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Due to recent comments on MCS/ IEI I am posting the following report by the Australian Dept. of Health and Ageing. Please note that while it is open to the possibility that MCS is a definite disease entity with possible multifactorial etiology, at this time:
1. The underlying mode(s) of action of MCS, i.e. the biological mechanisms by which the chemical sensitivity occurs, remain uncertain.
2. Although non-specific neurological symptoms are common, overall there is no characteristic symptom profile that identifies MCS.
3. Presently, a diagnosis of MCS is based commonly on self-reported symptoms and chemical exposure histories. The symptom profile of MCS is indistinguishable from other multi-symptom disorders. No laboratory tests currently exist for diagnosing MCS.
4. There are no standardised treatments for MCS.
To read the Full Report, go to:
http://www.nicnas.gov.au/Current_Issues/MCS/MCS_Final_Report_Nov_2010_PDF.pdf
1
EXECUTIVE SUMMARY
1.1
OVERVIEW
Multiple Chemical Sensitivity (MCS) is the most common term used to describe a condition presenting as a complex array of symptoms linked to low level chemical exposures. The underlying mode(s) of action of MCS, i.e. the biological mechanisms by which the chemical sensitivity occurs, remain uncertain.
A common theme reported by individuals is experiences of heightened responsiveness to chemicals at extremely low exposure levels. The agents linked with MCS symptoms in susceptible individuals are numerous and chemically diverse. They include individual chemicals and chemical products encompassing air pollutants, workplace and domestic chemicals, agricultural chemicals, therapeutics and foods.
Similarly, the symptoms experienced by individuals from exposures are diverse and involve multiple organ systems. Although non-specific neurological symptoms are common, overall there is no characteristic symptom profile that identifies MCS. Nevertheless, reported symptoms can, in some cases, be debilitating.
Numerous modes of action have been postulated for MCS. These include immunological changes, respiratory/neurogenic inflammation, limbic sensitisation, elevated NMDA receptor activity, altered metabolism as well as behavioural conditioning and psychological disorders. Alternative names for MCS in part reflect views on particular modes of action.
Several attempts have been made to establish diagnostic criteria for this disorder. A set of ‘Consensus Criteria’ developed in 1999 describes MCS as a chronic condition involving multiple organ systems with reproducible symptoms following low-level exposure to multiple unrelated chemicals. These criteria have been used to a limited extent for research and survey purposes. Worldwide, a small number of available studies indicate the prevalence of medically diagnosed MCS at 0.2% – 4%. In Australia, only limited surveys of the prevalence of chemical sensitivities and MCS in the community have been conducted. South Australian state health surveys reported a prevalence of medically diagnosed MCS of 0.9%.
At this time, worldwide, MCS is not an internationally classified disorder, with only Germany and Austria (via adoption of German diseases documentation) listing MCS in their national disease classifications.
Presently, a diagnosis of MCS is based commonly on self-reported symptoms and chemical exposure histories. The symptom profile of MCS is indistinguishable from other multi-symptom disorders. No laboratory tests currently exist for diagnosing MCS. Different case definitions and the lack of a characteristic symptom profile and objective laboratory biomarkers for MCS have impeded recognition of the disorder as a distinct clinical entity.
There are no standardised treatments for MCS. Current treatments advocated for MCS include dietary changes, nutritional supplements, detoxification and desensitisation techniques, holistic or body therapies, as well as prescription medicines and behavioural therapies. The most common management regime for MCS is avoidance of agents that trigger symptoms.
A Review of Multiple Chemical Sensitivity
1.2
FINDINGS
1.2.1
Research into biological mechanisms underpinning MCS
There is considerable debate as to what biological mechanisms (modes of action) are responsible for the state of chemical sensitivity in MCS. The literature describes numerous potential causative modes of action, both physiological and psychological in nature, many of which are amenable to further testing. MCS may have a multifactorial origin.
An understanding of mode of action and how chemicals interact with organ systems would be assisted by more detailed identification of the chemical species and the exposure scenarios responsible for symptoms in MCS.
Finding 1: Targeted research into mode (s) of action
While there are a number of proposed mechanism(s) that warrant further research consideration, based on biological plausibility, testability and known research gaps, the following modes of action for MCS are highlighted for further scientific research and investigation as priorities:
Immunological variables;
Respiratory disorder/neurogenic inflammation;
Limbic kindling/neural sensitisation and psychological factors;
Elevated nitric oxide, peroxynitrite and NMDA receptor activity;
Altered xenobiotic metabolism.
1.2.2
Clinical research needs
An Australian clinical review has highlighted differences with criteria used for the diagnosis of MCS and methods to treat MCS.
Overall, a number of primary clinical research needs are evident:
Standardising diagnostic criteria that are acceptable to, and utilised by, clinical and scientific groups;
Determining the prevalence of MCS in the community, for both self-reported cases and those that are medically diagnosed;
Exploring initiating/triggering agents/events and modes of action in MCS through the use of well designed and conducted blinded challenge tests and longitudinal studies of illness course;
Determining and documenting effective treatment/management protocols for MCS based on long-term therapeutic alliances and individual self-management.
Finding 2. Longitudinal study
To get a better understanding of the clinical picture of MCS in Australia there is a need to look more closely at the natural history of people with MCS. A longitudinal clinical and sociological study should assist in identifying key elements of MCS such as how MCS is initiated and/or triggered and how sensitivities vary over time.
Such a study should examine eliciting agents/events, diagnostic experiences, clinical course and impacts of treatment/management strategies. To undertake such a longitudinal study it would be necessary to identify people with MCS who would be prepared to be involved. Findings in Appendix 1 provide some practical suggestions to address this issue.
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A Review of Multiple Chemical Sensitivity
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Finding 3: Education/training
A survey of clinical approaches to MCS of Australian medical practitioners identified a lack of coverage of MCS within the current Australian medical curriculum given the relatively small amount of time devoted to minor specialties. Other than hospital protocols containing practical measures to assist inpatients with chemical sensitivities, there are also currently no clinical guidelines available to inform medical practitioners as to how to provide appropriate care for MCS individuals.
The development of a clinical education program should be investigated. Such a program should be based on evidence currently available, utilise any findings from clinical research in Australia (such as a longitudinal investigation) and consider the practical guidance on approaches to MCS clinical management agreed by participants in the recent clinical review of MCS.
This may be old news to some, but it bears repeating.
1.J Allergy Clin Immunol. 2000 Feb;105(2 Pt 1):358-63.
Carbon dioxide inhalation challenges in idiopathic environmental intolerance.Poonai N, Antony MM, Binkley KE, Stenn P, Swinson RP, Corey P, Silverman FS, Tarlo SM.
New York (MedscapeWire) Feb 18 — A study by Canadian researchers in the February issue of the Journal of Allergy and Clinical Immunology suggests that patients with idiopathic environmental intolerance (IEI, formerly known as multiple chemical sensitivity) display high anxiety sensitivity similar to patients with panic disorder (PD) under controlled conditions.
Previous studies have been unable to prove any underlying allergic or toxic basis to IEI. Other research has found that IEI has increased psychiatric morbidity and shares many features with PD which involve the onset of sudden anxiety. Symptoms shared include chest tightness, breathlessness, palpitations, apprehension, and avoidance of situations where symptoms occur.
In this blinded study, patients inhaled differing concentration of oxygen and CO2 through a flow spirometer. After each inhalation, patients were asked to rate each panic symptom and their sensations of panic and fear on an objective Diagnostic Symptom Questionnaire.
When inhaling increasing concentrations of CO2, a large percentage (48%-92%) of patients with PD frequently experienced panic symptoms, whereas only 5% of healthy subjects noted similar symptoms. Researchers found that 71% of IEI patients fulfilled similar PD criteria after inhaling CO2. There were no significant differences between IEI and control groups in terms of actual breathing rate, heart rate, and other physical measures.
Investigators concluded that the high rate of anxiety response to inhaled CO2 among IEI patients shows a tendency to overreport and possibly catastrophically misinterpret benign physical symptoms, a consistent finding among patients with PD. The authors suggest a psychological assessment should be considered in all patients with IEI.
2. J Allergy Clin Immunol. 2006 Dec;118(6):1257-64. Epub 2006 Sep 25.
Multiple chemical sensitivities: A systematic review of provocation studies.Das-Munshi J, Rubin GJ, Wessely S.
Section of Epidemiology, Institute of Psychiatry, London
A systematic review of provocation studies of persons reporting multiple chemical sensitivities (MCS) was conducted from databases searched from inception to May 2006. Thirty-seven studies were identified, testing 784 persons reporting MCS, 547 control subjects, and 180 individuals of whom a subset were chemically sensitive. Blinding was inadequate in most studies. In 21 studies odors of chemicals were probably apparent; 19 of these reported positive responses to provocations among chemically sensitive individuals, and 1 study demonstrated that negative expectations were significantly associated with increased symptom reporting after provocations. Seven studies used chemicals at or below odor thresholds, and 6 failed to show consistent responses among sensitive individuals after active provocation. Six studies used forced-choice discrimination and demonstrated that chemically sensitive individuals were not better at detecting odor thresholds than nonsensitive participants. Three studies tested individuals by using nose clips/face masks and confirmed response, possibly mediated through eye exposure. Three studies used olfactory masking agents to conceal stimuli, and none of these found associations between provocations and response. We conclude that persons with MCS do react to chemical challenges; however, these responses occur when they can discern differences between active and sham substances, suggesting that the mechanism of action is not specific to the chemical itself and might be related to expectations and prior beliefs.
PMID: 17137865 [PubMed - indexed for MEDLINE]
3. Clin Neuropsychol. 2006 Dec;20(4):848-57.
MMPI-2 profiles of persons with multiple chemical sensitivity.Binder LM, Storzbach D, Salinsky MC.
Oregon Health and Sciences University, Beaverton, OR, USA.
We compared the MMPI-2 profiles of adults with multiple chemical sensitivity (MCS), epileptic seizures (ES), and nonepileptic seizures (NES). Both NES and MCS are medically unexplained conditions. In previous studies profiles associated with NES were elevated on scales Hs and Hy, compared with profiles associated with ES. We predicted that profiles associated with MCS would be elevated on Hs and Hy compared with the ES group. Patients with ES and NES were diagnosed after intensive EEG monitoring using published criteria. MCS was diagnosed if there was a complaint of illness in response to multiple common odors at levels that are not noxious to most people. All the MCS cases had legal claims for injury related to chemical exposures. The results showed that on MMPI-2 scales Hs, D, and Hy the MCS group had means significantly higher than both the ES and NES groups. Fake Bad Scale scores were elevated in 11 MCS cases, and regression-based estimates of Fake Bad Scale scores showed elevation in the MCS group compared with both seizure groups. We conclude that MMPI-2 data, obtained from people seeking financial compensation, indicate that there is a strong psychological component to MCS symptoms.
PMID: 16980266 [PubMed - indexed for MEDLINE]
4.Ugeskr Laeger. 2006 Mar 13;168(11):1116-9.[Multiple chemical sensitivity, a well-defined illness?]
Kolstad HA, Silberschmidt M, Nielsen JB, Osterberg K, Andersen JH, Bonde JP, Fink P.
Arhus Universitetshospital, Arbejdsmedicinsk Klinik, Arhus C.
Some people react to smells or chemicals at levels far below toxicological thresholds with nonspecific symptoms, fear and social isolation. They may be diagnosed with multiple chemical sensitivity. There is no empirical evidence indicating that this condition is explained by toxicological mechanisms, even though a number of theories have been proposed. The authors of this review conclude that this is a functional condition. These patients need information and treatment in accordance with this fact. Instead of being advised how to avoid exposure to chemicals, they should be properly trained in appropriate confrontation with the chemicals encountered in everyday life.
PMID: 16545215 [PubMed - indexed for MEDLINE]
5. J Occup Environ Med. 2006 Jan;48(1):76-82.
New aspects of psychiatric morbidity in idiopathic environmental intolerances.
Hausteiner C, Mergeay A, Bornschein S, Zilker T, Förstl H.
Department of Psychiatry and Psychotherapy, Technical University Munich, Munich, Germany
OBJECTIVE: To understand idiopathic environmental intolerances (IEI)-formerly multiple chemical sensitivities (MCS)-it is helpful to outline its characteristic psychiatric morbidity. METHOD: We applied a standardized interview according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (SCID) to 305 environmental patients with and without IEI. RESULTS: Somatoform, affective and anxiety disorders were the most frequent diagnoses but only slightly differed between patients with or without IEI. In both groups, current substance-related disorders were rare. We found a clearly higher prevalence of psychotic, especially current delusional disorders, in IEI. CONCLUSION: Somatization, depression, and anxiety are frequent in IEI but nonspecific. Psychotic disorders are more common in IEI than in other types of environmental illness. It appears worthwhile to study personality and cognitive style to explain the pivotal features of IEI.
PMID: 16404213 [PubMed - indexed for MEDLINE]
6. Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder.Tarlo SM, Poonai N, Binkley K, Antony MM, Swinson RP.
Gage Occupational and Environmental Health Unit, University of Toronto, Toronto, Ontario, Canada.
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.
PMID: 12194904 [PubMed - indexed for MEDLINE]
LINKS:
Multiple Chemical Sensitivity: A Spurious Diagnosis
Seeking Modern Refuge from Modern Life
I found this shocking video on YouTube. It is a tragic example of what happens when a child is misdiagnosed and the family is given a diagnosis of “Multiple Chemical Sensitivity”.
From the video, I seriously doubt that this child is being treated by a board certified Allergist- Immunologist. Her treatment (sub-lingual drops for food allergy???) is definitely not a scientifically proven therapy. The insurance company is absolutely right. ($2500 a month? Who are they kidding?)
It also does not speak well of Fox News’ fact checking department. A phone call to any trained allergist would have revealed to them that this child’s treatment is bogus.
Also see Multiple Chemical Sensitivity and Food Allergy pages
June 2007 UPDATE: Thanks to Orac and “Respectful Insolence”, we have an insight into Dr. Patel’s finances and the income she has acquired through her practice($30M, dang! there’s gold in them thar neutralizing enzymes!)
LINKS:
Multiple Chemical Sensitivity Syndrome Has Strong Psychological Component
Self-reported multiple food intolerances/sensitivities have been reported to be frequently associated with Idiopathic Environmental Intolerance (IEI), formerly called Multiple Chemical Sensitivity (MCS) Syndrome . In 1987, Cullen introduced the term “multiple chemical sensitivities,” which he defined as “An acquired disorder characterized by recurrent symptoms, referable to multiple organ systems, occurring in response to demonstrable exposure to many chemically unrelated compounds at doses far below those established in the general population to cause harmful effects. No single widely accepted test of physiologic function can be shown to correlate with symptoms.” Other terms for IEI/ MCS are cerebral allergy, chemically induced immune dysregulation, total allergy syndrome, and ecologic illness.
The most common complaints are fatigue, headache, nausea, malaise, pain, mucosal irritation, disorientation, and dizziness, which are mostly non-specific. No gross or microscopic evidence of inflammation or other objective signs of pathology have been associated with IEI/MCS. As in somatoform disorders, these patients have multiple chronic symptoms and have previously consulted with numerous physicians and other health care professionals without satisfaction nor any finding of underlying immunologic, autoimmune, or any physical disease to explain their symptoms. Patients attribute their illness to exposure to a combination of environmental chemicals, multiple foods, and drugs. A unique feature of IEI is the general absence of a dose-response curve in the provocation of symptoms.
Evidence is growing in support of a causal role of underlying psychiatric illness, specifically somatoform, depression, and panic disorder in IEI/ MCS. IEI and panic disorder share common symptoms such as chest tightness, breathlessness, and palpitations; apprehension; and avoidance of situations that have been associated with onset of symptoms. Panic attacks may temporarily occur with non-noxious stimuli that are then associated with symptoms by the patient and are subsequently considered the cause of the symptoms. Reports of placebo-controlled studies using saline infusions, carbon dioxide inhalation, and provocative challenges note that these approaches provoke symptoms suggestive of panic disorder and anxiety syndrome with hyperventilation in IEI/ MCS patients. Evidence for a common neurogenetic basis linking IEI and panic disorders was reported in a study of 11 IEI patients who were found to have a significantly increased prevalence of cholecystokinin B (CCK-B) receptor alleles, which are known to be associated with panic disorder, compared to age-, sex-, and ethnic background-matched controls.
From: “Psychological Considerations in Food Allergy” Chapter in Food Allergy: Adverse Reactions to Foods and Food Additives, 3rd ed, Blackwell Science
LINK: Multiple Chemical Sensitivity Syndrome Has Strong Psychological Component
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