Skip to main content

Multiple chemical sensitivity and idiopathic environmental intolerance (part two)

Abstract

Multiple chemical sensitivity/idiopathic environmental intolerance (MCS/IEI) is a commonly used diagnostic term for a group of symptoms without apparent organic basis. The symptoms are characteristic of dysfunction in multiple organ systems. They wax and wane fluctuate according to exposure to low levels of chemical agents in the patient's environment, and sometimes begin after a distinct environmental change or injury such an industrial accident or chemical introduced after remodeling. Although traditional medical organizations have not agreed on a definition for this syndrome, it is being increasingly recognized and makes up an increasing percentage of the caseload at occupational/environmental medical clinics.

Part two of this review article discusses diagnosis, clinical examination, long-term follow up of MCS/IEI, and the role of physicians, research on odor and treatment, diseases with similar symptoms, and further research regarding MCS/IEI patients.

This is a preview of subscription content, access via your institution.

Abbreviations

CES:

Chronic fatigue syndrome

FM:

Fibromyalgia

IEI:

Idiopathic environmental intolerance

PGW:

Persian Gulf Warr

MCS:

Multiple chemical sensitivity

PTSD:

Posttraumatic stress disorder

References

  1. Black DW. Environmental illness and misdiagnosis: a growing problem. Regul. Toxicol. Pharmacol. 1993; 18: 23–31.

    PubMed  CAS  Google Scholar 

  2. Terr AI. Immunological issues in multiple chemical sensitivities. Regul. Toxicol. Pharmacol. 1993; 18: 54–60.

    PubMed  CAS  Google Scholar 

  3. Miller CS, Mitzel HC. Chemical sensitivity attributed to pesticide exposure versus remodeling. Arch. Environ. Health 1995; 50: 119–129.

    PubMed  CAS  Google Scholar 

  4. Sorg BA, Hochstatter T. Behavioral sensitization after repeated formaldehyde exposure in rats. Toxicol. Ind. Health 1999; 15: 346–355.

    PubMed  CAS  Google Scholar 

  5. Aaron LA, Buchwald D. A review of the evidence for overlap among unexplained clinical conditions. Ann. Intern. Med. 2001; 134: 868–881.

    PubMed  CAS  Google Scholar 

  6. Gibson PR, Cheavens J, Warren ML. Chemical sensitivity/chemical injury and life disruption. Women Therapy. 1996; 19: 63–79.

    Google Scholar 

  7. Cullen MR. The worker with multiple chemical sensitivities: an overview. In: Cullen MR, editor. Occupational Medicine, State of the Art Reviews Philadelphia: Hanley and Belfus Inc, 1987: 655–662.

    Google Scholar 

  8. Fiedler N, Maccia C, Kipen H. Evaluation of chemically sensitive patients. J. Occup. Med. 1992; 34: 529–538.

    PubMed  CAS  Google Scholar 

  9. Fiedler N, Kipen H, Deluca J, Kelly-McNeil K, Natelson B. Neuropsychology and psychology of MCS. Toxicol. Ind. Health 1994; 10: 545–554.

    PubMed  CAS  Google Scholar 

  10. Kreutzer R, Neutra RR, Lashuay N. Prevalence of people reporting sensitivities to chemicals in a population-based survey. Am. J. Epidemiol. 1999; 150: 1–12.

    PubMed  CAS  Google Scholar 

  11. Randolph TG. Ecologic orientation in medicine: comprehensive environmental control in diagnosis and therapy. Ann. Allergy 1965; 23: 11–22.

    Google Scholar 

  12. Thomson GM, Day JH, Evers S. Report of the Ad Hoc Committee on Environmental Hypersensitivity Disorders. Ontario; Ontario Ministry of Health, 1985: 17–18.

    Google Scholar 

  13. Rea WJ, Johnson AR, Ross GH, Butler JR, Fenyves EJ, Griffiths B, Laseter J. Considerations for the diagnosis of chemical sensitivity. In: National Research Council editor. Multiple chemical sensitivities. Addendum to biologic markers in immunotoxicology. Washington DC; National Academy Press, 1992: 169–192.

    Google Scholar 

  14. Nethercott JR, Davidoff LL, Curb WB, Abbey H. Multiple chemical sensitivities syndrome: toward a working case definition. Arch. Environ. Health. 1993; 48: 19–26.

    PubMed  CAS  Google Scholar 

  15. Multiple chemical sensitivity: A 1999 consensus. Arch. Environ. Health 1999; 54: 147–149.

  16. McKeown-Eyssen GE, Sokoloff ER, Jazmaji V, Marshall LM, Baines CJ. Reproducibility of the University of Toronto Self-administered Questionnaire used to assess environmental sensitivity. Am. J. Epidemiol. 2000; 151: 1216–1222.

    PubMed  CAS  Google Scholar 

  17. Sparks PJ, Daniell W, Black DW, Kipen HM, Altman LC, Simon GE, Terr AL. Multiple chemical sensitivity syndrome: a clinical perspective 2. treatment and social considerations. J. Occup. Med. 1994; 36: 731–737.

    PubMed  CAS  Google Scholar 

  18. Barsky A, Borus JF. Functional somatic syndrome. Ann. Intern. Med. 1999; 130: 910–921.

    PubMed  CAS  Google Scholar 

  19. Terr AI. Environmental illness: a clinical review of 50 cases. Arch. Intern. Med. 1986; 146: 145–149.

    PubMed  CAS  Google Scholar 

  20. Terr AI. “Multiple chemical sensitivities:” immunologic critique of clinical ecology theories and practice. In: Cullen MR, editor. Occupational Medicine, State of the Art Reviews Philadelphia; Hanley & Belfus Inc, 1987: 683–694.

    Google Scholar 

  21. Schwartz GE, Bell IR, Dikman ZV, Fernandez M, Kline JP, Peterson JM, Wright KP. EEG responses to low level chemicals in normals and cacosmias. Toxicol. Ind. Health 1994; 10: 633–643.

    PubMed  CAS  Google Scholar 

  22. Kipen HM, Hallman W, Kelly-McNeil K, Fiedler N. Measuring chemical sensitivity prevalence: a questionnaire for population studies. Am. J. Public Health 1995; 85: 574–577.

    PubMed  CAS  Google Scholar 

  23. Simon GE, Katon WJ, Sparks PJ Allergic to life: psychological factors in environmental illness. Am. J. Psychiatry 1990; 147: 901–906.

    PubMed  CAS  Google Scholar 

  24. Hu H, Stern A, Rotnitzky A, Schlesinger L, Proctor S, Wolfe J. Development of a brief questionnaire for screening for multiple chemical sensitivity syndrome. Toxicol. Ind. Health 1999; 15: 582–588.

    PubMed  CAS  Google Scholar 

  25. Heuser G, Wojdani A, Heuser S. Diagnostic markers of multiple chemical sensitivity. In: National Research Council editor. Multiple Chemical Sensitivities. Addendum to biologic markers in immunotoxicology. Washington DC; National Academy Press, 1992: 117–138.

    Google Scholar 

  26. Meggs WJ, Cleaveland CH. Rhinolaryngoscopic examinations of patients with the multiple chemical sensitivity syndrome. Arch. Environ. Health 1993; 48: 14–18.

    PubMed  CAS  Google Scholar 

  27. Rogers SA. Tired or toxic? Syracuse; Prestige, 1990.

  28. Bell IR, Baldwin CM, Russek LG, Schwartz GE, Hardin EE. Early life stress, negative paternal relationships, and chemical odor intolerance in middle-aged women: support for a neural sensitization model. J. Womans Health 1998; 7: 1135–1147.

    CAS  Google Scholar 

  29. Muttray A, Lang J, Mayer-Popken O, Konietzko J. Acute changes in the EEG of workers exposed to mixtures of organic solvents. Intern. J. Occup. Med. Environ. Health 1995; 8: 131–137.

    CAS  Google Scholar 

  30. Locatelli M, Bellodi R, Perna G, Heuser L. EEG power modifications in panic disorder during a temporolimbic activation task: relationships with temporal lobe clinical symptomatology. J. Neuropsychiatry Clin. Neurosci. 1993; 5: 409–414.

    PubMed  CAS  Google Scholar 

  31. Hu H, Johnson K, Heldman R, Jones K, Komaroff AL, Schacterle R, Barsky A, Holman L. Comparison of Single Photon Emission Computed Tomography in Normal Controls, in Subjects with Multiple Chemical Sensitivity Syndrome and in Subjects with Chronic Fatigue Syndrome. Olympia: Department of Labor and Industries, State of Washington: 1999.

    Google Scholar 

  32. Callender TJ, Morrow L, Subramanian K, Duhon D, Ristovy M. Three-dimensional brain metabolic imaging in patients with toxic encephalopathy. Environ. Res. 1993; 60: 295–319.

    PubMed  CAS  Google Scholar 

  33. Edling C, Hellman B, Arvidson B, Andersson J, Hartvig P, Lilja A, Valind S, Landgstrom B. Do organic solvents induce changes in the dopaminergic system? Positron emission tomography studies of occupationally exposed subjects. Int. Arch. Occup. Environ. Health 1997; 70: 180–186.

    PubMed  CAS  Google Scholar 

  34. Moser F, Schaeffer J, Waxman AD, Mayberg H, Newer MR. New modalities of brain imaging and neurocognitive assessment: emerging areas of interest and controversy related to applications in head injury, neurotoxicology and environmental medicine. Disability 1995; 4: 1–12.

    Google Scholar 

  35. Doty RL, Deems DA, Frye RE, Pelberg R, Shapiro A. Olfactory sensitivity, nasal resistance and autonomic function in patients with multiple chemical sensitivities. Arch. Otolaryngol. Head Neck Surg. 1988; 114: 1422–1427.

    PubMed  CAS  Google Scholar 

  36. Fiedler N, Kipen H. Chemical sensitivity: the scientific literature. Environ. Health Perspect. 1997; 105 (Suppl 2): 409–415.

    PubMed  Google Scholar 

  37. Bascon R. Multiple chemical sensitivity: a respiratory disorder? Toxicol. Ind. Health 1992; 8: 221–228.

    Google Scholar 

  38. Van den Bergh O, Stegen K, Van Diest I, Raes C, Stulens P, Eelen P, Veulemans H, Van de Woestijne KP, Nemery B. Acquisition and extinction of somatic symptoms in response to odours: a Pavlovian paradigm relevant to multiple chemical sensitivity. Occup. Environ. Med. 1999; 56: 295–301.

    PubMed  Google Scholar 

  39. Caccappolo E, Kipen H, Kelly-McNeil K, Knasko S, Hamer RM, Natelson B, Fiedler N. Odor perception: multiple chemical sensitivities, chronic fatigue, and asthma. J. Occup. Environ. Med. 2000; 42: 629–638.

    PubMed  CAS  Google Scholar 

  40. Dalton P, Wysocki CJ, Brody MJ, Lawley HJ. The influence of cognitive bias on the perceived odor, irritation and health symptoms from chemical exposure. Int. Arch. Occup. Environ. Health 1997; 69: 407–417.

    PubMed  CAS  Google Scholar 

  41. Koelega HS, Koster EP. Some experiments on sex differences in odor perception. Ann. NY Acad. Sci. 1974; 237: 234–246.

    PubMed  CAS  Google Scholar 

  42. Cain WS. Odor identification by males and females: predictions v.s. performance. Chem. Senses 1982; 7: 129–142.

    Google Scholar 

  43. Doty RL, Applebaum S, Zucho H. Sex differences in odor identification ability: a cross-cultured analysis. Neuropsychologia 1985; 23: 667–672.

    PubMed  CAS  Google Scholar 

  44. Corwin J, Loury M, Gilbert An. Workplace, age, and sex as mediators of olfactory function: data from the National Geographic Smell Survey. J. Gerontol. 1995; 50: 179–186.

    Google Scholar 

  45. Lehrer P. Gender differences in long-term odor recognition memory: verbal versus sensory influences and the consistency of label use. Chem. Senses. 1993; 18: 17–26.

    Google Scholar 

  46. Doty RL, Shaman P, Dann N. Development of the University of Pennsylvania Smell Identification Test: a standardized microencapsulated test of olfactory function. Physiol. Behav. 1984; 32: 489–502.

    PubMed  CAS  Google Scholar 

  47. Ashford NA, Miller CS. Chemical Exposures: Low Levels and High Stakes. New York: Van Nostrand Reinhold, 1991: 147–167.

    Google Scholar 

  48. Faust HS, Brilliant LB. Is the diagnosis of “mass hysteria” an excuse for incomplete investigation of low-level environmental contamination? J. Occup. Med. 1981; 23: 22–26.

    PubMed  CAS  Google Scholar 

  49. Donnell HD Jr, Bagby JR, Harmon RG. Report of an illness outbreak at the Harry S Truman state office building. Am. J. Epidemiol. 1989; 126: 550–558.

    Google Scholar 

  50. Henkin RI. Sensory changes during the menstrual cycle. In: Ferin M et al., editors. Biorhythms and Human Reproduction. New York: Wiley, 1974: 277–285.

    Google Scholar 

  51. Marshall JR, Henkin RI. Olfactory acuity, menstrual abnormalities, and oocyte status. Ann. Intern. Med. 1971; 75: 207–211.

    PubMed  CAS  Google Scholar 

  52. Stenberg B, Wall S. Why do women report ‘sick building symptoms’ more than men? Soc. Sci. Med. 1995; 40: 491–502.

    PubMed  CAS  Google Scholar 

  53. McLellan RK. Biologic interventions in the treatment of patients with multiple chemical sensitivities. Occup. Med. 1987; 2: 755–777.

    PubMed  CAS  Google Scholar 

  54. Ziem GE. Multiple chemical sensitivity: Treatment and follow-up with avoidance and control of chemical exposures. Toxicol. Ind. Health 1992; 8: 73–86.

    PubMed  CAS  Google Scholar 

  55. Krohn J, Taylor F, Larson EM. The Whole Way to Allergy Relief and Prevention. 2nd edition. Point Robers; Hartley & Makers Publishers, 1996.

    Google Scholar 

  56. Sprague DE, Milam MF. The concept of an environmental unit. In: Brostoff J, Challacombe S, editors. Food Allergy and Intolerance. London: Bailliere Tindall, 1987: 947–960.

    Google Scholar 

  57. Ross GH. Treatment option in multiple chemical sensitivity. Toxicol. Ind. Health 1992; 8: 97–104.

    Google Scholar 

  58. Maberly DJ, Anthony HM. Asthma management in a “clean” environment. 1: The effect of challenge with foods and chemicals in the peak flow rate. J. Nutr. Med. 1992; 3: 215–230.

    Google Scholar 

  59. Maberly DJ, Anthony HM. Asthma management in a “clean” environment. 2: Progress and outcome in a cohort of patients. J. Nutr. Med. 1992; 3: 215–230.

    Google Scholar 

  60. Maberly DJ, Anthony HM, Birtwistle S. Polysymptomatic patients: a two-centre outcome audit study. J. Nutr. Med. 1996; 6: 7–32.

    Google Scholar 

  61. Speckens AEM, van Hemert AM, Spinhoven P, Hawton KE, Bolk JH, Rooijmans HGM. Cognitive behavioral therapy for medically unexplained physical symptoms: a randomized controlled trial. Brit. Med. J 1995; 311: 328–332.

    Google Scholar 

  62. Deale A, Chalder A, Marks I, Wessely S. Cognitive behavioral therapy for chronic fatigue syndrome: a randomized clinical trial. Am. J. Psychiatry 1997; 154: 408–414.

    PubMed  CAS  Google Scholar 

  63. Guglielmi RS, Cox DJ, Spyker DA. Behavioral treatment of phobic avoidance in multiple chemical sensitivity. J. Behav. Ther. Exp. Psychiatry 1994; 3: 197–209.

    Google Scholar 

  64. Kipen HM, Fiedler N. A 37-years-old mechanic with multiple chemical sensitivities. Environ. Health Perspect. 2000; 108: 377–381.

    PubMed  CAS  Google Scholar 

  65. Kipen HM, Fiedler N, Lehrer P. Multiple chemical sensitivities: a primer for pulmonologists. Clin. Pulmon. Med. 1997; 4: 76–84.

    Google Scholar 

  66. Stewart DE, Raskin J. Psychiatric assessment of patients with ‘20th-century disease’ (‘total allergy syndrome’). Can. Med. Assoc. J. 1985; 133: 1001–1006.

    CAS  Google Scholar 

  67. Schottenfeld RS. Workers with multiple chemical sensitivities: a psychiatric approach to diagnosis and treatment. State Art Rev. Occup. Med. 1987; 2: 739–753.

    CAS  Google Scholar 

  68. Andine P, Ronnback L, Jarvholm B. Successful use of a selective serotonin reuptake inhibitor in a patient with multiple chemical sensitivities. Acta Psychiatr. Scand. 1997; 96: 82–83.

    PubMed  CAS  Google Scholar 

  69. Black DW, Okiishi C, Schlosser S. A nine-year follow-up of people diagnosed with multiple chemical sensitivities. Psycosomatics 2000; 41: 253–261.

    CAS  Google Scholar 

  70. Lax MB, Henneberger PK. Patients with multiple chemical sensitivities in an occupational health clinic: Presentation and follow-up. Arch. Environ. Health 1995; 50: 425–431.

    PubMed  CAS  Google Scholar 

  71. Gupta K, Horne R. The influence of health beliefs on the presentation and consultation outcome in patients with chemical sensitivities. J. Psychosom. Res. 2001; 50: 131–137.

    PubMed  CAS  Google Scholar 

  72. Ross GH. Clinical characteristics of chemical sensitivity: an illustrative case history of asthma and MSC. Environ. Health Perspect. 1997; 105: 437–441.

    PubMed  Google Scholar 

  73. Black DW, Rathe A, Goldstein RB. Environmental illness. A controlled study of 26 subjects with 20th century disease. JAMA 1990; 264: 3166–3170.

    PubMed  CAS  Google Scholar 

  74. Davidoff AL, Fogarty L. Psychogenic origins of multiple chemical sensitivities syndrome: a critical review of the research literatures. Arch. Environ. Health 1994; 49: 316–324.

    PubMed  CAS  Google Scholar 

  75. Bell IR, Schwartz GE, Baldwin CM, Kline JP. Differential resting quantitative electroencephalographic alpha patterns in women with environmental chemical intolerance, depressives, and normals. Biol. Psychiatry 1998; 43: 376–388.

    PubMed  CAS  Google Scholar 

  76. Bell IR, Bootzin RR, Ritenbaugh C, Wyatt JK, DeGiovanni G, Kulinovich T, Anthony JL, Kuo TF, Rider SP, Peterson JM, Schwartz GE, Johnson KA. A polysomnographic study of sleep disturbance in community elderly, with self-reported environmental chemical odor intolerance. Biol. Psychiatry 1996; 40: 123–133.

    PubMed  CAS  Google Scholar 

  77. Fiedler N, Kipen HM, DeLuca J, Kelly-McNeil K, Natelson B. A controlled comparison of multiple chemical sensitivity and chronic fatigue syndrome. Psychosom. Med. 1996; 58: 38–49.

    PubMed  CAS  Google Scholar 

  78. Bell IR, Walsh ME, Goss A, Germeyer J, Schwartz GE, Knof P. Cognitive dysfunction and disability in geriatric veterans with self-reported sensitivity to environmental chemicals. J. Chronic Fatigue Syndrome 1997; 3: 15–42.

    Google Scholar 

  79. Bell IR, Wyatt JK, Bootzin RR, Schwartz GE. Slowed reaction time performance on a divided attention task in elderly with environmental chemical odor intolerance. Int. J. Neurosci. 1995; 84: 127–134.

    Google Scholar 

  80. Bell IR, Schwartz GE, Bootzin RR, Wyatt JK. Time-dependent sensitization of heart rate and blood pressure over multiple aaboratory sessions in elderly individuals with chemical intolerance. Arch. Environ. Health 1997; 52: 6–17.

    PubMed  CAS  Google Scholar 

  81. Bell IR, Peterson JM, Schwartz GE. Medical histories and psychological profiles middle-aged women with and without self-reported illness from environmental chemicals. J. Clin. Psychiatry 1995; 56: 151–160.

    PubMed  CAS  Google Scholar 

  82. Levin AS, Byers VS. Multiple chemical sensitivities: A practicing clinician's point of view-Clinical and immunologic research findings. Toxicol. Ind. Health 1992; 8: 95–109.

    PubMed  CAS  Google Scholar 

  83. Morrow LA, Ryan CM, Goldstein G, Hodgson MJ. A distinct pattern of personality disturbance following exposure to mixtures of organic solvents. J. Occup. Med. 1989; 31: 743–748.

    PubMed  CAS  Google Scholar 

  84. Dager SR, Holland JP, Cowley DS, Dunner DL. Panic disorder precipitated by exposure to organic solvents in the work place. Am. J. Psychiatry 1987; 144: 1056–1058.

    PubMed  CAS  Google Scholar 

  85. Miller CS. Toxicant-induced loss of tolerance: an emerging theory of disease? Environ. Health Perspect. 1997; 105 (Suppl 2): 445–453.

    PubMed  Google Scholar 

  86. Simon GE, Danniel W, Stockbridge JC, Claypoole K, Rosenstock L. Immunologic, psychological and neuropsychological factors in multiple chemical sensitivity: a controlled study. Ann. Intern. Med. 1993; 19: 97–103.

    Google Scholar 

  87. Tonori H, Aizawa A, Ojima M, Miyata M, Ishikawa S, Sakabe K. Anxiety and depressive states in multiple chemical sensitivity. Tohoku J. Exp. Med. 2001; 193: 115–126.

    PubMed  CAS  Google Scholar 

  88. Joffres MR, Williams T, Sabo B, Fox RA. Environmental sensitivities: Prevalence of major symptoms in a referral center: The Nova Scotia Environmental Sensitivities Research Center study. Environ. Health Perspect. 2001; 109: 161–165.

    PubMed  CAS  Google Scholar 

  89. Burge S, Hedge A, Wilson S, Bass JH, Robertson A. Sick building syndrome: a study of 4373 office workers. Ann. Occup. Hyg. 1987; 31: 493–504.

    PubMed  CAS  Google Scholar 

  90. Marmot MG, Smith GD, Stansfeld S, Patel C, North F, Head J, White I, Brunner E, Feeney A. Inequalities in health 20 years on: the Whitehall_study of British civil servants. Lancet 1991; 337: 1387–1393.

    PubMed  CAS  Google Scholar 

  91. Skov P, Vallojorn O, Pedersen BV. Influence of personal characteristics, job-related factors and psychosocial factors on sick building syndrome. Scand. J. Work Environ. Health 1989; 15: 286–295.

    PubMed  CAS  Google Scholar 

  92. Stenberg B, Hansson MK, Sandstorm M, Sundell J, Wall S. A prevalence study of the sick building syndrome (SBS) and facial skin symptoms in office workers. Indoor Air 1993; 3: 71–81.

    Google Scholar 

  93. Meggs WJ, Dunn KA, Bloch RM, Goodman PE, Davidoff AL. Prevalence and nature of allergy and chemical sensitivity in a general population. Arch. Environ. Health 1996; 51: 275–282.

    PubMed  CAS  Google Scholar 

  94. Buchwald D, Garrity D. Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity. Arch. Intern. Med. 1994; 154: 2049–2053.

    PubMed  CAS  Google Scholar 

  95. Fiedler N, Kipen HM, Natelson B, Otterweller J. Chemical sensitivities and the Gulf War: Department of Veterans Affairs Research Center in basic and clinical science studies of environmental hazards. Reg. Toxicol. Pharmacol. 1996; 24 (Suppl): 129–138.

    Google Scholar 

  96. Bell IR, Warg-Damiani L, Baldwin CM, Walsh M, Schwartz GE. Self-reported chemical sensitivity and wartime chemical exposures in Gulf War veterans with and without decreased global health ratings. Mil. Med. 1998; 168: 725–732.

    Google Scholar 

  97. Schottenfeld RS, Cullen MR. Occupation-induced posttraumatic stress disorders. Am. J. Psychiatry 1985; 142: 198–202.

    PubMed  CAS  Google Scholar 

  98. Staudenmayer H, Selner JC. Post-traumatic stress syndrome (PTSS): escape into the environment. J. Clin. Psychol. 1987; 43: 156–157.

    PubMed  CAS  Google Scholar 

  99. Shim C, Williams M. Effect of odors in Asthma. Am. J. Med. 1986; 80: 18–22.

    PubMed  CAS  Google Scholar 

  100. Brooks SM, Bernstein IL, Raghuprasad PK, Maccia CA, Mieczkowski L. Assessment of airway heperresponsiveness in chronic stable asthma. J. Allergy Clin. Immunol. 1990; 85: 17–26.

    PubMed  CAS  Google Scholar 

  101. Juniper EF, Guyatt GH, Epstein RS, Ferrie PJ, Jaeschke R, Hiller TK. Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials. Thorax 1992; 47: 76–83.

    PubMed  CAS  Google Scholar 

  102. Pollet C, Natelson BH, Lange G, Tiersky L, DeLuca J, Policastro T, Desai P, Ottenweller JE, Korn L, Fiedler N, Kipen H. Medical evaluation of Persian Gulf Veterans with fatigue and/or chemical sensitivity. J. Med. 1998; 29: 101–113.

    PubMed  CAS  Google Scholar 

  103. Donnay A, Ziem G. Prevalence and overlap of chronic fatigue syndrome and fibromyalgia syndrome among 100 new patients with multiple chemical sensitivity syndrome. Proceeding of the American Association of Chronic Fatigue Syndrome Resarch Conference: 1998 October; Cambridge, MA. 1998.

  104. Demitrack MA. Chronic fatigue syndrome: A disease of the hypothalamic-pituitary-adrenal axis? Ann. Med. 1994; 26: 1–5.

    PubMed  CAS  Google Scholar 

  105. Clauw DJ, Chrousos GP. Chronic pain and fatigue syndromes: overlapping clinical and neuroendocrine features and potential pathogenic mechanisms. Neuroimmunomodulation 1997; 4: 134–153.

    PubMed  CAS  Google Scholar 

  106. Griep WN, Boersma JW, De Kloet ER. Altered reactivity of the hypothalamic-pituinary-adrenal axis in the primary fibromyalgia syndrome. J. Reumatol. 1993; 20: 469–474.

    CAS  Google Scholar 

  107. Yehuda R. Sensitization of the hypothalamic-pituitary-adrenal axis in post-traumatic stress disorder. Ann. NY Acad. Sci. 1997; 821: 57–75.

    PubMed  CAS  Google Scholar 

  108. NIH Technology Assessment Workshop Panel. The Persian Gulf experience and health. JAMA 1994; 272: 391–396.

    Google Scholar 

  109. Persian Gulf Veterans Coordinating Board. Unexplained illnesses among Desert Storm veterans: a search for cause, treatment, and cooperation. Arch. Intern. Med. 1995; 155: 262–268.

    Google Scholar 

  110. Committee to review the health consequences of service during the Persian Gulf War. Initial findings and recommendations for immediate action. Washington, DC: American Academy Press, 1994.

    Google Scholar 

  111. The Iowa Persian Gulf Study Group. Self-reported illness and health status among Gulf War veterans: a population-based study. J. Am. Med. Assoc. 1997; 277: 238–245.

    Google Scholar 

  112. Reid S, Hotopf M, Hull L, Ismail K, Unwin C, Wessely S. Multiple chemical sensitivity and chronic fatigue syndrome in British Gulf War veterans. Am. J. Epidemiol. 2001; 153: 604–609.

    PubMed  CAS  Google Scholar 

  113. Miller CS. White paper: chemical sensitivity: history and phenomenology. Toxicol. Ind. Health 1994; 10: 253–276.

    PubMed  CAS  Google Scholar 

  114. Miller L. Toxic trauma and chemical sensitivity: clinical syndromes and psychotherapic strategies. Psychotherapy 1995; 32: 648–656.

    Google Scholar 

  115. Fukuda K, Nisenbaum R, Stewart G, Thompson WW, Robin L, Washko RM, Noah DL, Barrett DH, Randall B, Herwaldt BL, Mawle AC, Reeves WC. Chronic multiple illness affecting air force veterans of the Gulf War. JAMA 1998; 280: 981–988.

    PubMed  CAS  Google Scholar 

  116. Kipen HM, Hallman W, Kang H, Fiedler N, Natelson BH. Prevalence of chronic fatigue and chemical sensitivities in Gulf registry veterans. Arch. Environ. Health 1999; 54: 313–318.

    PubMed  CAS  Google Scholar 

  117. Black DW, Doebbeling BN, Voelker MD, Clarke WR, Woolson RF, Barrett DH, Schwartz DA. Multiple chemical sensitivity syndrome-symptom prevalence and risk factors in a military population. Arch. Intern. Med. 2000; 60: 1169–1176.

    Google Scholar 

  118. Unwin C, Blatchley N, Coker W, Ferry S, Hotopf M, Hull L, Ismail K, Palmer I, Devid A, Wessely S. Health of UK servicemen who served in Persian Gulf War. Lancet 1999; 353: 169–178.

    PubMed  CAS  Google Scholar 

  119. Fukuda K, Straus S, Hickie I. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann. Intern. Med. 1994; 121: 953–959.

    PubMed  CAS  Google Scholar 

  120. Ducatmas AM. Multiple chemical sensitivities. In: Rom WR, editor. Environmental and Occupational Medicine, Third Edition. Philadelphia: Lippincott-Raven, 1998: 891–904.

    Google Scholar 

  121. Staudenmayer H, Selner JC, Buhr MP. Double-blind provocation chamber challenges in 20 patients presenting with ‘multiple chemical sensitivity. Regul. Toxicol. Pharmacol. 1993; 18: 44–53.

    PubMed  CAS  Google Scholar 

  122. Fiedler N, Kipen HM, eds. Experimental Approaches to Chemical Sensitivity. Environ. Health Perspect. 1997; 105 (Suppl 2): 405–407.

  123. Sparks PJ, Daniell W, Black DW, Kipen HM, Altman LC, Simon GE, Terr AL. Multiple chemical sensitivity syndrome: a clinical perspective. 1. Case definition, theories of pathogenesis, and research needs. J. Occup. Med. 1994; 36: 718–730.

    PubMed  CAS  Google Scholar 

  124. Stenn PG, Binkley KE. Misattribution and attribution in psychiatric care of patients with pseudoallergy and chemical sensitivity syndrome. Psychosomatics 1998; 39: 212–213.

    Google Scholar 

  125. Poonai N, Antony MM, Binkley KE, Stenn P, Swinson RP, Corey P, Silverman FS, Tarlo SM. Carbon dioxide inhalation challenges in idiopathic environmental intolerance. J. Allergy Clin. Immunol. 2000; 105: 358–363.

    PubMed  CAS  Google Scholar 

  126. International Programme on Chemical Safety. Conclusions and recommendations of a workshop on multiple chemical sensitivity (MCS). Regul. Toxicol. Pharmacol. 1996; 24 (Suppl): 188–189.

    Google Scholar 

  127. American College of Physicians. Clinical ecology: position paper. Ann. Intern. Med. 1989; 111: 168–178.

    Google Scholar 

  128. Council on Scientific Affairs. American Medical Association. Clinical Ecology. JAMA 1992; 268: 3465–3467.

    Google Scholar 

  129. American College of Occupational and Environmental Medicine. Multiple chemical sensitivities: idiopathic environmental intolerance. J. Occup. Environ. Med. 1999; 41: 940–942.

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Hideki Tonori.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Watanabe, M., Tonori, H. & Aizawa, Y. Multiple chemical sensitivity and idiopathic environmental intolerance (part two). Environ Health Prev Med 7, 273–282 (2003). https://doi.org/10.1007/BF02908886

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02908886

Key words

  • multiple chemical sensitivity
  • idiopathic environmental intolerance
  • chemical intolerance
  • diagnosis
  • treatment