasma beta-endorphin. Findings implicate, in part, dopaminergic mesolimbic pathways and limbic structures. A convergence of evidence suggests that persons with MCS or with low-level CI may share some characteristics with individuals genetically vulnerable to substance abuse: (a) elevated family histories of alcohol or drug problems; (b) heightened capacity for sensitization of autonomic variables in the laboratory; (c) increased amounts of electroencephalographic alpha activity at rest and under challenge conditions over time. Sensitization is compatible with other models for MCS as well. The neural sensitization model provides a direction for further systematic human and animal research on the physiological bases of MCS and CI.

A rat model of neurobehavioral sensitization to toluene

Some individuals report that, following either a single high-level or repeated lower-level exposures to chemicals (initiation), subsequent exposure to very low concentrations of chemicals (triggering) produces a variety of adverse effects, including disruption of cognitive processes. Our objective was to model this two-step process in a laboratory animal. Two groups of 16 rats, eight male and eight female, received whole-body inhalation exposure to toluene, either at 80 ppm for 6 h/day for 4 weeks (Repeat group) or to 1600 ppm for 6 h/day on one day only (Acute group). Two other groups (Trigger group and Clean group) of 16 were sham-exposed. After 17 days without toluene exposure, the Acute, Repeat and Trigger groups began a series of daily toluene 'trigger' exposures (10 ppm for 1 h) followed immediately by testing on an operant repeated-acquisitions task requiring learning within and across sessions. The Clean group was sham-exposed prior to operant testing. Trigger or sham exposures and operant testing continued 5 days/week for 17 sessions. Analysis of variance revealed a variety of statistically significant (P < 0.05) differences between treatment groups. Furthermore, the patterns of differences between groups differed (P < 0.05) for female and male rats. For example, male rats of the Trigger group made the most responses, and female rats of the Repeat group responded most slowly. The observation of important changes in the operant behavior of female and male rats previously exposed to toluene, at relatively low concentrations (80 or 1600 ppm) and then later re-exposed at very low concentrations (10 ppm), is consistent with the experiences of humans reporting cognitive difficulties following acute or chronic exposures to chemicals.

A controlled comparison of symptoms and chemical intolerances reported by Gulf War veterans, implant recipients and persons with multiple chemical sensitivity

Using the Environmental Exposure and Sensitivity Inventory (EESI), a standardized instrument for measuring chemical sensitivity, we obtained and compared ratings of symptoms, chemical (inhalant) intolerances, other intolerances (e.g., drugs, caffeine, alcohol, skin contactants), lifeimpact, and masking (ongoing exposures) in five populations: multiple chemical sensitivity (MCS) patients who did (n = 96) or did not (n = 90) attribute onset of their illness to a specific exposure event, patients with implanted devices (n = 87), Gulf War veterans (n = 72), and controls (n = 76). For each patient group, mean scores on the first four scales were significantly greater than for controls. MCS patients reported avoiding more chemical exposures (were less masked) than the other groups. Across groups, for a given level of symptoms, as masking increased, mean scores on the Chemical Intolerance Scale decreased. In contrast, mean scores on the Other Intolerance Scale appeared to be less affected by masking. These findings suggest that some patients with antecedent chemical exposures, whether exogenous (chemical spill, pesticide application, indoor air contaminants) or endogenous (implant), develop new chemical, food, and drug intolerances. Reports of new caffeine, alcohol, medication, food, or other intolerances by patients may signal exposure-related illness. Masking may reduce individuals' awareness of chemical intolerances, and, to a lesser degree, other intolerances.

Evolutionary game theory and multiple chemical sensitivity

Newlin's [Newlin D.B. Evolutionary game theory of tolerance and sensitization in substance abuse. Paper presented to the Research Society on Alcoholism, Hilton Head, SC, 1998] evolutionary game theory of addictive behavior specifies how evolutionarily stable strategies for survival and reproduction may lead to addiction. The game theory of multiple chemical sensitivity (MCS) assumes that: (1) the MCS patient responds to low-level toxicants as stressors or as direct threats to their survival and reproductive fitness, (2) this activates the cortico-mesolimbic dopamine system, (3) this system is a survival motivation center--not a 'reward center', (4) the subject emits a counter-response that is in the same direction as the naive response to the chemicals, (5) previously neutral stimuli associated with chemicals also trigger conditioned responses that mimic those to the chemicals, (6) these counter-responses further activate the dopaminergic survival motivation system, and (7) this produces a positive feedback loop that leads to strong neural sensitization in these structures and in behavior controlled by this system, despite a small initial response. Psychologically, the MCS patient with a sensitized cortico-mesolimbic dopamine system is behaving as though his/her survival is directly threatened by these chemicals. Non-MCS subjects have counter-responses opposite in direction to those of the chemicals and show tolerance. An autoshaping/sign-tracking model of this game is discussed. This evolutionary game makes several specific, testable predictions about differences between MCS subjects, non-MCS controls, and substance abusers in laboratory experiments, and between sensitized and nonsensitized animals.

Psychiatric illness in the first-degree relatives of persons reporting multiple chemical sensitivities

The multiple chemical sensitivities (MCS) syndrome is characterized by unexplained physical and psychiatric complaints attributed by patients and some of their physicians to low-level chemical exposures. In this study, we interviewed 15 subjects with MCS and 21 controls about their first-degree relatives using the Family History-Research Diagnostic Criteria (FH-RDC). Subjects with MCS were more likely than controls to report their relatives to have major depression, alcoholism, panic disorder, obsessive-compulsive disorder, and antisocial personality disorder. They were also likely to have past suicide attempts, and to have received some form of psychiatric treatment (hospitalization, medication or electroconvulsive therapy, or counseling). Nearly 30% of the relatives of subjects with MCS were reported to have MCS themselves. Possible reasons for the findings are discussed.

Patterns of waking EEG spectral power in chemically intolerant individuals during repeated chemical exposures

Previous studies indicate that low level chemical intolerance (CI) is a symptom of several different controversial conditions with neuropsychiatric features, e.g., chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity, and "Persian Gulf Syndrome". Prior studies suggest that limbic and/or mesolimbic sensitization may contribute to development of CI. The purpose of this report was to document the waking electroencephalographic (EEG) patterns of individuals with CI during chemical exposures presented over repeated sessions. Three groups of adult subjects who were recruited from the community participated in the study: self-reported CI who had made associated lifestyle changes due to their intolerance (CI/ LSC), self-reported CI who had not made such changes (CI), and normal controls without self-reported CI. Subjects underwent two sessions involving one-minute EEG recordings during exposures to low level chemical odors (a probe for limbic activation). The CI, but not the CI/ LSC, subjects had increased absolute delta power after the chemical exposures during the second, but not the first, session. The findings support the neural sensitization hypothesis for intolerance to low levels of environmental chemicals in vulnerable individuals. As in human studies of stimulant drug sensitization, those with the strongest past history with sensitizing agents may not show-term sensitization to low level exposures in the laboratory.

A review of multiple chemical sensitivity

OBJECTIVE

To review critically the scientific literature on multiple chemical sensitivity (MCS). Definitions of MCS vary but, for this review, a broad definition of MCS was adopted as symptoms in more than one organ system elicited by various unrelated chemicals at very low levels of exposure.

METHODS

A systematic literature search identified several hundred references from which key papers were selected. Two questions are considered, does MCS exist and what causes MCS.

RESULTS AND CONCLUSIONS

Despite extensive literature on the existence of MCS, there is no unequivocal epidemiological evidence; quantitative exposure data are singularly lacking; and qualitative exposure data are, at best, patchy. There is also some evidence to suggest that MCS is sometimes used as an indiscriminate diagnosis for undiagnosed disorders. Despite this, the collated evidence suggests that MCS does exist although its prevalence generally seems to be exaggerated. Many causal mechanisms have been proposed, some suggesting a physical origin--such as MCS reflecting an immunological overload (total body load)--others favouring a psychological basis--such as MCS symptoms being evoked as part of a conditioned response to previous trauma. The available evidence seems most strongly to support a physical mechanism involving sensitisation of part of the midbrain known as the limbic system. However, it is increasingly being recognised that the psychological milieu of a person can considerably influence physical illness, either through generating a predisposition to disease or in the subsequent prognosis. Work is needed to establish the prevalence of MCS and to confirm or refute selected causal mechanisms.

Differential resting quantitative electroencephalographic alpha patterns in women with environmental chemical intolerance, depressives, and normals

BACKGROUND

Previous research suggests that a subset of individuals with intolerance to low levels of environmental chemicals have increased levels of premorbid and/or comorbid psychiatric disorders such as depression, anxiety, and somatization. The purpose of this study was to evaluate the psychological profiles and quantitative electroencephalographic (qEEG) profiles at baseline of women with and without chemical intolerance (CI).

METHODS

Participants were middle-aged women who reported illness from the odor of common chemicals (CI, n = 14), depressives without such intolerances (D, n = 10), and normal controls (N, n = 11). They completed a set of psychological scales and underwent two separate qEEG recording laboratory sessions spaced 1 week apart, at the same time of day for each subject.

RESULTS

CI were similar to D with increased lifetime histories of physician-diagnosed depression (71% vs. 100%), Symptom Checklist 90 (revised) (SCL-90-R) somatization scores, Barsky Somatic Symptom Amplification, and perceived life stressfulness, although D had more distress than either CI or N on several other SCL-90-R subscales. CI scored significantly higher on the McLean Limbic Symptom Checklist somatic symptom subscale than did either D or N. On qEEG, CI exhibited significantly greater overall resting absolute alpha activity with eyes closed, especially at the parietal midline site (Pz), and increased (sensitized) frontal alpha from session 1 to 2, in contrast with the D and N groups. D showed right frontal asymmetry in both sessions, in comparison with CI.

CONCLUSIONS

The data indicate that CI with affective distress diverge from both D without chemical intolerance and N in qEEG alpha patterns at resting baseline. Although CI descriptively resemble D with increased psychological distress, the CI's greater alpha suggests the possibility of a) central nervous system hypo-, not hyper-, activation; and/or b) an overlap with EEG alpha patterns of persons with positive family histories of alcoholism.

Quantitative EEG patterns during nose versus mouth inhalation of filtered room air in young adults with and without self-reported chemical odor intolerances

Individuals who report illness (e.g. nausea, headache) from common chemical odors tend to report CNS symptoms suggestive of olfactory-limbic system involvement. This study compared the resting quantitative electroencephalographic (qEEG) patterns of young adult college students reporting subjectively elevated chemical odor intolerance ratings (HICI) with those of controls reporting little or no odor intolerance (LOCI). Each group was subdivided into those with higher (HIDEP) vs. lower (LODEP) ratings of concomitant depression. Nineteen channels of EEG were recorded during a single session over four separate rest periods, respectively, following baseline, cognitive, chemical exposure and olfactory identification tests. Each recording involved two 30-s, eyes-closed, filtered room air breathing conditions: (1) nose inhalation followed by mouth exhalation and (2) mouth inhalation followed by mouth exhalation. HICI showed significantly less beta 1 (beta 1) over the temporal-central region during nose than during mouth inhalation. Over some temporal and central leads, task, DEP and CI interacted to influence beta 1 as well. For theta (theta), CI differences emerged during nose inhalation after the cognitive task at Cz, after chemical exposures at C3, Cz and C4 and after the olfactory ID task at C4. CI differences emerged during mouth breathing after the olfactory ID task at Cz, C4 and T4. The T5-T6 coronal array showed significant CI differences after chemical exposures during nose breathing and during mouth breathing after the cognitive and olfactory ID tasks. The theta findings in the HICI may be related to reports of disturbed attention in CI.

An overview of the development, validation, and application of neurobehavioral and neuromolecular toxicity assessment batteries: potential applications to combustion toxicology

Currently, there are few alternatives to the use of animals in toxicology for human risk assessment. Neurobehavioral toxicology is an emerging area in which complex performance capacity is evaluated during or following toxicological exposure. While a number of single tests and a few more complex neurobehavioral batteries exist, no fully validated and comprehensive neurobehavioral toxicity assessment battery has yet been developed. The Neurobehavioral Toxicity Assessment Battery (NTAB) is a multi-test battery being developed by the Naval Medical Research Institute Detachment (Toxicology) (NMRI/TD) to categorize the potential neurobehavioral toxicity of compounds of Navy interest, especially those found in combustion atmospheres. The NTAB is intended to identify specific areas of deficit (e.g. motivational, sensory, motor, and cognitive) from complex changes in performance induced by toxic exposures, as well as to provide a mechanism to evaluate recovery of neurobehavioral integrity. Portions of the NTAB have been successfully used to assess the risk of brief exposure to low concentrations of combustion gases, including smoke from electrical aircraft fires, ozone-depleting substances and their replacements, and the novel neuroconvulsant trimethylolpropane phosphate. The goal of the NMRI/TD Neurobehavioral Toxicology Group and the Tri-Service Toxicology Consortium's neurobehavioral toxicology program is the incorporation of more molecular techniques involving neurophysiology, neuropharmacology, in vivo electrochemistry, and real-time microdialysis for correlative use with the neurobehavioral battery in human risk assessment. This overview discusses the application of neurobehavioral and neuromolecular endpoint test batteries to combustion toxicology.

Multiple chemical sensitivities: an overview

At the present time multiple chemical sensitivities (MCS) is generally acknowledged to be a poorly understood clinical syndrome which is exhibited by individuals exposed to low levels of exposure to environmental agents that the general population tolerate quite well. A wide range of individual symptoms (typically multiple and related to neurologic, endocrine/metabolic, and immunological, often occurring simultaneously) are displayed by MCS patients. Questions concerning whether or not MCS is a real clinical condition, a form of psychiatric illness or a combination of both remain to be unambiguously clarified.

Multiple chemical sensitivity (MCS) : Idiopathic environmental intolerances (IEI)

Multiple Chemical Sensitivity (MCS) is a systemic disorder causing central nervous, irritative and gastrointestinal symptoms, and can be included in the category of "idiopathic environmental intolerance" (IEI). This term describes phenomena with multiple, recurrent symptoms associated with various environmental factors that are tolerated by most people without problems. Those advocating these concepts attribute the symptoms to exogenous substances. Those opposing them explain the phenomena by classical conditioning or other psychopathological processes. To the extent that controlled studies are available, they have not furnished any hard evidence for toxic or immunological causes. In addition to psychopathological origins, neurobiological processes are also implicated.

Sensitization induced by kindling and kindling-related phenomena as a model for multiple chemical sensitivity

It has been suggested that the neurobehavioral dysfunction observed in persons presenting with symptoms of Multiple Chemical Sensitivity (MCS) syndrome involves sensitization of neural circuits. Two hypotheses for the route of exposure in induction of neural sensitization in MCS are: (a) direct chemical stimulation of olfactory processes, or (b) general systemic response to inhaled chemicals. In either case, the mechanism of action may involve chemical kindling or kindling-related phenomena. A neural sensitization mechanism based on kindling or kindling-related phenomena is attractive and has been previously demonstrated in both in vitro and in vivo animal models. Without a testable animal model for chemically mediated induction of MCS, however, any argument that MCS is mediated by kindling or kindling-related phenomena is reduced to the circular argument "the mechanism of sensitization is sensitization." The present survey provides an overview of the experimental paradigms that result in sensitization, differentiated on the basis of probable neurophysiological and neurochemical mechanisms. Neurophysiological potentiation, electrical kindling, chemical kindling and behavioral sensitization are evaluated and discussed in relationship to MCS.

Clinically relevant EEG studies and psychophysiological findings: possible neural mechanisms for multiple chemical sensitivity

This paper addresses the evidence for the face, construct, and criterion-related validity of the olfactory-limbic/neural sensitization model for multiple chemical sensitivity (MCS). MCS is a poorly-understood, controversial condition in which low levels of environmental chemicals are reported to trigger disabling levels of illness in certain individuals. Neural sensitization processes could generate an endogenous amplification of responsivity to exogenous substances, thereby providing a plausible explanation for the apparent lack of a classical toxicological dose-response relationship in MCS. Convergent data from both survey and psychophysiological studies of MCS patients and of persons from the community without MCS, but who report elevated frequency of illness from chemical odors (cacosmics), support the involvement of the limbic system and the sensitizability of cacosmics, as predicted by the model. Recent studies show that cacosmics do sensitize their heart rate, blood pressure, and plasma beta-endorphin responses to repeated exposures to a novel laboratory procedure involving dietary manipulations over time. Cacosmia may represent a pathological form of neural plasticity. Taken together, the model and the available evidence suggest the need for more intensive investigation of MCS from the standpoint of possible neurobiological mechanisms affecting cognitive, emotional, and somatic functions.

Chemical sensitivity: symptom, syndrome or mechanism for disease?

Several different meanings have been attached to the term "chemical sensitivity" by those who use it. Feeling ill from odors is a symptom reported by approximately one-third of the population. The syndrome of chemical sensitivity, frequently called "Multiple Chemical Sensitivity" or "MCS" has been the subject of three federally-sponsored workshops; at least five different case definitions for research on MCS have been proposed. In contrast, the hypothesis that chemical sensitivity may be a mechanism for disease posits that a broad spectrum of "recognized" chronic illnesses, ranging from asthma and migraine to depression and chronic fatigue, may be the consequence of environmental chemical exposures. According to this theory, a two-step process occurs: (1) an initial salient exposure event(s) (for example, a one-time, intermittent, or continuous exposure to pesticides, solvents, or air contaminants in a sick building) interacts with a susceptible individual, causing loss of tolerance for everyday, low level chemical inhalants (car exhaust, fragrances, cleaning agents), as well as for foods, drugs, alcohol, and caffeine; (2) thereafter, such common, formerly well-tolerated substances trigger symptoms, thus perpetuating illness. "Masking" (acclimatization, apposition, and addiction) may hide these exposure-symptom relationships, thus obfuscating the environmental etiology of the illness. Accumulating clinical observations lend credence to a view of chemical sensitivity as an emerging theory of disease causation and underscore the need for its testing in a rational, scientific manner. While chemical sensitivity may be the consequence of chemical exposure, the term "toxicant-induced loss of tolerance" more fully describes the two-step process under scrutiny.