Environmental Intolerance, Symptoms and Disability Among Fertile-Aged Women

AWMF mold guideline "Medical clinical diagnostics for indoor mold exposure" - Update 2023 AWMF Register No. 161/001

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The Continuum of Severity of Functional Impairment Due to Indoor Air Symptoms: Prevalence and Determinants

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.

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

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

Multiple Chemical Sensitivity Syndrome: First Symptoms and Evolution of the Clinical Picture: Case-Control Study/Epidemiological Case-Control Study

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.

Symptoms of Idiopathic Environmental Intolerance associated with chemicals (IEI-C) are positively associated with perceptual anomalies

OBJECTIVE

Idiopathic Environmental Intolerance (IEI; i.e. the experience of somatic symptoms attributed to environmental agents) represents a functional somatic syndrome of unclear aetiology. Based on previous findings that suggest an association between IEI and perceptual anomalies, this study aimed to investigate the relationship between symptoms of IEI associated with chemicals (IEI-C) and facets of the schizotypy spectrum.

METHODS

A cross-sectional study design was used with N = 410 (78.3% female) persons responding to an online survey in which chemical odor sensitivity (COS) and modern health worries (MHW) that are associated with IEI-C, as well as schizotypal personality traits (SPQ), hallucination proneness (LSHS) and delusional ideation (PDI) as core components of the schizotypy spectrum were assessed.

RESULTS

Schizotypal traits were found to be significantly positively associated with MHWs (r = 0.20, p = .01), COS (r = 0.23, p = .01), and showed significant positive associations with hallucination proneness. Magical thinking was found to exhibit a significant positive relationship with both MHW (r = 0.17, p = .01) and COS (r = 0.21, p = .01). These small associations between IEI-C and facets of the psychosis spectrum remained significant even after statistically controlling for individual levels of trait anxiety and depression.

CONCLUSION

Schizotypal personality traits, particularly magical thinking, and hallucination proneness, appear positively related to facets of IEI-C. The findings are of relevance for the advancement of theoretical models of IEI.

Physiological changes and symptoms associated with short-term exposure to electromagnetic fields: a randomized crossover provocation study

BACKGROUND

The biological association between electromagnetic fields (EMF) and idiopathic environmental intolerance attributed to EMF (IEI-EMF) has not been established. To assess the physiological changes and symptoms associated with exposure to EMF, we conducted a randomized crossover provocation study.

METHODS

We recruited 58 individuals with IEI-EMF (IEI-EMF group) and 92 individuals without IEI-EMF (control group). In a controlled environment, all participants received EMF signals mimicking those from mobile phone base stations in a randomized sequence under the blinded condition. During the course, participants reported their symptoms and whether they perceived EMF, and we monitored their physiological parameters, including blood pressure (BP), heart rate (HR), and HR variability.

RESULTS

The IEI-EMF and control groups reported similar frequencies of symptoms during both the provocation and sham sessions. No participant could accurately identify the provocation. In both groups, physiological parameters were similar between the two sessions. The control group, but not the IEI-EMF group, had elevated HR when they perceived EMF exposure.

CONCLUSIONS

No symptoms or changes in physiological parameters were found to be associated with short-term exposure to EMF, and no participant could accurately detect the presence of EMF. Moreover, the participants in the control group, but not those in the IEI-EMF group, had elevated HR when they perceived EMF.

Multiple Chemical Sensitivity in Patients Exposed to Moisture Damage at Work and in General Working-Age Population-The SAMDAW Study

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.

"Symptoms associated with environmental factors" (SAEF) - Towards a paradigm shift regarding "idiopathic environmental intolerance" and related phenomena

Health conditions characterized by symptoms associated with chemical, physical and biological environmental factors unrelated to objectifiable pathophysiological mechanisms are often labelled by the general term "idiopathic environmental intolerances". More specific, exposure-related terms are also used, e.g. "multiple chemical sensitivities", "electromagnetic hypersensitivity" and "candidiasis hypersensitivity". The prevalence of the conditions varies from a few up to more than 50%, depending on definitions and populations. Based on evolving knowledge within this field, we provide arguments for a paradigm shift from terms focusing on exposure and intolerance/(hyper-)sensitivity towards a term more in line with the perceptual elements that seem to underlie these phenomena. Symptoms caused by established pathophysiologic mechanisms should not be included, e.g. allergic or toxicological conditions, lactose intolerance or infections. We discuss different alternatives for a new term/concept and end up proposing an open and descriptive term, "symptoms associated with environmental factors" (SAEF), including a definition. "Symptoms associated with environmental factors" both is in line with the current knowledge and acknowledge the experiences of the afflicted persons. Thus, the proposed concept is likely to facilitate therapy and communication between health professionals and afflicted persons, and to provide a base for better understanding of such phenomena in healthcare, society and science.

Healthy people in healthy premises: the Finnish Indoor Air and Health Programme 2018-2028

Clean and fresh indoor air supports health and well-being. However, indoor air can contain pollutants that can cause a variety of symptoms and reduce well-being. Individual exposure agents can also increase the risk of certain diseases. Finns have taken major steps to improve the quality of indoor air for several decades. The primary focus of these activities has been the prevention and reduction of exposure to poor indoor air quality through guidance and regulation directing remediation of damaged buildings. Nevertheless, reported symptoms related to poor indoor air quality are common in Finland. In addition to exposure to indoor air pollutants, this may be partly due to the lively public discussion on the health risks caused by poor indoor air quality, conflicting views between experts, and mistrust towards public authorities, building owners and builders. Because of the scale of the indoor air problems in Finland, people’s needs for reliable information and support, and the major costs involved, there is a call for new evidence-based methods, perspectives and solutions. Therefore, the Finnish Institute for Health and Welfare initiated the Finnish Indoor Air and Health Programme 2018–2028 together with a number of collaborators and stakeholders. The primary, long-term objective of the programme is to reduce hazards to health and well-being linked to indoor environments in Finland. To fulfill this objective, the programme will focus on the promotion of human health and well-being, the prevention of hazards, improved communication and engage the whole health-care sector to manage better patients´ symptoms and complaints. The 10-year Finnish Indoor Air and Health Programme consists of four areas that aim (1) to increase understanding of the effects of indoor environments on health and well-being; (2) to develop the management of problems linked to indoor environments; (3) to improve the treatment and working and functional capacity of people with symptoms and illnesses; and (4) to strengthen the competence in matters related to indoor environments. The progress of the programme and reaching the predefined, quantitative goals will be monitored throughout the programme.

A case report of idiopathic environmental intolerance: A controversial and current issue

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.

Clinical Characteristics of Disability in Patients with Indoor Air-Related Environmental Intolerance

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.

Background factors of chemical intolerance and parent-child relationships

Background

Chemical intolerance is a widespread public health problem characterized by symptoms that reportedly result from low-level exposure to chemicals. Although several studies have reported factors related to chemical intolerance in adults, the impact of family members has not been reported. In the present study, we investigated the background factors related to chemical intolerance in family members and parent–child relationships.

Methods

We distributed a self-reported questionnaire to 4325 mothers who were invited to visit the Kishiwada Health Center in Kishiwada City, Osaka, between January 2006 and December 2007 for the regular health checkup of their three-and-a-half-year-old children.

Results

The prevalence of chemical intolerance in the 3-year-old children was almost one eighteenth of that reported by their mothers. Multiple logistic regression analyses revealed that cold sensitivity [odds ratio (OR), 1.89; 95% confidence interval (CI), 1.04–3.44], past bronchial asthma (OR, 2.84; 95% CI, 1.46–5.53), and any past allergies (OR, 2.21; 95% CI, 1.36–3.60) were significantly associated with chemical intolerance in the mother. The presence of indoor cat during childhood (OR, 1.99; 95% CI, 1.08–3.69) was significantly associated with chemical intolerance in the mother; however, the association was weak compared with cold sensitivity and past asthma and allergies. The current chemical intolerance of the mother was significantly associated with allergic rhinitis (OR, 2.32; 95% CI, 1.19–4.53), bronchial asthma (OR, 3.66; 95% CI, 2.00–6.69), and chronic bronchitis (OR, 3.69; 95% CI, 1.04–13.03) in her 3-year-old child.

Conclusions

The results suggest that inherent physical constitution and childhood housing environment are associated with a risk of acquiring chemical intolerance. Children of mothers with chemical intolerance have a possible risk of respiratory hypersensitivity or inflammation. Further investigation is recommended to determine the inherent physical constitution and background environmental factors associated with the risk of acquiring chemical intolerance. The impact of having mothers with chemical intolerance on the health of children also requires further study.

Electronic supplementary material

The online version of this article (10.1186/s12199-018-0743-y) contains supplementary material, which is available to authorized users.