1
|
Fares-Medina S, Díaz-Caro I, García-Montes R, Corral-Liria I, García-Gómez-Heras S. Multiple Chemical Sensitivity Syndrome: First Symptoms and Evolution of the Clinical Picture: Case-Control Study/Epidemiological Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15891. [PMID: 36497963 PMCID: PMC9737200 DOI: 10.3390/ijerph192315891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Multiple chemical sensitivity (MCS) is a chronic condition characterized by the appearance of symptoms caused by exposure to chemical compounds that are tolerable for the general population. It mainly affects middle-aged women. There are very few studies focusing on the most frequent symptoms of MCS considering age groups and gender. The main goal of this study was to find the most frequent symptoms both at the onset of the disease and at the present time describing them by age groups. The QEESI (Quick Environmental Exposure and Sensitivity Inventory) questionnaire, Scale 3 which assesses symptoms and their severity, was used as a diagnostic tool for the disease. A case-control study was conducted with the participation of 210 people. Of the cases, 94.3% were women. The symptoms that most often manifested first were airway and mucous membrane alterations (68.9%). In the development of the disease, we found cognitive alterations (OR = 31.25), heart or chest problems (OR = 22.49), neuromuscular problems (OR = 20.00) and head-related symptomatology (OR = 19.29). Identifying the most frequent pattern of symptoms by age group and sex will allow an early diagnosis of the disease to improve its prognosis and treatment.
Collapse
Affiliation(s)
- Sandra Fares-Medina
- Student International Doctoral School, Rey Juan Carlos University (URJC), 28922 Madrid, Spain
| | | | - Rebeca García-Montes
- Student International Doctoral School, Rey Juan Carlos University (URJC), 28922 Madrid, Spain
| | | | | |
Collapse
|
2
|
Abstract
Aim: To determine whether environmental house calls that improved indoor air quality (IAQ) is effective in reducing symptoms of chemical intolerance (CI). Background: Prevalence of CI is increasing worldwide. Those affected typically report symptoms such as headaches, fatigue, ‘brain fog’, and gastrointestinal problems – common primary care complaints. Substantial evidence suggests that improving IAQ may be helpful in reducing symptoms associated with CI. Methods: Primary care clinic patients were invited to participate in a series of structured environmental house calls (EHCs). To qualify, participants were assessed for CI with the Quick Environmental Exposure and Sensitivity Inventory. Those with CI volunteered to allow the EHC team to visit their homes to collect air samples for volatile organic compounds (VOCs). Initial and post-intervention IAQ sampling was analyzed by an independent lab to determine VOC levels (ng/L). The team discussed indoor air exposures, their health effects, and provided guidance for reducing exposures. Findings: Homes where recommendations were followed showed the greatest improvements in IAQ. The improvements were based upon decreased airborne VOCs associated with reduced use of cleaning chemicals, personal care products, and fragrances, and reduction in the index patients’ symptoms. Symptom improvement generally was not reported among those whose homes showed no VOC improvement. Conclusion: Improvements in both IAQ and patients’ symptoms occur when families implement an action plan developed and shared with them by a trained EHC team. Indoor air problems simply are not part of most doctors’ differential diagnoses, despite relatively high prevalence rates of CI in primary care clinics. Our three-question screening questionnaire – the BREESI – can help physicians identify which patients should complete the QEESI. After identifying patients with CI, the practitioner can help by counseling them regarding their home exposures to VOCs. The future of clinical medicine could include environmental house calls as standard of practice for susceptible patients.
Collapse
|
3
|
Multiple Chemical Sensitivity in Patients Exposed to Moisture Damage at Work and in General Working-Age Population-The SAMDAW Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312296. [PMID: 34886041 PMCID: PMC8657242 DOI: 10.3390/ijerph182312296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022]
Abstract
A considerable proportion of patients having respiratory tract or voice symptoms associated with workplace moisture damage (MD) could have multiple chemical sensitivity (MCS). MCS is characterized by symptoms of different organ systems in association with low-level chemical exposure. The objective of this study was to assess the prevalence of MCS among patients referred to secondary health care because of respiratory or voice symptoms associated with workplace MD compared to the general working-age population. Using three subscales of the QEESI© questionnaire, we assessed MCS in the study patients and 1500 controls in the same district randomly selected from the Finnish Population Information System. Study patients had significantly more often high scores in chemical intolerance (39% vs. 23%, p = 0.001), symptom severity (60% vs. 27%, p < 0.001), and life impact subscales (53% vs. 20%, p < 0.001). Asthma, chronic rhinosinusitis, laryngeal problems, and atopy were not associated with the presence of MCS. MCS is common among patients referred to secondary health care with respiratory tract and/or voice symptoms associated with workplace MD, and it considerably affects their everyday life. MCS should be considered as a possible explanatory factor for MD-associated symptoms.
Collapse
|
4
|
Damiani G, Alessandrini M, Caccamo D, Cormano A, Guzzi G, Mazzatenta A, Micarelli A, Migliore A, Piroli A, Bianca M, Tapparo O, Pigatto PDM. Italian Expert Consensus on Clinical and Therapeutic Management of Multiple Chemical Sensitivity (MCS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111294. [PMID: 34769816 PMCID: PMC8582949 DOI: 10.3390/ijerph182111294] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 12/29/2022]
Abstract
Multiple chemical sensitivity (MCS) is a multisystem, recurrent, environmental disorder that flares in response to different exposures (i.e., pesticides, solvents, toxic metals and molds) under the threshold limit value (TLV) calculated for age and gender in the general population. MCS is a syndrome characterized by cutaneous, allergic, gastrointestinal, rheumatological, endocrinological, cardiological and neurological signs and symptoms. We performed a systematic review of the literature to summarize the current clinical and therapeutic evidence and then oriented an eDelphi consensus. Four main research domains were identified (diagnosis, treatment, hospitalization and emergency) and discussed by 10 experts and an MCS patient. Thus, the first Italian MCS consensus had the double aim: (a) to improve MCS knowledge among healthcare workers and patients by standardizing the clinical and therapeutic management to MCS patients; and (b) to improve and shed light on MCS misconceptions not supported by evidence-based medicine (EBM).
Collapse
Affiliation(s)
- Giovanni Damiani
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy;
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- PhD Degree Program in Pharmacological Sciences, Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Daniela Caccamo
- Department of Biomedical Sciences, Dental Sciences, & Morpho-Functional Imaging, Polyclinic Hospital University, 98124 Messina, Italy;
| | - Andrea Cormano
- International Society of Doctors for Environment, 82100 Benevento, Italy;
| | - Gianpaolo Guzzi
- Italian Association for Metals and Biocompatibility Research—A.I.R.M.E.B., 20122 Milan, Italy;
| | - Andrea Mazzatenta
- Department of Neuroscience, Imaging and Clinical Science, ‘G. d’Annunzio’ University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Alessandro Micarelli
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy;
- ITER Center for Balance and Rehabilitation Research (ICBRR), 02032 Rome, Italy
| | - Alberto Migliore
- Department of Internal Medicine, Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, 00189 Rome, Italy;
| | - Alba Piroli
- Department of MeSVA, University of L’Aquila, 67100 L’Aquila, Italy;
| | | | | | - Paolo Daniele Maria Pigatto
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy;
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Correspondence: ; Tel.: +39-02-5031-9971
| |
Collapse
|
5
|
Palmer RF, Walker T, Kattari D, Rincon R, Perales RB, Jaén CR, Grimes C, Sundblad DR, Miller CS. Validation of a Brief Screening Instrument for Chemical Intolerance in a Large U.S. National Sample. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168714. [PMID: 34444461 PMCID: PMC8391803 DOI: 10.3390/ijerph18168714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022]
Abstract
Background: Chemical intolerance (CI) is characterized by multisystem symptoms triggered by low levels of exposure to xenobiotics including chemicals, foods/food additives, and drugs/medications. Prior prevalence estimates vary from 8–33% worldwide. Clinicians and researchers need a brief, practical screening tool for identifying possible chemical intolerance. This large, population-based study describes the validation of a three-item screening questionnaire, the Brief Environmental Exposure and Sensitivity Inventory (BREESI), against the international reference standard used for assessing chemical intolerance, the Quick Environmental Exposure and Sensitivity Inventory (QEESI). Methods: More than 10,000 people in the U.S. responded to the BREESI and the QEESI in a population-based survey. We calculated the overall prevalence of CI in this sample, as well as by gender, age, and income. Common statistical metrics were used to evaluate the BREESI as a screener for CI against the QEESI. Results: The prevalence estimate for QEESI-defined chemical intolerance in the U.S. was 20.39% (95% CI 19.63–21.15%). The BREESI had 91.26% sensitivity (95% CI: 89.20–93.04%) and 92.89% specificity (95% CI: 91.77–93.90%). The positive likelihood ratio was 12.83 (95% CI: 11.07–14.88), and the negative likelihood ratio was 0.09 (95% CI: 0.08–0.12). Logistic regression demonstrates that the predicted probability of CI increased sharply with each increase in the number of BREESI items endorsed (Odds Ratio: 5.3, 95% CI: 4.90–5.75). Conclusions: Chemical intolerance may affect one in five people in the U.S. The BREESI is a new, practical instrument for researchers, clinicians, and epidemiologists. As a screening tool, the BREESI offers a high degree of confidence in case ascertainment. We recommend: screen with the BREESI, confirm with the QEESI.
Collapse
Affiliation(s)
- Raymond F. Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; (T.W.); (R.R.); (R.B.P.); (C.R.J.); (C.S.M.)
- Correspondence: ; Tel.: +1-210-827-7681
| | - Tatjana Walker
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; (T.W.); (R.R.); (R.B.P.); (C.R.J.); (C.S.M.)
| | - David Kattari
- Hayward Score, Carmel, CA 93921, USA; (D.K.); (C.G.); (D.R.S.)
| | - Rudy Rincon
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; (T.W.); (R.R.); (R.B.P.); (C.R.J.); (C.S.M.)
| | - Roger B. Perales
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; (T.W.); (R.R.); (R.B.P.); (C.R.J.); (C.S.M.)
| | - Carlos R. Jaén
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; (T.W.); (R.R.); (R.B.P.); (C.R.J.); (C.S.M.)
| | - Carl Grimes
- Hayward Score, Carmel, CA 93921, USA; (D.K.); (C.G.); (D.R.S.)
| | | | - Claudia S. Miller
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; (T.W.); (R.R.); (R.B.P.); (C.R.J.); (C.S.M.)
| |
Collapse
|
6
|
Palmer R, Walker T, Perales R, Rincon R, Jaén C, Miller C. Disease comorbidities associated with chemical intolerance. ENVIRONMENTAL DISEASE 2021. [DOI: 10.4103/ed.ed_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|