[Multiple chemical sensitivity is for real]

Diagnosis of multiple chemical sensitivity is based on symptoms described by the patient. Sometimes the symptom is manifested as flushing of the face and as watering of the eyes and nose. Patients with multiple chemical sensitivity do not sense lower concentrations of scents and smells than do healthy persons, but their olfaction does not adapt to the smell. Because the mechanism of the sensitivity is not properly known, a good treatment does not exist. Some patients are alleviated by antihistamines or nasally sprayed corticosteroids or dilute local anesthetics. The best way is to avoid intense smells.

Air emissions from Wagerup alumina refinery and community symptoms: an environmental case study

Commissioning of a liquor burner at Wagerup alumina refinery gave rise to complaints of malodor and irritation among employees. Subsequently, community members complained about odor and various health issues. Some employees and community members were diagnosed by general practitioners as having multiple chemical sensitivity. After implementation of emission controls, the situation improved; however, community concerns lingered. This paper describes this experience and summarizes several recent investigations including air dispersion modeling, health risk assessment, ambient air quality monitoring, and complaints analyses. It is concluded that refinery emissions currently present negligible risks of acute or chronic health effects including cancer. Communication of these findings has been generally well received, but modifying the perception of risk among some elements of the community has been difficult. Organizations need to effectively address both technical and perception of risk issues.

Multiple-drug intolerance syndrome: clinical findings and usefulness of challenge tests

BACKGROUND

Multiple-drug intolerance syndrome (MDIS) is characterized by adverse reactions to several classes of chemically unrelated drugs.

OBJECTIVE

To analyze all patients with a history of adverse reactions to at least 3 drugs at the Allergy Unit of Policlinico Gemelli in a 6-year period to better characterize patients with MDIS and to find safe alternative drugs.

METHODS

We studied 480 patients (aged >16 years) with a history of adverse reactions to at least 3 unrelated drugs and with negative allergy test results. Patients who had experienced mild adverse reactions that remitted spontaneously underwent challenge tests without any premedication (group A). Patients with a clinical history of moderate reactions received sodium cromolyn, 500 mg, before the challenge (group B). Patients with a clinical history of severe reactions or undergoing parenteral challenges were given an antihistamine 30 minutes before the challenge (group C).

RESULTS

In group A, 491 tolerance challenge tests were performed: 414 had negative results and 77 had positive results. In group B, 1,077 tolerance challenge tests were performed: 956 had negative results and 121 had positive results. In group C, 240 tolerance challenge tests were performed: 214 had negative results and 26 had positive results. Comparing the tolerance of alternative drugs in groups A and B, groups A and C, and groups B and C, no significant results were observed (P = .24, .14, and .44, respectively).

CONCLUSIONS

Patients with MDIS can tolerate alternative drugs. Premedication with sodium cromolyn or oral H1-antihistamines may be useful in preventing adverse reactions.

Multiple chemical sensitivity in the clinical setting

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

Hazards in the radiology department

OBJECTIVE

This article views, collectively, the problems associated with darkroom disease, multiple chemical sensitivity and latex allergy. Each is discussed individually to establish a case definition.

METHOD

Common threads and similarities are identified among the 3 conditions along with potential sources.

RESULTS

A model is proposed to change attitudes among radiographers in individual departments to improve workplace safety.

CONCLUSION

We propose the use of an established health education/disease prevention model to change the attitudes of radiographers toward chemical threats.

Idiopathic environmental intolerances: overview

The editor discusses usage of the terms "iidiopathic environmental intolerance," "multiple chemical sensitivity," and "environmental illness." Also addressed are prevalence, theories of etiology, evaluation and treatment, and social and political implications.

"Eco-syndrome" ("multiple chemical sensitivity"--MCS)

In the physicians's practice in past decades, an increasing number of patients suffering from polysomatic complaints with a subjective feeling of allergy against environmental noxious agents have been seen. Various names for this condition include "Eco-Syndrome" or "Multiple Chemical Sensitivity" (MCS), "Multiorgan Dysesthesia" or "Idiopathic Environmental Intolerances". The uncertainty in the nomenclature reflects the deficiency in the knowledge of the etiopathophysiology and accordingly the diagnostic and therapeutic procedures. Most patients have completed an odyssey of visiting various specialists including psychiatrists and undergone many kinds of so-called alternative or parascientific procedures. We studied such patients since the early 1980s performing intensive interdisciplinary and allergological investigations. In about two third of the patients psychiatric or psychosomatic disturbances were obvious, but in one third of the patients somatic pathophysiological conditions were regarded as predominant cause of the present complaints. Many patients exhibited various pathophysiological patterns including somatic and psychosomatic alterations. Measurements of indoor air pollutants in the dust or in the air showed in some cases increased values of aromatic hydrocarbones, terpenes etc., without, however, explaining the main complaints. We conclude from our experience that patients presenting with hypersensitivity phenomena related to indoor air pollution are a heterogeneous group. There is no evidence, that "MCS" really exists, often it is diagnosed by the patients themselves. The term "eco-syndrome" describes a "working diagnosis" in order to apply careful interdisciplinary investigations for this heterogeneous group of patients. For the practical management of these patients mutual confidence is a prerequisite for success. The role of indoor air pollutants in triggering unspecific complaints beyond the exclusively toxicological field remains to be elucidated by future studies.

Hope in multiple chemical sensitivity: social support and attitude towards healthcare delivery as predictors of hope

This paper examines hope, as measured by the Herth Hope Scale, and its predictors in a sample of 305 people self-identified with multiple chemical sensitivity. The sample had relatively low levels of hope with scores unrelated to gender, severity or length of illness, income loss as a result of illness, or reported iatrogenic harm. Hope scores were positively correlated with perceived social support, having found personal growth through illness, age, reported level of supportiveness from a partner, an improved course of illness and level of reported safety of the home environment in regard to chemical exposures. Negative correlations were found with attitude toward healthcare delivery, fatigue and reported abuse/ostracism from family members other than partner. Social support, Healthcare Orientation, growth through illness, fatigue and age predicted hope scores accounted for 55% of the variance. Implications and suggestions for future research are discussed.

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

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

Developing a pesticide policy for individuals with multiple chemical sensitivity: considerations for institutions

Institutions are increasingly being asked to accommodate individuals with multiple chemical sensitivity (MCS). Most establishments have chosen to provide such accommodations on a case-by-case basis only. This paper investigates feasible actions that may be taken by institutions to reduce exposure of MCS individuals as well as the general institutional population to pesticides and other substances. Emphasis is placed on procedures that can be instituted on a regular basis and may be combined with case-by-case management for better resolution of problems.

Social support in persons with self-reported sensitivity to chemicals

Social support was examined in 305 persons with multiple chemical sensitivity using the Personal Resource Questionnaire 85 (PRQ85; Weinert, 1987) and qualitative descriptions of respondents' social interactions. PRQ85 scores were lower than those of healthy populations, but similar to samples with chronic illness. Participants needed but were prevented from receiving support for personal difficulties due to their limited public access, their need for chemical avoidance including fragrances, and others' lack of information and negative attitudes regarding chemical sensitivities. Respondents drew some support and validation from support groups and from romantic relationships. Fatigue level, being in a romantic relationship, contact with a support group on a monthly or more frequent basis, chemical avoidance in the home, gender, and an improved course of illness predicted 19% of the variance for perceived social support. Qualitative data are used to illustrate particular problems of persons in this sample, and suggestions are made for practitioners who encounter this population.

Patients with multiple chemical sensitivities in an occupational health clinic: presentation and follow-up

Thirty-five people with work-related Multiple Chemical Sensitivities were studied to learn about the onset and progression of illness. The subjects were selected from patients at an occupational health clinic. Individuals were identified as subjects if they fulfilled a seven-point case definition for Multiple Chemical Sensitivities and if onset of symptoms was related to workplace exposures. Three occupational exposures to solvents, poor indoor-air quality, and remodeling were associated with onset of Multiple Chemical Sensitivities in 63% of the subjects. Symptoms indicative of a nervous-system disorder topped the list of the most frequently reported symptoms. Commonalities in exposures and symptoms suggest that Multiple Chemical Sensitivities represents a distinct diagnostic category. Even with an incomplete understanding of etiology, it may be possible to limit the onset of work-related Multiple Chemical Sensitivities.

Practical application of air-quality research incorporated in CMHC's research house

The Canada Mortgage and Housing Corporation has been looking at ways to improve indoor air quality since 1984 and now hopes to interest house designers and manufacturers in the results of its research. Its flagship project has been the construction of a proto-type research house for environmentally hypersensitive people.

Odor-associated idiopathic anaphylaxis. A case report

A 44 year old woman is described who appears to have idiopathic anaphylaxis triggered by chemical odors. Her case and a general discussion of anaphylaxis are presented. The known causes of anaphylaxis and a discourse on idiopathic anaphylaxis are given. The treatment of idiopathic anaphylaxis is discussed.