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Nynäs P, Vilpas S, Kankare E, Karjalainen J, Lehtimäki L, Numminen J, Tikkakoski A, Kleemola L, Uitti J. Laboratory Test Results in Patients with Workplace Moisture Damage Associated Symptoms—The SAMDAW Study. Healthcare (Basel) 2023; 11:healthcare11070971. [PMID: 37046898 PMCID: PMC10093791 DOI: 10.3390/healthcare11070971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
The mechanisms of health effects of moisture damage (MD) are unclear, but inflammatory responses have been suspected. The usefulness of laboratory and allergy tests among patients in secondary healthcare with symptoms associated with workplace MD were examined. Full blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), total serum immunoglobulin E (IgE), fractional exhaled nitric oxide (FeNO), and skin prick testing were assessed and analyzed in relation to multiple chemical sensitivity (MCS) and perceived stress in 99 patients and 48 controls. In analysis, t-tests, Mann-Whitney tests, and chi-squared tests were used. Minor clinically insignificant differences in blood counts were seen in patients and controls, but among patients with asthma an elevated neutrophil count was found in 19% with and only in 2% of patients without asthma (p = 0.003). CRP levels and ESR were low, and the study patients’ FeNO, total IgE, or allergic sensitization were not increased compared to controls. The level of stress was high among 26% of patients and 6% of controls (p = 0.005), and MCS was more common among patients (39% vs. 10%, p < 0.001). Stress or MCS were not significantly associated with laboratory test results. In conclusion, no basic laboratory or allergy test results were characteristic of this patient group, and neither inflammatory processes nor allergic sensitization were found to explain the symptoms among these patients. While the value of basic laboratory tests should not be ignored, the use of allergy tests does not seem necessary when symptoms are indicated to be workplace-related.
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Affiliation(s)
- Pia Nynäs
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Correspondence:
| | - Sarkku Vilpas
- Department of Phoniatrics, Tampere University Hospital, 33520 Tampere, Finland
| | - Elina Kankare
- Department of Phoniatrics, Tampere University Hospital, 33520 Tampere, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Allergy Centre, Tampere University Hospital, 33520 Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Allergy Centre, Tampere University Hospital, 33520 Tampere, Finland
| | - Jura Numminen
- Allergy Centre, Tampere University Hospital, 33520 Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Leenamaija Kleemola
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
| | - Jukka Uitti
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
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Zucco GM, Doty RL. Multiple Chemical Sensitivity. Brain Sci 2021; 12:46. [PMID: 35053790 PMCID: PMC8773480 DOI: 10.3390/brainsci12010046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 01/09/2023] Open
Abstract
Multiple Chemical Sensitivity (MCS), a condition also known as Chemical Sensitivity (CS), Chemical Intolerance (CI), Idiopathic Environmental Illness (IEI) and Toxicant Induced Loss of Tolerance (TILT), is an acquired multifactorial syndrome characterized by a recurrent set of debilitating symptoms. The symptoms of this controversial disorder are reported to be induced by environmental chemicals at doses far below those usually harmful to most persons. They involve a large spectrum of organ systems and typically disappear when the environmental chemicals are removed. However, no clear link has emerged among self-reported MCS symptoms and widely accepted objective measures of physiological dysfunction, and no clear dose-response relationship between exposure and symptom reactions has been observed. In addition, the underlying etiology and pathogenic processes of the disorder remain unknown and disputed, although biologic and psychologic hypotheses abound. It is currently debated whether MCS should be considered a clinical entity at all. Nevertheless, in the last few decades MCS has received considerable scientific and governmental attention in light of the many persons reporting this illness. In this review, we provide a general overview of the history, definition, demographics, prevalence, and etiologic challenges in defining and understanding MCS.
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Affiliation(s)
- Gesualdo M Zucco
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, 35100 Padova, Italy
| | - Richard L Doty
- Smell and Taste Center, Department of Otorhinolaryngology, Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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3
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Multiple Chemical Sensitivity in Patients Exposed to Moisture Damage at Work and in General Working-Age Population-The SAMDAW Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312296. [PMID: 34886041 PMCID: PMC8657242 DOI: 10.3390/ijerph182312296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022]
Abstract
A considerable proportion of patients having respiratory tract or voice symptoms associated with workplace moisture damage (MD) could have multiple chemical sensitivity (MCS). MCS is characterized by symptoms of different organ systems in association with low-level chemical exposure. The objective of this study was to assess the prevalence of MCS among patients referred to secondary health care because of respiratory or voice symptoms associated with workplace MD compared to the general working-age population. Using three subscales of the QEESI© questionnaire, we assessed MCS in the study patients and 1500 controls in the same district randomly selected from the Finnish Population Information System. Study patients had significantly more often high scores in chemical intolerance (39% vs. 23%, p = 0.001), symptom severity (60% vs. 27%, p < 0.001), and life impact subscales (53% vs. 20%, p < 0.001). Asthma, chronic rhinosinusitis, laryngeal problems, and atopy were not associated with the presence of MCS. MCS is common among patients referred to secondary health care with respiratory tract and/or voice symptoms associated with workplace MD, and it considerably affects their everyday life. MCS should be considered as a possible explanatory factor for MD-associated symptoms.
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Suojalehto H, Ndika J, Lindström I, Airaksinen L, Karvala K, Kauppi P, Lauerma A, Toppila-Salmi S, Karisola P, Alenius H. Transcriptomic Profiling of Adult-Onset Asthma Related to Damp and Moldy Buildings and Idiopathic Environmental Intolerance. Int J Mol Sci 2021; 22:ijms221910679. [PMID: 34639020 PMCID: PMC8508786 DOI: 10.3390/ijms221910679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/18/2022] Open
Abstract
A subset of adult-onset asthma patients attribute their symptoms to damp and moldy buildings. Symptoms of idiopathic environmental intolerance (IEI) may resemble asthma and these two entities overlap. We aimed to evaluate if a distinct clinical subtype of asthma related to damp and moldy buildings can be identified, to unravel its corresponding pathomechanistic gene signatures, and to investigate potential molecular similarities with IEI. Fifty female adult-onset asthma patients were categorized based on exposure to building dampness and molds during disease initiation. IEI patients (n = 17) and healthy subjects (n = 21) were also included yielding 88 study subjects. IEI was scored with the Quick Environmental Exposure and Sensitivity Inventory (QEESI) questionnaire. Inflammation was evaluated by blood cell type profiling and cytokine measurements. Disease mechanisms were investigated via gene set variation analysis of RNA from nasal biopsies and peripheral blood mononuclear cells. Nasal biopsy gene expression and plasma cytokine profiles suggested airway and systemic inflammation in asthma without exposure to dampness (AND). Similar evidence of inflammation was absent in patients with dampness-and-mold-related asthma (AAD). Gene expression signatures revealed a greater degree of similarity between IEI and dampness-related asthma than between IEI patients and asthma not associated to dampness and mold. Blood cell transcriptome of IEI subjects showed strong suppression of immune cell activation, migration, and movement. QEESI scores correlated to blood cell gene expression of all study subjects. Transcriptomic analysis revealed clear pathomechanisms for AND but not AAD patients. Furthermore, we found a distinct molecular pathological profile in nasal and blood immune cells of IEI subjects, including several differentially expressed genes that were also identified in AAD samples, suggesting IEI-type mechanisms.
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Affiliation(s)
- Hille Suojalehto
- Occupational Medicine, Finnish Institute of Occupational Health, 00032 Helsinki, Finland; (H.S.); (I.L.); (L.A.); (K.K.)
| | - Joseph Ndika
- Human Microbiome (HUMI) Research Program, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (J.N.); (P.K.)
| | - Irmeli Lindström
- Occupational Medicine, Finnish Institute of Occupational Health, 00032 Helsinki, Finland; (H.S.); (I.L.); (L.A.); (K.K.)
| | - Liisa Airaksinen
- Occupational Medicine, Finnish Institute of Occupational Health, 00032 Helsinki, Finland; (H.S.); (I.L.); (L.A.); (K.K.)
| | - Kirsi Karvala
- Occupational Medicine, Finnish Institute of Occupational Health, 00032 Helsinki, Finland; (H.S.); (I.L.); (L.A.); (K.K.)
- Varma, 00098 Helsinki, Finland
| | - Paula Kauppi
- Skin and Allergy Hospital, Helsinki University Hospital, 00250 Helsinki, Finland; (P.K.); (A.L.); (S.T.-S.)
| | - Antti Lauerma
- Skin and Allergy Hospital, Helsinki University Hospital, 00250 Helsinki, Finland; (P.K.); (A.L.); (S.T.-S.)
| | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, 00250 Helsinki, Finland; (P.K.); (A.L.); (S.T.-S.)
| | - Piia Karisola
- Human Microbiome (HUMI) Research Program, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (J.N.); (P.K.)
| | - Harri Alenius
- Human Microbiome (HUMI) Research Program, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (J.N.); (P.K.)
- Institute of Environmental Medicine (IMM), Karolinska Institutet, 171 77 Stockholm, Sweden
- Correspondence: ; Tel.: +358-50-4489526
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Pekkanen J. Letter to the Study by Hyvönen et al. on Moisture Damage and MCS. Saf Health Work 2020; 11:378-379. [PMID: 34194868 PMCID: PMC8226189 DOI: 10.1016/j.shaw.2020.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/25/2020] [Indexed: 11/23/2022] Open
Abstract
Due to the significant methodological problems in the empirical part of the paper and the very selective literature review, the conclusions of the paper are mostly unsupported.
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Affiliation(s)
- Juha Pekkanen
- Corresponding author. University of Helsinki, Department of Public Health, P.O.Box 20, 00014, Finland.
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Quarato M, De Maria L, Caputi A, Cavone D, Cannone ESS, Mansi F, Gatti MF, Vimercati L. A case report of idiopathic environmental intolerance: A controversial and current issue. Clin Case Rep 2020; 8:79-85. [PMID: 31998492 PMCID: PMC6982481 DOI: 10.1002/ccr3.2535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/21/2019] [Indexed: 11/13/2022] Open
Abstract
In this case of idiopathic environmental intolerance, a little known disease characterized by many symptoms of irritation due to exposure to several toxic compounds, genetic analysis could be helpful in case of differential diagnosis issue.
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Affiliation(s)
- Marco Quarato
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Luigi De Maria
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Antonio Caputi
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Domenica Cavone
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Enza Sabrina Silvana Cannone
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Francesca Mansi
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Maria Franca Gatti
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Luigi Vimercati
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
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Health-related quality among life of employees with persistent nonspecific indoor-air-associated health complaints. J Psychosom Res 2019; 122:112-120. [PMID: 30935665 DOI: 10.1016/j.jpsychores.2019.03.181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/24/2019] [Accepted: 03/24/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Nonspecific health complaints associated with indoor air are common in work environments. In some individuals, symptoms become persistent without an adequate explanation. The aim was to study factors that associate with the health-related quality of life (HRQoL) of employees with persistent, nonspecific indoor-air-related symptomatology. METHODS We present baseline results of a randomized controlled trial of interventions targeted on the HRQoL of the employees with indoor-air-associated nonspecific symptoms. The main participant-inclusion criterion was the presence of persistent indoor-air-related multiorgan symptoms with no known pathophysiological or environment-related explanation. As a comparison for participants´ HRQoL (n = 52) we used data from the general-population Health 2011 study (BRIF8901) including information on subjects matched to the participants´ working status and age and subjects with asthma, anxiety or depressive disorder, or other chronic conditions with work disability. RESULTS The participants showed greater and a clinically significant impairment of HRQoL [M = 0.83, SE = 0.013] than individuals from the general population [M = 0.95, SE = 0.001, p < .001, Hedges´ g = 2.33] and those with asthma [M = 0.93, SE = 0.005, p < .001, Hedges´ g = 1.46], anxiety and depressive disorder [M = 0.89, SE = 0.006, p < .001, Hedges´ g = 0.73], or a chronic condition with work disability [M = 0.91, SE = 0.003, p < .001, Hedges´ g = 1.11]. Prevalent symptoms of depression, anxiety, and insomnia and poor recovery from work were associated with a poor HRQoL. CONCLUSIONS Individuals with nonspecific indoor-air-associated symptoms have a poorer HRQoL than individuals in the general population with a globally burdensome disease. Psychological distress associated with a poor HRQoL should be considered in the making of decisions about the treatment of these patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT02069002.
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Vuokko A, Karvala K, Suojalehto H, Lindholm H, Selinheimo S, Heinonen-Guzejev M, Leppämäki S, Cederström S, Hublin C, Tuisku K, Sainio M. Clinical Characteristics of Disability in Patients with Indoor Air-Related Environmental Intolerance. Saf Health Work 2019; 10:362-369. [PMID: 31497334 PMCID: PMC6717934 DOI: 10.1016/j.shaw.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 11/28/2022] Open
Abstract
Background Chronic nonspecific symptoms attributed to indoor nonindustrial work environments are common and may cause disability, but the medical nature of this disability is unclear. The aim was to medically characterize the disability manifested by chronic, recurrent symptoms and restrictions to work participation attributed to low-level indoor pollutants at workplace and whether the condition shares features with idiopathic environmental intolerance. Methods We investigated 12 patients with indoor air–related work disability. The examinations included somatic, psychological, and psychiatric evaluations as well as investigations of the autonomic nervous system, cortisol measurements, lung function, and allergy tests. We evaluated well-being, health, disability, insomnia, pain, anxiety, depression, and burnout via questionnaires. Results The mean symptom history was 10.5 years; for disabling symptoms, 2.7 years. Eleven patients reported reactions triggered mainly by indoor molds, one by fragrances only. Ten reported sensitivity to odorous chemicals, and three, electric devices. Nearly all had co-occurrent somatic and psychiatric diagnoses and signs of pain, insomnia, burnout, and/or elevated sympathetic responses. Avoiding certain environments had led to restrictions in several life areas. On self-assessment scales, disability showed higher severity and anxiety showed lower severity than in physician assessments. Conclusion No medical cause was found to explain the disability. Findings support that the condition is a form of idiopathic environmental intolerance and belongs to functional somatic syndromes. Instead of endless avoidance, rehabilitation approaches of functional somatic syndromes are applicable.
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Affiliation(s)
- Aki Vuokko
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Kirsi Karvala
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | | | | | - Marja Heinonen-Guzejev
- University of Helsinki, Department of Public Health, Faculty of Medicine, Helsinki, Finland
| | - Sami Leppämäki
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Sebastian Cederström
- Outpatient Clinic for Assessment of Ability to Work, Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Katinka Tuisku
- Outpatient Clinic for Assessment of Ability to Work, Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Markku Sainio
- Finnish Institute of Occupational Health, Helsinki, Finland
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9
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Karvala K, Sainio M, Palmquist E, Claeson AS, Nyback MH, Nordin S. Building-Related Environmental Intolerance and Associated Health in the General Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092047. [PMID: 30235805 PMCID: PMC6163389 DOI: 10.3390/ijerph15092047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 01/13/2023]
Abstract
People frequently attribute adverse symptoms to particular buildings when exposure to pollutants is low, within nonhazardous levels. Our aim was to characterize building-related intolerance (BRI) in the general population. Data were derived from two population-based questionnaire surveys, the Västerbotten and Österbotten Environmental Health Study. We identified cases of BRI if respondents reported symptoms emerging from residing in certain buildings, when most other people had none. The questionnaires covered lifestyle factors, perceived general health, BRI duration and symptom frequency, the emotional and behavioral impact of BRI, coping strategies, and physician-diagnosed diseases. From the total of 4941 participants, we formed two case groups, 275 (5.6%) fulfilled criteria for self-reported BRI, and 123 (2.5%) for BRI with wide-ranging symptoms. Individuals in both case groups were significantly more often female, single, and perceived their general health as poorer than the referents, i.e., those reporting no BRI symptoms. The mean duration of BRI was 12 years. In both case groups, avoidance behavior was found in over 60%, and nearly half of the sample had sought medical care. BRI with wide-ranging symptoms was associated with elevated odds for all studied comorbidities (somatic and psychiatric diseases and functional somatic syndromes). The perceived health of individuals with BRI is poorer and comorbidities are more frequent than among referents. BRI seems to be similar to other environmental intolerances and shares features with functional somatic syndromes.
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Affiliation(s)
- Kirsi Karvala
- Finnish Institute of Occupational Health, 00032 Helsinki, Finland.
| | - Markku Sainio
- Finnish Institute of Occupational Health, 00032 Helsinki, Finland.
| | - Eva Palmquist
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden.
| | | | | | - Steven Nordin
- Department of Psychology, Umeå University, 901 87 Umeå, Sweden.
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Vuokko A, Karvala K, Lampi J, Keski-Nisula L, Pasanen M, Voutilainen R, Pekkanen J, Sainio M. Environmental Intolerance, Symptoms and Disability Among Fertile-Aged Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020293. [PMID: 29419757 PMCID: PMC5858362 DOI: 10.3390/ijerph15020293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 12/12/2022]
Abstract
The purpose was to study the prevalence of environmental intolerance (EI) and its different manifestations, including behavioral changes and disability. Fertile-aged women (n = 680) of the Kuopio Birth Cohort Study were asked about annoyance to 12 environmental factors, symptoms and behavioral changes. We asked how much the intolerance had disrupted their work, household responsibilities or social life. We chose intolerance attributed to chemicals, indoor molds, and electromagnetic fields to represent typical intolerance entities. Of the respondents, 46% reported annoyance to chemicals, molds, or electromagnetic fields. Thirty-three percent reported symptoms relating to at least one of these three EIs, 18% reported symptoms that included central nervous system symptoms, and 15% reported behavioral changes. Indicating disability, 8.4% reported their experience relating to any of the three EIs as at least “somewhat difficult”, 2.2% “very difficult” or “extremely difficult”, and 0.9% “extremely difficult”. Of the latter 2.2%, all attributed their intolerance to indoor molds, and two thirds also to chemicals. As the number of difficulties increased, the number of organ systems, behavioral changes and overlaps of the three EIs also grew. EI is a heterogeneous phenomenon and its prevalence depends on its definition. The manifestations of EI form a continuum, ranging from annoyance to severe disability.
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Affiliation(s)
- Aki Vuokko
- Finnish Institute of Occupational Health, P.O. Box 40, 00032 Helsinki, Finland.
| | - Kirsi Karvala
- Finnish Institute of Occupational Health, P.O. Box 40, 00032 Helsinki, Finland.
| | - Jussi Lampi
- Environmental Health, National Institute for Health and Welfare, P.O. Box 95, 70701 Kuopio, Finland.
- Social and Health Services, 70701 Kuopio, Finland.
| | - Leea Keski-Nisula
- Department of Obstetrics and Gynecology, Kuopio University Hospital, P.O. Box 100, 70029 KYS Kuopio, Finland.
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, P.O Box 1627, 70211 Kuopio, Finland.
| | - Markku Pasanen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland.
| | - Raimo Voutilainen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, P.O Box 1627, 70211 Kuopio, Finland.
- Department of Pediatrics, Kuopio University Hospital, P.O. Box 100, 70029 KYS Kuopio, Finland.
| | - Juha Pekkanen
- Environmental Health, National Institute for Health and Welfare, P.O. Box 95, 70701 Kuopio, Finland.
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland.
| | - Markku Sainio
- Finnish Institute of Occupational Health, P.O. Box 40, 00032 Helsinki, Finland.
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Karvala K, Sainio M, Palmquist E, Nyback MH, Nordin S. Prevalence of various environmental intolerances in a Swedish and Finnish general population. ENVIRONMENTAL RESEARCH 2018; 161:220-228. [PMID: 29161654 DOI: 10.1016/j.envres.2017.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/27/2017] [Accepted: 11/08/2017] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To determine the prevalence of various environmental intolerances (EIs), using several criteria in a Swedish and a Finnish general population. Ill-health attributed to low-level environmental exposures is a commonly encountered challenge in occupational and environmental medicine. METHODS In population-based questionnaire surveys, the Västerbotten Environmental Health Study (Sweden) and the Österbotten Environmental Health Study (Finland), EI was inquired by one-item questions on symptom attribution to chemicals, certain buildings, or electromagnetic fields (EMFs), and difficulties tolerating sounds. The respondents were asked whether they react with central nervous system (CNS) symptoms or have a physician-diagnosed EI attributed to the corresponding exposures. Prevalence rates were determined for different age and sex groups and the Swedish and Finnish samples in general. RESULTS In the Swedish sample (n = 3406), 12.2% had self-reported intolerance to chemicals, 4.8% to certain buildings, 2.7% to EMFs, and 9.2% to sounds. The prevalence rates for the Finnish sample (n = 1535) were 15.2%, 7.2%, 1.6%, and 5.4%, respectively, differing statistically significantly from the Swedish. EI to chemicals and certain buildings was more prevalent in Finland, while EI to EMFs and sounds more prevalent in Sweden. The prevalence rates for EI with CNS-symptoms were lower and physician-diagnosed EIs considerably lower than self-reported EIs. Women reported EI more often than men and the young (18-39 years) to a lesser degree than middle-aged and elderly. CONCLUSIONS The findings reflect the heterogeneous nature of EI. The differences in EI prevalence between the countries might reflect disparities concerning which exposures people perceive harmful and focus their attention to.
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Affiliation(s)
- Kirsi Karvala
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 b, 00250 Helsinki, Finland.
| | - Markku Sainio
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 b, 00250 Helsinki, Finland.
| | - Eva Palmquist
- Department of Psychology, Umeå University, SE-90187 Umeå, Sweden.
| | - Maj-Helen Nyback
- Novia University of Applied Sciences, PO BOX 6, 65201 Vaasa, Finland.
| | - Steven Nordin
- Department of Psychology, Umeå University, SE-90187 Umeå, Sweden.
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Role of polymorphisms of inducible nitric oxide synthase and endothelial nitric oxide synthase in idiopathic environmental intolerances. Mediators Inflamm 2015; 2015:245308. [PMID: 25878398 PMCID: PMC4387900 DOI: 10.1155/2015/245308] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/08/2015] [Indexed: 11/29/2022] Open
Abstract
Oxidative stress and inflammation play a pathogenetic role in idiopathic environmental intolerances (IEI), namely, multiple chemical sensitivity (MCS), fibromyalgia (FM), and chronic fatigue syndrome (CFS). Given the reported association of nitric oxide synthase (NOS) gene polymorphisms with inflammatory disorders, we aimed to investigate the distribution of NOS2A −2.5 kb (CCTTT)n as well as Ser608Leu and NOS3 −786T>C variants and their correlation with nitrite/nitrate levels, in a study cohort including 170 MCS, 108 suspected MCS (SMCS), 89 FM/CFS, and 196 healthy subjects. Patients and controls had similar distributions of NOS2A Ser608Leu and NOS3 −786T>C polymorphisms. Interestingly, the NOS3 −786TT genotype was associated with increased nitrite/nitrate levels only in IEI patients. We also found that the NOS2A −2.5 kb (CCTTT)11 allele represents a genetic determinant for FM/CFS, and the (CCTTT)16 allele discriminates MCS from SMCS patients. Instead, the (CCTTT)8 allele reduces by three-, six-, and tenfold, respectively, the risk for MCS, SMCS, and FM/CFS. Moreover, a short number of (CCTTT) repeats is associated with higher concentrations of nitrites/nitrates. Here, we first demonstrate that NOS3 −786T>C variant affects nitrite/nitrate levels in IEI patients and that screening for NOS2A −2.5 kb (CCTTT)n polymorphism may be useful for differential diagnosis of various IEI.
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Jeong I, Kim I, Park HJ, Roh J, Park JW, Lee JH. Allergic diseases and multiple chemical sensitivity in korean adults. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 6:409-14. [PMID: 25228997 PMCID: PMC4161681 DOI: 10.4168/aair.2014.6.5.409] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/13/2013] [Accepted: 10/22/2013] [Indexed: 11/20/2022]
Abstract
Purpose Multiple chemical sensitivity (MCS) is a clinical syndrome representing multi-organ and psychological symptoms caused by chronic exposure to various chemicals in low concentrations. We evaluated the prevalence and related factors of MCS targeting Korean adults using the Quick Environmental Exposure and Sensitivity Inventory (QEESI©). Methods A total of 446 participants were recruited from Severance Hospital. Participants underwent a questionnaire interview including questions on sociodemographic factors, occupational and environmental factors, allergic diseases, and the QEESI©. Among them, 379 participants completed the questionnaire and the QEESI©. According to the QEESI© interpretation results, participants were divided into very suggestive (VS) group and less suggestive (LS) group. Results The estimated prevalence of MCS was higher in allergic patients than non-allergic participants (19.7% and 11.3%, respectively, P=0.04). In the multivariate logistic regression analysis, ages of 30-39 (OR, 2.94; 95% CI, 1.25-6.95) and those of 40-49 (OR, 2.51; 95% CI, 1.02-6.21) were significantly related to MCS compared to those aged less than 30 years. Female sex (OR, 2.16; 95% CI, 1.11-4.18), experience of dwelling in a new house (OR, 2.05; 95% CI, 1.04-4.03), and atopic dermatitis (OR, 1.95; 95% CI, 1.04-3.69) were also significantly related to MCS. However, only age of 30-39 in the allergic group was significant in the stratified analysis. Conclusions The estimated prevalence of MCS was higher among allergic patients than non-allergic participants. People with experience of dwelling in a new house and atopic dermatitis were more at risk of being intolerant to chemicals. Further studies to provide the nationally representative prevalence data and clarify risk factors and mechanisms of MCS are required.
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Affiliation(s)
- Inchul Jeong
- Graduate School of Public Health, Yonsei University, Seoul, Korea. ; Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea
| | - Inah Kim
- Graduate School of Public Health, Yonsei University, Seoul, Korea. ; Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Jung Park
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jaehoon Roh
- Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea. ; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Won Park
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
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