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Watai K, Suda W, Kurokawa R, Sekiya K, Hayashi H, Iwata M, Nagayama K, Nakamura Y, Hamada Y, Kamide Y, Fukutomi Y, Nakabayashi T, Tanaka K, Kamita M, Taniguchi M, Hattori M. Metagenomic gut microbiome analysis of Japanese patients with multiple chemical sensitivity/idiopathic environmental intolerance. BMC Microbiol 2024; 24:84. [PMID: 38468206 PMCID: PMC10926566 DOI: 10.1186/s12866-024-03239-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/26/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Although the pathology of multiple chemical sensitivity (MCS) is unknown, the central nervous system is reportedly involved. The gut microbiota is important in modifying central nervous system diseases. However, the relationship between the gut microbiota and MCS remains unclear. This study aimed to identify gut microbiota variations associated with MCS using shotgun metagenomic sequencing of fecal samples. METHODS We prospectively recruited 30 consecutive Japanese female patients with MCS and analyzed their gut microbiomes using shotgun metagenomic sequencing. The data were compared with metagenomic data obtained from 24 age- and sex-matched Japanese healthy controls (HC). RESULTS We observed no significant difference in alpha and beta diversity of the gut microbiota between the MCS patients and HC. Focusing on the important changes in the literatures, at the genus level, Streptococcus, Veillonella, and Akkermansia were significantly more abundant in MCS patients than in HC (p < 0.01, p < 0.01, p = 0.01, respectively, fold change = 4.03, 1.53, 2.86, respectively). At the species level, Akkermansia muciniphila was significantly more abundant (p = 0.02, fold change = 3.3) and Faecalibacterium prausnitzii significantly less abundant in MCS patients than in HC (p = 0.03, fold change = 0.53). Functional analysis revealed that xylene and dioxin degradation pathways were significantly enriched (p < 0.01, p = 0.01, respectively, fold change = 1.54, 1.46, respectively), whereas pathways involved in amino acid metabolism and synthesis were significantly depleted in MCS (p < 0.01, fold change = 0.96). Pathways related to antimicrobial resistance, including the two-component system and cationic antimicrobial peptide resistance, were also significantly enriched in MCS (p < 0.01, p < 0.01, respectively, fold change = 1.1, 1.2, respectively). CONCLUSIONS The gut microbiota of patients with MCS shows dysbiosis and alterations in bacterial functions related to exogenous chemicals and amino acid metabolism and synthesis. These findings may contribute to the further development of treatment for MCS. TRIAL REGISTRATION This study was registered with the University Hospital Medical Information Clinical Trials Registry as UMIN000031031. The date of first trial registration: 28/01/2018.
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Affiliation(s)
- Kentaro Watai
- Center for Immunology and Allergy, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.
| | - Wataru Suda
- Laboratory for Microbiome Sciences, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa, Japan
| | - Rina Kurokawa
- Laboratory for Microbiome Sciences, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa, Japan
| | - Kiyoshi Sekiya
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Hiroaki Hayashi
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Maki Iwata
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Kisako Nagayama
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Yuto Nakamura
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Yuto Hamada
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Yosuke Kamide
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Yuma Fukutomi
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | | | - Kosei Tanaka
- H.U. Group Research Institute G.K., Akiruno, Tokyo, Japan
| | | | - Masami Taniguchi
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Masahira Hattori
- Laboratory for Microbiome Sciences, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa, Japan
- Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan
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Kleinbeck S, Wolkoff P. Exposure limits for indoor volatile substances concerning the general population: The role of population-based differences in sensory irritation of the eyes and airways for assessment factors. Arch Toxicol 2024; 98:617-662. [PMID: 38243103 PMCID: PMC10861400 DOI: 10.1007/s00204-023-03642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/16/2023] [Indexed: 01/21/2024]
Abstract
Assessment factors (AFs) are essential in the derivation of occupational exposure limits (OELs) and indoor air quality guidelines. The factors shall accommodate differences in sensitivity between subgroups, i.e., workers, healthy and sick people, and occupational exposure versus life-long exposure for the general population. Derivation of AFs itself is based on empirical knowledge from human and animal exposure studies with immanent uncertainty in the empirical evidence due to knowledge gaps and experimental reliability. Sensory irritation in the eyes and airways constitute about 30-40% of OELs and is an abundant symptom in non-industrial buildings characterizing the indoor air quality and general health. Intraspecies differences between subgroups of the general population should be quantified for the proposal of more 'empirical' based AFs. In this review, we focus on sensitivity differences in sensory irritation about gender, age, health status, and vulnerability in people, based solely on human exposure studies. Females are more sensitive to sensory irritation than males for few volatile substances. Older people appear less sensitive than younger ones. However, impaired defense mechanisms may increase vulnerability in the long term. Empirical evidence of sensory irritation in children is rare and limited to children down to the age of six years. Studies of the nervous system in children compared to adults suggest a higher sensitivity in children; however, some defense mechanisms are more efficient in children than in adults. Usually, exposure studies are performed with healthy subjects. Exposure studies with sick people are not representative due to the deselection of subjects with moderate or severe eye or airway diseases, which likely underestimates the sensitivity of the group of people with diseases. Psychological characterization like personality factors shows that concentrations of volatile substances far below their sensory irritation thresholds may influence the sensitivity, in part biased by odor perception. Thus, the protection of people with extreme personality traits is not feasible by an AF and other mitigation strategies are required. The available empirical evidence comprising age, lifestyle, and health supports an AF of not greater than up to 2 for sensory irritation. Further, general AFs are discouraged for derivation, rather substance-specific derivation of AFs is recommended based on the risk assessment of empirical data, deposition in the airways depending on the substance's water solubility and compensating for knowledge and experimental gaps. Modeling of sensory irritation would be a better 'empirical' starting point for derivation of AFs for children, older, and sick people, as human exposure studies are not possible (due to ethical reasons) or not generalizable (due to self-selection). Dedicated AFs may be derived for environments where dry air, high room temperature, and visually demanding tasks aggravate the eyes or airways than for places in which the workload is balanced, while indoor playgrounds might need other AFs due to physical workload and affected groups of the general population.
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Affiliation(s)
- Stefan Kleinbeck
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.
| | - Peder Wolkoff
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Binkley KE. Multiple Chemical Sensitivity/Idiopathic Environmental Intolerance: A Practical Approach to Diagnosis and Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3645-3649. [PMID: 37660733 DOI: 10.1016/j.jaip.2023.08.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023]
Abstract
Patients with multiple chemical sensitivity, now called idiopathic environmental intolerance, frequently present to clinical immunologists and allergists for diagnosis and treatment. Patients report a plethora of respiratory and multisystem problems attributed to a wide variety of unrelated, otherwise non-noxious, triggers. They may go to extreme, often seemingly bizarre lengths to avoid contact with everyday exposures and may become housebound, unable to work or function socially. Often beginning with exposure to odors, triggers can multiply to involve foods, clothing, medications, and even electromagnetic radiation. The condition cannot be explained by IgE-mediated or other immune processes, and clinical immunologists and allergists may feel unprepared to care for such patients. In this article, a paradigm to understand the probable mechanisms underlying this condition and a practical approach to diagnosis and management will be presented.
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Affiliation(s)
- Karen E Binkley
- Division of Clinical Immunology and Allergy, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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Palmer RF, Dempsey TT, Afrin LB. Chemical Intolerance and Mast Cell Activation: A Suspicious Synchronicity. J Xenobiot 2023; 13:704-718. [PMID: 37987446 PMCID: PMC10660865 DOI: 10.3390/jox13040045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/19/2023] [Accepted: 11/10/2023] [Indexed: 11/22/2023] Open
Abstract
Background: Chemical Intolerance (CI) is characterized by intolerances for chemicals, foods, and drugs with multi-system symptoms. As yet, the biomechanism remains unclear. One study reported converging lines of evidence supporting a substantive association between mast cell activation syndrome (MCAS) and CI. The purpose of this study is to (1) confirm a previous report demonstrating that 60% of MCAS patients report CI and (2) examine the parallels between symptoms and intolerances in CI and MCAS. Methods: Five hundred forty-four MCAS patients were assigned a clinical MCAS score using a validated assessment instrument and were assessed for CI using the validated Quick Environmental Exposure Sensitivity Index. Results: Our outcomes confirm the previously published study where the majority of MCAS patients also have CI. There was a clear overlap between various ICD-10 diagnostic categories and CI symptoms, providing further support for a potential shared mechanism. Conclusions: Exposures to pesticides, volatile organic compounds, combustion products, and mold have previously been reported as initiators of CI. However, until recently, little was known about the biological mechanism involved that could explain the multisystem symptoms associated with CI. This paper addresses a newly identified biomechanism for disease, which may underlie a host of "medically unexplained symptoms" triggered by xenobiotics.
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Affiliation(s)
- Raymond F Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA
| | - Tania T Dempsey
- AIM Center for Personalized Medicine, Purchase, NY 10577, USA
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Eidstø E, Selinheimo S, Lampi J, Salmela A, Pekkanen J. The Continuum of Severity of Functional Impairment Due to Indoor Air Symptoms: Prevalence and Determinants. J Occup Environ Med 2023; 65:717-724. [PMID: 37231645 PMCID: PMC10487355 DOI: 10.1097/jom.0000000000002884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The aim of the study is to study functional impairment due to indoor air-related symptoms and associated characteristics. METHODS A questionnaire survey of a random sample of Finnish people aged 25 to 64 years. Analyses were done using multivariate multinomial logistic regression. RESULTS A total of 23.1% reported indoor air-related symptoms, 1.8% severe functional impairment due to symptoms, 5.3% moderate, 11.1% mild, and 4.9% reported no impairment. Those with severe functional impairment showed the strongest associations with comorbid diseases, for example, asthma and irritable bowel syndrome, perceived sensitivities to several environmental factors, like chemicals, and likelihood of having symptoms in multiple organs, while those with no or little functional impairment showed weak or even inverse associations. Similar results emerged with severity of indoor air-related symptoms. CONCLUSIONS Individuals with indoor air-related symptoms are a very heterogeneous group. This should be better considered in future research and clinical practice.
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Affiliation(s)
- Einar Eidstø
- From the Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland (E.E., S.S., J.P.); Finnish Institute of Occupational Health, Helsinki, Finland (S.S.); and Department of Health Security, Environmental Health Unit, Finnish Institute for Health and Welfare, Kuopio, Finland (J.L., A.S., J.P.)
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Köteles F, Szemerszky R, Petrie K, Nordin S. Modern health worries and annoyance from environmental factors are largely unrelated to smoking, alcohol consumption, and physical activity. J Psychosom Res 2023; 172:111417. [PMID: 37331267 DOI: 10.1016/j.jpsychores.2023.111417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE Modern health worries, as well as environmental annoyance from chemical agents, noise, and electromagnetic exposure are associated with symptom reporting and marked affective-behavioural changes. As promotion and protection of health is a primary characteristic of these conditions, it can be expected that they will be related to less risk behaviour (smoking and alcohol consumption) and more health behaviour (physical activity), both cross-sectionally and longitudinally. METHODS Hypotheses were tested in a sample of 2336 individuals participating in T1 and T2 data collection (3 years apart) of the Västerbotten Environmental Health Study, Sweden. Health-related behaviours were assessed using single self-report questions. Smoking was measured on a binary (yes-or-no) scale; frequency of alcohol consumption and physical activity was measured on a 5-point and a 4-point scale, respectively. RESULTS Modern health worries showed no cross-sectional association with the three behaviours, whereas annoyance was typically inversely, very weakly, related to smoking and alcohol consumption. Physical activity was significantly positively associated only with chemical annoyance. None of the variables significantly predicted change of behaviours at T2 after controlling for the respective T1 value and demographic variables. CONCLUSIONS Individuals with high levels of modern health worries and annoyance from various environmental agents are not clearly characterized by a healthier lifestyle. Perhaps they focus on the alleviation of their existing symptoms; alternatively, somatic symptom distress decreases their cognitive-affective resources necessary for a long-term life style change.
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Affiliation(s)
- Ferenc Köteles
- Institute of Psychology, Károli Gáspár University of the Reformed Church in Hungary, Hungary.
| | - Renáta Szemerszky
- Institute of Psychology, Károli Gáspár University of the Reformed Church in Hungary, Hungary.
| | - Keith Petrie
- Department of Psychological Medicine, University of Auckland, New Zealand.
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden.
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7
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Molot J, Sears M, Anisman H. Multiple Chemical Sensitivity: It's time to catch up to the science. Neurosci Biobehav Rev 2023; 151:105227. [PMID: 37172924 DOI: 10.1016/j.neubiorev.2023.105227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
Multiple chemical sensitivity (MCS) is a complex medical condition associated with low dose chemical exposures. MCS is characterized by diverse features and common comorbidities, including fibromyalgia, cough hypersensitivity, asthma, and migraine, and stress/anxiety, with which the syndrome shares numerous neurobiological processes and altered functioning within diverse brain regions. Predictive factors linked to MCS comprise genetic influences, gene-environment interactions, oxidative stress, systemic inflammation, cell dysfunction, and psychosocial influences. The development of MCS may be attributed to the sensitization of transient receptor potential (TRP) receptors, notably TRPV1 and TRPA1. Capsaicin inhalation challenge studies demonstrated that TRPV1 sensitization is manifested in MCS, and functional brain imaging studies revealed that TRPV1 and TRPA1 agonists promote brain-region specific neuronal variations. Unfortunately, MCS has often been inappropriately viewed as stemming exclusively from psychological disturbances, which has fostered patients being stigmatized and ostracized, and often being denied accommodation for their disability. Evidence-based education is essential to provide appropriate support and advocacy. Greater recognition of receptor-mediated biological mechanisms should be incorporated in laws, and regulation of environmental exposures.
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Affiliation(s)
- John Molot
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
| | - Margaret Sears
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
| | - Hymie Anisman
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
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Ahrendt Bjerregaard A, Schovsbo SU, Gormsen LK, Skovbjerg S, Eplov LF, Linneberg A, Cedeño-Laurent JG, Jørgensen T, Dantoft TM. Social economic factors and the risk of multiple chemical sensitivity in a Danish population-based cross-sectional study: Danish Study of Functional Disorders (DanFunD). BMJ Open 2023; 13:e064618. [PMID: 36972962 PMCID: PMC10069487 DOI: 10.1136/bmjopen-2022-064618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 03/11/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES Multiple chemical sensitivity (MCS) is a rare multisystem and poly-symptomatic disease characterised by a report of various somatic symptoms attributed to inhalation of volatile chemicals in usually harmless doses. The aim was to explore four selected social factors and the risk of MCS in the general Danish population. DESIGN A cross-sectional general population-based study. SETTING The Danish Study of Functional Disorders was conducted from 2011 to 2015 which included 9656 participants. PARTICIPANTS A total of 8800 participants were included in analyses after observations with missing data on exposure and/or outcome were excluded. A total of 164 cases fulfilled the questionnaire criteria for MCS. Of the 164 MCS cases, 101 reported no comorbid functional somatic disorder (FSD) and were included in a subgroup analysis. A total of 63 MCS cases fulfilled the criteria for at least one additional FSD, this subgroup was not included in further analysis. The remaining study population without MCS or any FSD were regarded as controls. OUTCOME MEASURES We used adjusted logistic regression to calculate OR and 95% CIs of MCS and MCS without FSD comorbidities for each social variable separately including education, employment, cohabitation and subjective social status. RESULTS We found an increased risk of MCS among the unemployed (OR: 2.95, 95% CI: 1.75 to 4.97), and a twofold increased risk of MCS among individuals with low subjective social status (OR: 2.00, 95% CI: 1.08 to 3.70). At the same time, 4 years or more of vocational training were protective of MCS. No significant associations were observed among MCS cases with no comorbid FSD. CONCLUSION Lower socioeconomic status was found to be associated with a higher risk of having MCS but not with MCS without FSD comorbidities. Due to the cross-sectional design of the study, we cannot determine whether social status is a determinant or a consequence of MCS.
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Affiliation(s)
- Anne Ahrendt Bjerregaard
- Section of Epidemiology, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Signe Ulfbeck Schovsbo
- Section of Epidemiology, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Lise K Gormsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Sine Skovbjerg
- Department of Clinical Medicine, The Danish Center for Mindfulness, Aarhus University, Aarhus, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Center for Mental Health- CORE, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Allan Linneberg
- Section of Epidemiology, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - José G Cedeño-Laurent
- Department of Exposure Epidemiology and Risk Program, Harvard T.H. Chan School of Public Health, Cambridge MA, Massachusetts, USA
| | - Torben Jørgensen
- Section of Epidemiology, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Meinertz Dantoft
- Section of Epidemiology, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
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Fares-Medina S, Díaz-Caro I, García-Montes R, Corral-Liria I, García-Gómez-Heras S. Multiple Chemical Sensitivity Syndrome: First Symptoms and Evolution of the Clinical Picture: Case-Control Study/Epidemiological Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15891. [PMID: 36497963 PMCID: PMC9737200 DOI: 10.3390/ijerph192315891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Multiple chemical sensitivity (MCS) is a chronic condition characterized by the appearance of symptoms caused by exposure to chemical compounds that are tolerable for the general population. It mainly affects middle-aged women. There are very few studies focusing on the most frequent symptoms of MCS considering age groups and gender. The main goal of this study was to find the most frequent symptoms both at the onset of the disease and at the present time describing them by age groups. The QEESI (Quick Environmental Exposure and Sensitivity Inventory) questionnaire, Scale 3 which assesses symptoms and their severity, was used as a diagnostic tool for the disease. A case-control study was conducted with the participation of 210 people. Of the cases, 94.3% were women. The symptoms that most often manifested first were airway and mucous membrane alterations (68.9%). In the development of the disease, we found cognitive alterations (OR = 31.25), heart or chest problems (OR = 22.49), neuromuscular problems (OR = 20.00) and head-related symptomatology (OR = 19.29). Identifying the most frequent pattern of symptoms by age group and sex will allow an early diagnosis of the disease to improve its prognosis and treatment.
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Affiliation(s)
- Sandra Fares-Medina
- Student International Doctoral School, Rey Juan Carlos University (URJC), 28922 Madrid, Spain
| | | | - Rebeca García-Montes
- Student International Doctoral School, Rey Juan Carlos University (URJC), 28922 Madrid, Spain
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Schovsbo SU, Møllehave LT, Petersen MW, Ahrendt Bjerregaard A, Eliasen M, Pedersen SB, Eplov LF, Kårhus LL, Fink P, Linneberg A, Dantoft TM, Jørgensen T, Benros ME. Association between infections and functional somatic disorders: a cross-sectional population-based cohort study. BMJ Open 2022; 12:e066037. [PMID: 36323461 PMCID: PMC9639106 DOI: 10.1136/bmjopen-2022-066037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES It has been suggested that infections can trigger functional somatic disorders (FSD). However, current evidence is limited by inconsistent findings in smaller studies conducted in clinical settings within selected populations and short follow-up times. We aimed to test the hypothesis that former infections are associated with FSD using data from nationwide registries and a large population-based cohort study, the Danish Study of Functional Disorders study. DESIGN FSD cases were identified in a cross-sectional population-based cohort and linked retrospectively to former hospital contacts with infections identified in the Danish National Patient Registry. The associations between FSD and former infections within 17 years were analysed using logistic regressions to calculate ORs and 95% CIs adjusted for age, sex and subjective social status. SETTING A population-based cohort in Denmark examined between 2011 and 2015. PARTICIPANTS A total of 9656 men and women aged 18-76 years. MAIN OUTCOME MEASURES FSD measured by various delimitations, including bodily distress syndrome (BDS), irritable bowel (IB), chronic fatigue (CF), chronic widespread pain (CWP), and multiple chemical sensitivity (MCS). RESULTS Overall, infections were associated with increased risk of all delimitations of FSD. The associations were more pronounced for multisystemic FSD. The number of prior infections increased the risk in a dose-response manner (p<0.0001). Bacterial but not viral infections were significantly associated with BDS (OR 1.69 (95% CI 1.46 to 1.96)), IB (OR 1.41 (95% CI 1.06 to 1.88)), CWP (OR 1.47 (95% CI 1.13 to 1.90)) and CF (OR 1.62 (95% CI 1.34 to 1.96)), but not MCS. CONCLUSION Former infections leading to hospital contacts were associated with a higher risk of having FSD. These associations were more pronounced for bacterial than viral infections, and more infections increased the risk in a dose-response manner. These results tend to support the idea that severe infections could play a role in FSD.
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Affiliation(s)
- Signe Ulfbeck Schovsbo
- Centre for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Line Tang Møllehave
- Centre for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Marie Weinreich Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Ahrendt Bjerregaard
- Centre for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Marie Eliasen
- Centre for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Susanne Brix Pedersen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Line Lund Kårhus
- Centre for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Allan Linneberg
- Centre for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Meinertz Dantoft
- Centre for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Torben Jørgensen
- Centre for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen C, Denmark
| | - Michael Eriksen Benros
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Jørgensen T, Dantoft TM, Weinreich Petersen M, Benros ME, Poulsen CH, Falgaard Eplov L, Gormsen L, Frostholm L, Carstensen TBW, Holm Eliasen M, Kårhus LL, Skovbjerg S, Bjerregaard AA, Brix S, Linneberg A, Fink P. Examine the public health impacts of functional somatic disorders using the DanFunD study. Scand J Public Health 2022; 50:988-994. [PMID: 36245407 DOI: 10.1177/14034948221122886] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Persistent physical symptoms (e.g. pain, fatigue) are prevalent in the population and some persons may develop a functional somatic disorder (FSD). We still need to explore the limits between general bodily sensations and FSD, and great controversies exist as regard delimitation, occurrence, risk factors, prognosis, and costs of FSD in the general population. This is mainly due to the lack of focused, sufficient powered, population-based epidemiological studies. Material and Methods: The DanFunD study is the largest focused population-based study on FSD and has the potential to answer these crucial questions regarding the FSD disorders. DanFunD has its origin in the Copenhagen area of Denmark and was initiated in 2009 by an interdisciplinary team of researchers including basic scientists, clinical researchers, epidemiologists, and public health researchers. A population-based cohort of nearly 10,000 people have filled in detailed questionnaires, gone through a thorough health examination, and a biobank is established. The cohort was re-examined after five years. Results:The prevalence of FSD in the Danish population is about 10-15% and is twice as common in women as in men. Persons with FSD report impaired daily activities and low self-perceived health, which qualifies FSD as a major public health problem. The research plan to unravel the risk factors for FSD employs a bio-psycho-social approach according to a detailed plan. Preliminary results are presented, and work is in progress. Likewise, plans for assessing prognosis and health care costs are provided. Conclusion: We invite researchers in the field to collaborate on this unique data material.
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Affiliation(s)
- Torben Jørgensen
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Marie Weinreich Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Michael Eriksen Benros
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark.,Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Chalotte Heinsvig Poulsen
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark
| | - Lise Gormsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Tina Birgitte Wisbech Carstensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Marie Holm Eliasen
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Line Lund Kårhus
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Sine Skovbjerg
- Department of Clinical Medicine, The Danish Centre for Mindfulness, Aarhus University, Denmark
| | | | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Denmark
| | - Allan Linneberg
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
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12
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Bjerregaard AA, Petersen MW, Skovbjerg S, Gormsen LK, Cedeño-Laurent JG, Jørgensen T, Linneberg A, Dantoft TM. Physiological Health and Physical Performance in Multiple Chemical Sensitivity-Described in the General Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159039. [PMID: 35897408 PMCID: PMC9331319 DOI: 10.3390/ijerph19159039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023]
Abstract
Multiple chemical sensitivity (MCS) is a multifactorial somatic disorder characterized by physical reactions triggered by even extremely low levels of different airborne chemicals. In most individuals with MCS, these reactions have substantial negative impact on social, occupational, and everyday life often including limited or no engagement in physical activities. The aim of this study was to explore associations between MCS and objective measurements of anthropometry, cardiorespiratory health, and physical performance. From the Danish population-based cohort DanFunD counting 9656 participants aged 18–76 years, 1.95% (n = 188) were categorized as MCS individuals (MCS All). Of those 188, 109 participants were subcategorized as having MCS without functional somatic disorders (FSD) (MCS with no comorbid FSD). The remaining study population without any FSD were regarded controls. We used adjusted multiple linear regression analyses to evaluate associations between MCS and anthropometry, cardiorespiratory fitness, and physical performance. Compared with the general population, MCS All had less optimal body composition, increased risk of obesity, impaired cardiorespiratory fitness, and physical performance which was not seen in MCS with no comorbid FSD. MCS individuals may be inhibited to maintain an active lifestyle which can increase risk of obesity and consequently have negatively impact on general health, which may not be the case among MCS with no comorbid FSD.
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Affiliation(s)
- Anne A. Bjerregaard
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen, Entrance 5, 2000 Frederiksberg, Denmark; (T.J.); (A.L.); (T.M.D.)
- Correspondence: or
| | - Marie W. Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Universitetsbyen 22–23, 8000 Aarhus C, Denmark; (M.W.P.); (L.K.G.)
| | - Sine Skovbjerg
- The Danish Center for Mindfulness, Department of Clinical Medicine, Aarhus University, Hack Kampmanns Plads, 8000 Aarhus C, Denmark;
| | - Lise K. Gormsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Universitetsbyen 22–23, 8000 Aarhus C, Denmark; (M.W.P.); (L.K.G.)
| | - José G. Cedeño-Laurent
- Department of Exposure Epidemiology and Risk Program, Harvard T.H. Chan School of Public Health, 1350 Massachusetts Ave, Cambridge, MA 02138, USA;
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen, Entrance 5, 2000 Frederiksberg, Denmark; (T.J.); (A.L.); (T.M.D.)
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen, Entrance 5, 2000 Frederiksberg, Denmark; (T.J.); (A.L.); (T.M.D.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen, Entrance 5, 2000 Frederiksberg, Denmark; (T.J.); (A.L.); (T.M.D.)
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13
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Suzuki K, Okamura M, Haruyama Y, Suzuki S, Shiina T, Kobashi G, Hirata K. Exploring the contributing factors to multiple chemical sensitivity in patients with migraine. J Occup Health 2022; 64:e12328. [PMID: 35363938 PMCID: PMC9176718 DOI: 10.1002/1348-9585.12328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/08/2022] [Accepted: 03/20/2022] [Indexed: 12/17/2022] Open
Abstract
Objective Multiple chemical sensitivity (MCS) is a form of chemical intolerance in which various systemic symptoms are triggered by exposure to a variety of chemical substances. Although migraine has been associated with central sensitivity syndrome, the relationship between MCS and migraine has not been studied. We assessed the frequency of MCS and its related factors in patients with migraine. Methods We performed a cross‐sectional study that included 95 patients (14 M/81 F; age, 45.4 ± 12.4 years) out of 100 consecutive patients with migraine from our outpatient headache clinic. MCS was defined as having a combination of Q1 ≥ 30, Q3 ≥ 13, and Q5 ≥ 17 on the quick environment exposure sensitivity inventory (QEESI; Japanese version). Central sensitization inventory‐A scores >40 were considered an indication of central sensitization. Headache‐related disability and psychological distress were evaluated with the Migraine Disability Assessment score (MIDAS) and Kessler Psychological Distress Scale (K6), respectively. Results MCS was identified in 20% of patients with migraine; however, none had previously been diagnosed with MCS. The MCS‐positive group had higher rates of photophobia, osmophobia, visual aura, sensory aura, and central sensitization and higher MIDAS and K6 scores than the MCS‐negative group. A logistic regression analysis showed that osmophobia, sensory aura, and central sensitization were significant contributors to MCS. Conclusion We showed that MCS was observed in 20% of patients with migraine, and our study results may indicate a possible association of MCS with central sensitization and hypersensitivity‐related symptoms in patients with migraine.
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Affiliation(s)
- Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Madoka Okamura
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Science, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Shiho Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Tomohiko Shiina
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
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14
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Azuma K, Uchiyama I, Kunugita N. Potential factors affecting chronic chemical intolerance associated with constitutional predisposition or lifestyle and environment during childhood: From a six-year follow-up study. J Psychosom Res 2021; 151:110665. [PMID: 34763204 DOI: 10.1016/j.jpsychores.2021.110665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/31/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The Japanese chemical intolerance (JCI) study was conducted in January 2012 with a cohort of 7245 adults from population-based sampling. This study aimed to investigate the childhood constitutional and environmental factors involved in the development of chronic CI from the prospective cohort study. METHODS In the cohort, 4683 persons were identified after six years. Self-reported questionnaires were administered to the subjects to obtain information on CI status; medical history; constitution, lifestyle, and housing environment during childhood; and recent psychosomatic states. We assessed the differences between individuals with persisting CI status during the follow-up (defined as chronic CI) and controls not having CI status during the follow-up. RESULTS A total of 2500 individuals responded. Multiple logistic regression analyses revealed significant associations between chronic CI and motion sickness to car or bus and allergic conjunctivitis during childhood. Significant associations between a possible increased risk of CI and the existence of high-voltage power lines close to housing, the use of vinyl covering in wall material, the use of strong perfume by a family member, and the experience of stinky odor of paint or wax at elementary school were observed. However, the use of carpet in floor material and plaster coating in wall material was associated with a possible decreased risk of CI. CONCLUSIONS Some potential constitutional predisposition from childhood, including inherent susceptibility in the autonomic nervous system may be involved in the development of CI.
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Affiliation(s)
- Kenichi Azuma
- Department of Environmental Medicine and Behavioral Science, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan; Department of Environmental Health, National Institute of Public Health, Wako 351-0197, Japan.
| | - Iwao Uchiyama
- Sick-house Medical Science Laboratory, Division of Basic Research, Louis Pasteur Center for Medical Research, Kyoto 606-8225, Japan.
| | - Naoki Kunugita
- Occupational and Community Health Nursing Division, Department of Nursing, School of Health Sciences, University of Occupational and Environmental Health, Japan; Department of Environmental Health, National Institute of Public Health, Wako 351-0197, Japan.
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15
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Insulin Resistance Is Associated with Multiple Chemical Sensitivity in a Danish Population-Based Study-DanFunD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312654. [PMID: 34886380 PMCID: PMC8657139 DOI: 10.3390/ijerph182312654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022]
Abstract
Multiple chemical sensitivity (MCS) is a multisystem syndrome, and limited knowledge of its pathophysiology exists. Based on the population-based Danish cohort DanFunD, this study investigated metabolic health in people with MCS compared to individuals who did not have MCS. From 9656 cohort participants aged 18–76 years old, 1.95% were categorized as MCS individuals with comorbid functional somatic disorders (MCS +FSD, n = 188), and 1.13% were categorized as MCS without functional somatic disorders (MCS ÷FSD, n = 109). MCS was characterized based on three criteria: the experience of symptoms upon exposure to common odors and airborne chemicals, symptoms related the central nervous systems and others organ symptoms, and significant impact on every day, social, and occupational life. The remaining study population without MCS or any other functional somatic disorders were regarded as controls. We used adjusted multiple linear regression with link-function to evaluate the associations between lipid and glucose metabolism markers and MCS. We also tested the odds ratio of metabolic syndrome in MCS. Results did not point to statistically significant associations between lipid biomarkers or metabolic syndrome and both MCS groups compared to the controls. We found that MCS individuals may be more insulin resistant and that MCS ÷ FSD may have an impaired glucose metabolism when compared to controls.
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16
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Petersen MW, Skovbjerg S, Jensen JS, Wisbech Carstensen TB, Dantoft TM, Fink P, Benros ME, Mortensen EL, Jørgensen T, Gormsen LK. Conditioned pain modulation and pain sensitivity in functional somatic disorders: The DanFunD study. Eur J Pain 2021; 26:154-166. [PMID: 34309927 PMCID: PMC9292427 DOI: 10.1002/ejp.1847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/20/2021] [Indexed: 11/09/2022]
Abstract
Background Disrupted pain regulation has been proposed as a component in functional somatic disorders (FSD). The objective of this study was to examine a general population sample, encompassing three delimitations of FSD while assessing pain sensitivity and conditioning pain modulation (CPM). Methods Pressure pain thresholds (PPTs) at the tibialis and trapezius muscles were recorded at baseline. During cold pressor stimulation of the hand, the tibialis PPTs were re‐assessed and the difference from baseline measures defined the CPM effect. Participants (n = 2,198, 53% females) were randomly selected from the adult Danish population. FSD was established by self‐reported symptom questionnaires. Results With a few exceptions, only weak associations were seen between PPTs and CPM in cases with FSD (p > .1). A high PPT was associated with lower odds of having multi‐organ bodily distress syndrome (ORPPT trapezius: 0.66, 95% CI: 0.49–0.88, p = .005), with the symptom profile characterized by all symptoms (ORPPT trapezius: 0.72, 95% CI: 0.58–0.90, p = .003 and ORPPT tibialis: 0.75, 95% CI: 0.62–0.91, p = .004), and with multiple chemical sensitivity (ORPPT trapezius: 0.81, 95% CI: 0.67–0.97, p = .022). High CPM was associated with high odds of having irritable bowel (ORCPM relative: 1.22, 95% CI: 1.04–1.43, p = .013 and ORCPM absolute = 2.66, 95% CI: 1.07–6.45, p = .033). Conclusion However, only PPT measured over the trapezius muscle were still significant after correction for multiple testing for the symptom profile characterized by all symptoms. Findings from this study do not support altered pain regulation in questionnaire‐based FSD which is in contrast with the existing presumption. Further epidemiological studies in this field are needed. Significance Disrupted pain regulation as measured by abnormal pain thresholds has been hypothesized as a central mechanism in Functional Somatic Disorders (FSD). The hypothesis has been raised in clinical setting where patients presented subjective and objective features of hypersensitivity. The present population‐based study does not support this notion. This points to the importance of further studies into the underlying pathophysiology mechanisms of FSD.
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Affiliation(s)
- Marie Weinreich Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Sine Skovbjerg
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospital, Capital Region and University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, The Danish Center for Mindfulness, Aarhus University, Aarhus, Denmark
| | - Jens Søndergaard Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Tina Birgitte Wisbech Carstensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospital, Capital Region and University of Copenhagen, Copenhagen, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | | | - Erik Lykke Mortensen
- Department of Public health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospital, Capital Region and University of Copenhagen, Copenhagen, Denmark.,Department of Public health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Lise Kirstine Gormsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
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17
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Palmer R, Walker T, Perales R, Rincon R, Jaén C, Miller C. Disease comorbidities associated with chemical intolerance. ENVIRONMENTAL DISEASE 2021. [DOI: 10.4103/ed.ed_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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