Environmental factors in medically unexplained symptoms and related syndromes: the evidence and the challenge. (17/104)

Symptoms, and especially those without clear underlying medical explanations, account for a large percentage of clinical encounters. Many unexplained symptoms have been organized by patients and practitioners into syndromes such as chronic fatigue syndrome, multiple chemical sensitivity, sick building syndrome, Gulf War syndrome, and the like. All these syndromes are defined solely on the basis of symptoms rather than by medical signs. Some of the above-described conditions overlap strongly with explained conditions such as asthma. The relationship of such symptoms and syndromes to environmental exposure is often sharply debated, as is the distinction between the various syndromes. This leads to problems of what type of research should be conducted and who should conduct it. It is time to develop a comprehensive research agenda to sort out nomenclature, epidemiology, and environmental causation for these conditions, moving toward comprehensive and effective public health and clinical approaches.  (+info)

Hypersensitivity of human subjects to environmental electric and magnetic field exposure: a review of the literature. (18/104)

Hypersensitivity to exposure to electric and magnetic fields (EMFs) has been reported for nearly 20 years; however, the literature on the subject is still very limited. Nearly all the literature published concerns a dermatological syndrome that consists of mainly subjective symptoms (itching, burning, dryness) and a few objective symptoms (redness, dryness) appearing after individuals begin working with video display units and decreasing during absence from work. Case-control studies as well as some good but limited double-blind trials have not found any clear relationship between this syndrome and exposure to EMFs. A "general syndrome" with more general symptoms has been rarely described but seems to have a worse prognosis. The symptoms often associated with skin disorders are mainly of neurasthenic type and can cover a lot of nonspecific symptoms present in other atypical syndromes such as multiple chemical sensitivity or chronic fatigue. Most of these symptoms are allegedly triggered by exposure to different sources of EMFs, but there have been no valid etiological studies published on this more general syndrome. It appears that the so-called hypersensitivity to environmental electric and magnetic fields is an unclear health problem whose nature has yet to be determined.  (+info)

Study of self-reported hypersensitivity to electromagnetic fields in California. (19/104)

Cases of alleged hypersensitivity to electromagnetic fields (EMFs) have been reported for more than 20 years, and some authors have suggested some connection with the "multiple chemical sensitivity" illness. We report the results of a telephone survey among a sample of 2,072 Californians. Being "allergic or very sensitive" to being near electrical devices was reported by 68 subjects, resulting in an adjusted prevalence of 3.2% (95% confidence interval = 2.8, 3.7). Twenty-seven subjects (1.3%) reported sensitivity to electrical devices but no sensitivity to chemicals. Characteristics of the people reporting hypersensitivity to EMFs were generally different from those of people reporting being allergic to everyday chemicals. Alleging environmental illness or multiple chemical sensitivity diagnosed by a doctor was the strongest predictor of reporting being hypersensitive to EMFs in this population. Other predictive factors apart from self-reporting chemical sensitivity were race/ethnicity other than White, Black, or Hispanic; having low income; and being unable to work. The perception of risk of exposure to EMFs through the use of hair dryers (vs. exposure to power and distribution lines) was the factor the most associated with self-reporting about hypersensitivity to EMFs. However, risk perception was not sufficient to explain the characteristics of people reporting this disorder.  (+info)

The vomeronasal organ and chemical sensitivity: a hypothesis. (20/104)

Environmental exposures to very low levels of airborne chemicals are associated with adverse symptoms, often affecting multiple organ systems, in the phenomenon of chemical sensitivity (CS). Recent surveys suggest a significant prevalence of chemically sensitive subjects in the United States, but the mechanism linking exposure to symptoms remains unclear, despite the advancement of a variety of theoretical models. In many of these models, exposure of the nasal respiratory system to an airborne agent is the first step in the pathway leading to symptoms. In this article, we advance the hypothesis that interactions between environmental chemicals and the vomeronasal organ (VNO) may play a role in the etiology of CS. The VNO, a bilateral, tubular organ located in the nose, serves in animals as part of a sensitive chemosensory system; however, evidence suggesting that the VNO retains a functional role in the adult human is controversial. Reported characteristics of the human VNO relevant to CS, including location, prevalence, selective sensitivity to airborne chemical exposure, and capacity to produce systemic effects, are discussed within the context of this ongoing debate. Beyond relevance to CS, the demonstration of an active, adult VNO could have significant impact on environmental toxicology.  (+info)

Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder. (21/104)

Idiopathic environmental intolerance (IEI), also known as multiple chemical sensitivity, is a clinical description for a cluster of symptoms of unknown etiology that have been attributed by patients to multiple environmental exposures when other medical explanations have been excluded. Because allergy has not been clearly demonstrated and current toxicological paradigms for exposure-symptom relationships do not readily accommodate IEI, psychogenic theories have been the focus of a number of investigations. A significantly higher lifetime prevalence of major depression, mood disorders, anxiety disorders, and somatization disorder has been reported among patients with environmental illness compared with that in controls. Symptoms often include anxiety, lightheadedness, impaired mentation, poor coordination, breathlessness (without wheezing), tremor, and abdominal discomfort. Responses to intravenous sodium lactate challenge or single-breath inhalation of 35% carbon dioxide versus a similar breath inhalation of clean air have shown a greater frequency of panic responses in subjects with IEI than in control subjects, although such responses did not occur in all subjects. Preliminary genetic findings suggest an increased frequency of a common genotype with panic disorder patients. The panic responses in a significant proportion of IEI patients opens a therapeutic window of opportunity. Patients in whom panic responses may at least be a contributing factor to their symptoms might be responsive to intervention with psychotherapy to enable their desensitization or deconditioning of responses to odors and other triggers, and/or may be helped by anxiolytic medications, relaxation training, and counseling for stress management.  (+info)

NMDA sensitization and stimulation by peroxynitrite, nitric oxide, and organic solvents as the mechanism of chemical sensitivity in multiple chemical sensitivity. (22/104)

Multiple chemical sensitivity (MCS) is a condition where previous exposure to hydrophobic organic solvents or pesticides appears to render people hypersensitive to a wide range of chemicals, including organic solvents. The hypersensitivity is often exquisite, with MCS individuals showing sensitivity that appears to be at least two orders of magnitude greater than that of normal individuals. This paper presents a plausible set of interacting mechanisms to explain such heightened sensitivity. It is based on two earlier theories of MCS: the elevated nitric oxide/peroxynitrite theory and the neural sensitization theory. It is also based on evidence implicating excessive NMDA activity in MCS. Four sensitization mechanisms are proposed to act synergistically, each based on known physiological mechanisms: Nitric oxide-mediated stimulation of neurotransmitter (glutamate) release; peroxynitrite-mediated ATP depletion and consequent hypersensitivity of NMDA receptors; peroxynitrite-mediated increased permeability of the blood-brain barrier, producing increased accessibility of organic chemicals to the central nervous system; and nitric oxide inhibition of cytochrome P450 metabolism. Evidence for each of these mechanisms, which may also be involved in Parkinson's disease, is reviewed. These interacting mechanisms provide explanations for diverse aspects of MCS and a framework for hypothesis-driven MCS research.  (+info)

Odor perception in patients with multiple chemical sensitivity. (23/104)

Since symptoms typical for multiple chemical sensitivity (MCS) are induced by exposure to low levels of chemicals, we hypothesize that MCS represents an impaired recognition of odors or an increased emotional reaction to common odors. Twenty-five subjects with MCS, 20 women and 5 men, and 50 gender-and-age matched controls participated in this study. The University of Pennsylvania Smell Identification Test (UPSIT) and the Cross-Cultural Smell Identification Test (CC-SIT) were administered. In addition to selecting the most probable odor among the four, the subjects were asked their impression of each odor. Odor identifiability evaluated by the scores of two tests, were almost equal in MCS and control groups. The mean CC-SIT odor per person with pleasant feeling was lower in MCS than in controls. The mean odor per person creating an unpleasant sensation was higher in MCS than in the controls. Gingerbread was the only odor making MCS subjects more pleasant than the controls. Nine out of 40 UPSIT odors were felt as unpleasant by MCS subjects more than by controls. This study indicates that MCS subjects are able to identify the odors equally as well as the controls but feel unpleasant to a larger number of odors than the controls. Despite unknown mechanisms of the altered odor perception in MCS, the application of these tests for diagnostic procedure of MCS is proposed.  (+info)

Annoyance and performance during the experimental chemical challenge of subjects with multiple chemical sensitivity. (24/104)

OBJECTIVES: This study explored the subjective reactions and psychological test performance of smell-intolerant subjects during consecutive challenges to chemicals with contrasting neurotoxic properties. METHODS: Women with symptoms compatible with multiple chemical sensitivity (N=10) and healthy referents (N=20) were individually challenged in an exposure chamber. All the subjects attended two separate 2-hour sessions of exposure to n-butyl acetate and toluene, in counterbalanced sequence. After an initial phase without exposure, air concentrations were increased in steps ranging from 3.6 to 57 mg/m3 for n-butyl acetate and from 11 to 180 mg/m3 for toluene. The response measures comprised ratings of annoyance and smell intensity and also neurobehavioral test performance. RESULTS: Both groups showed an increase in annoyance ratings and a decrease in test performance in the initial unexposed chamber phase and also in the first phase of the chemical exposure, these results indicating slight immediate expectancy or "suggestion" effects. During the six chamber phases, the ratings of mucous membrane irritation and fatigue showed a steeper increase in the group with multiple chemical sensitivity than among the referents, while the ratings of smell intensity and smell annoyance were similar in the two groups. A reduction in test performance was observed during the chamber phases, particularly in the group with multiple chemical sensitivity. No relation was found between the ratings or performance and chemical substance. CONCLUSIONS: Stronger immediate expectancy or "suggestion" reactions than normal did not characterize the group with multiple chemical sensitivity. This group showed a stronger than normal gradual build-up of fatigue, mucous membrane irritation, and reduced performance during chemical exposure. The results offer the most support to an irritative basis for multiple chemical sensitivity.  (+info)