Multiple chemical sensitivity

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Multiple chemical sensitivity (MCS), also known as "20th Century Syndrome", "Environmental illness", "Sick Building Syndrome", Idiopathic Environmental Intolerance (IEI), can be defined as a "chronic, recurring disease caused by a person's inability to tolerate an environmental chemical or class of foreign chemicals" according to the NIH National Institute of Environmental Health Sciences web site.

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Cullen [1], et al, of Yale Environmental Medicine have published a definition of MCS, making diagnosis possible. Yale Environmental Health provides a comprehensive evaluation, considering differential diagnosis as well Yale Environmental Health Clinical Services.

MCS etiology is hotly debated among physicians. Professionals are divided: some believe that MCS is a physical illness with a yet-to-be-determined mechanism, some believe that MCS is the result of increase in exposure to irritants or a toxic injury, some believe that MCS is psychosomatic. Despite this debate, however, there is consensus that patients who complain of symptoms are recommended to avoid irritants as best as possible. Respect in care and recommendation of avoidance of irritants is now standard protocol recommended by the American Medical Association. [2]

Several chemical-producing companies, especially producers of pesticides, have also funded studies that have cast doubts on the existence and cause of MCS.

Just as physicians debate etiology, those with MCS do not all agree on causation. While many with MCS believe that they have been injured by overexposure to chemicals, some believe that they have developed an intolerance over time, and still others are uncertain as to the cause and are open to a yet-to-be-determined mechanism. What is clear and agreed upon is that exposure to chemical irritants precipitates sometimes disabling symptoms such as migraine headache, sinus congestion, itchy eyes and throat, nausea and vomiting.

MCS is a non-coded medical diagnosis in the United States. Conventional medicine does not typically recognize this diagnosis, because to date there is no definitive test for diagnosis or proven scientific mechanism. Symptoms may be explainable by allergic, metabolic, enzymatic, inflammatory,infectious, or psychological mechanism.

Preliminary scientific testing has been unable to validate the correlation of symptoms with exposure to chemicals. Because the nature and cause(s) of MCS are still unanswered, effective testing may not yet be available. Complications may include propellants and other chemicals in the testing environment. In one blinded test, patients appeared to show no reaction to suspected substances. The same patients also seemed to react to saline solution injections and purified air injected into their environment. However, there has not been sufficient analysis to challenge or verify these tests.

Allergist Theron G. Randolph (1906-1995) is generally seen as the 'inventor' of the term and introducing this condition to the public. It was he who first speculated that exposure to modern synthetic chemicals was the cause. Allergic reactions to minute traces of chemicals goes against what is known about the correlation between dose and effect. Randolph, however, theorized that the human body is like a barrel filling up with small or even minute doses of chemicals until it is full. Any further exposure will then cause allergic reactions, like the straw that broke the camel's back. Science recognizes that there are chemicals that build up in the body (such as mercury), but these do not cause allergic reactions. They can, though, cause organ failure, such as failure of the liver (which is involved in storing these chemicals) or the kidneys (involved in filtering them out). Some chemicals are also stored in body fat. These effects have never been found in MCS patients, either suggesting that they actually do not suffer from the effects of chemicals or that there is another mechanism (possibly the one Randolph proposed) to blame for their symptoms. People who treat MCS generally identify themselves as "clinical ecologists", and many belong to the American Academy of Environmental Medicine, which Randolph founded in 1965 as the Society for Clinical Ecology. Clinical Ecology is not a recognised field of medical science.

An alternative sensitization mechanism has been proposed by H.R. Eriksen and H. Ursin in a paper publicized April 2004. They propose the term 'subjective health complaints' for MCS and a number of other conditions that are similarly vague, such as epidemic fatigue, chronic musculoskeletal pain, chronic low back pain, chronic fatigue syndrome, and fibromyalgia. According to them: 'These complaints are particularly common in individuals with low coping and high levels of helplessness and hopelessness'. They suggest that: 'These complaints are based on sensations from what in most people are normal physiological processes. In some individuals these sensations become intolerable. In some cases it may signal somatic disease, in most cases not'. In their conclusion they suggest that the psychobiological mechanisms for this is sensitization in neural loops maintained by sustained attention and arousal.

People diagnosed with MCS suffer widely assorted symptoms blamed on exposure to trace levels of environmental chemicals. No two MCS patients will experience exactly the same symptoms.

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Common symptoms of MCS

MCS patients often suffer from depression, anxiety and other psychological problems, leading some experts to believe that MCS is a physical manifestation of psychological disturbance (a psychosomatic illness) which should be treated with psychotherapy and anti-depressants. It is however difficult to judge cause and effect, as some experience anxiety after exposure to triggers (due to the effects of the exposure and the stress on the adrenal system). Irritable Bowel Syndrome provides an example of an illness with no definitive diagnostic test that is often mistakenly seen as psychological. It is now known that when IBS patients are put on a special diet and improve, many of their "neurotic" symptoms clear.(Brostoff J. Irritable Bowel Syndrome. N Engl J Med 1994)

People can get anxious or depressed because of their illness, or their anxiety or depression can be the underlying cause. The use of anti-depressants [specifically, SSRIs] with a number of patients has shown dramatic improvement, with disappearance of MCS symptoms, though it would be incorrect reasoning to conclude that this will work for all patients. This raises interesting questions about the role of neurological chemicals in MCS, specifically serotonin, and as to the interplay of neurological and hormonal chemicals.

Treatments, offered by practitioners of alternative medicine, usually revolve around avoiding exposure to suspect substances, which can have a severe impact on peoples lives. Enclosed air-conditioned buildings with a recycled air supply such as shopping centres, malls or large office buildings are deemed particularly bad environments for the chemically-sensitive. Patients avoid certain types of fabric for their clothing, hang printed paper outside for days (or avoid it all together), use only untreated wooden furniture, take only organic food etc. Some avoid contact with the outside world all together.

Supporters of MCS sufferers argue that MCS should be taken seriously, and most importantly, that people suffering from it (again, regardless whether it is a 'real' or psychosomatic problem) should not be treated with disdain or labeled fakers because they suffer from real problems. They say that the debate on MCS is about the cause and not about the effects.

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Commonly suspect chemicals

  • bleach, fabric softeners, wool-wash, and detergents
  • perfumes, air-fresheners and anything scented or perfumed
  • petrol or gasoline, diesel and exhaust fumes
  • pesticides, fertilisers, and other agricultural chemicals
  • shampoos, hairsprays and personal care products
  • dishwashing liquid and detergent (may cause migraine headaches for those without MCS)
  • most glues (including carpet glue), varnishes, polishes, paints, solvents and paint-thinners
  • petroleum-based products (including petroleum jelly)
  • Formaldyhyde and aldehyde

In particular, offgassing chemicals (some odorless, some not) are suspect.

Solvents are suspect, because there is no debate in medical science that these can cause permanent brain damage after long exposure. The associated illness is popularly known as painters' syndrome, since (professional) painters are exposed to paint-thinner fumes on a daily basis for many years. For this reason, many countries have banned thinner-based paints and replaced them with water-based paints. There is however no evidence thinner causes damage to people only occasionally exposed to them. Non VOC, healthier paints may be obtained.

One hypothesis is that buildup of trace levels of chemicals is the cause of MCS. This would seem to make almost any substance suspect, since every substance is fatal if the dose is high enough. However, some chemicals have a greater tendency to accumulate in the body than others.

Many people with MCS also avoid exposure to inks, laser printers, and other potentially offgassing substances such as new furniture and plastic items.

MCS patients do not all agree about the possible etiology of the symptoms. While many believe that chemical or mold exposure is central to the etiology of MCS, others believe that their symptoms, including sensitivity to smell, are a part of a larger picture such as severe migraine with aura or depression -- both of which involve neurotransmitters.

See also Gulf War syndrome

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Further reading

  • Theron G. Randolph, M.D., and Ralph W. Moss, Ph.D (1990). An Alternative Approach to Allergies: Revised Edition ISBN 0060916931
  • Peter Radetsky (1997). Allergic to the Twentieth Century ISBN 0316732214
  • Nicholas Ashford and Claudia Miller (1998). Chemical Exposures:Low Levels and High Stakes. Second Edition. ISBN 0471292400
  • Bonnye L. Matthews, Ed. (1998). Defining Multiple Chemical Sensitivity. McFarland & Company. ISBN 0786404132
  • Sherry Rogers (1998). Chemical Sensitivity. McGraw-Hill. ISBN 0879836342
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External links

it:MCS ja:化学物質過敏症 es:Síndrome Químico Múltiple

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