Aug 23, 2013

Multiple Chemical Sensitivity: a diagnosis not to be missed.

Environmental Health and Safety 

Brief Overview
People in modern societies spend more than 90% of their time indoors. Hence, indoor environmental quality (IEQ) has a significant impact on public health. In this article are described health risks associated with indoor environments, illuminate barriers to overcoming these risks, and provide policy recommendations to achieve healthier indoor environments. environmental quality (IEQ) refers to the quality of a building’s environment in relation to the health and well-being of those who occupy space within it. IEQ is determined by many factors, including lighting, air quality, and damp conditions. Workers are often concerned that they have symptoms or health conditions from exposures to contaminants in the buildings where they work.  One reason for this concern is that their symptoms often get better when they are not in the building. While research has shown that some respiratory symptoms and illnesses can be associated with damp buildings, it is still unclear what measurements of indoor contaminants show that workers are at risk for disease.  In most instances where a worker and his or her physician suspect that the building environment is causing a specific health condition, the information available from medical tests and tests of the environment is not sufficient to establish which contaminants are responsible.  Despite uncertainty about what to measure and how to interpret what is measured, research shows that building-related symptoms are associated with building characteristics, including dampness, cleanliness, and ventilation characteristics.

Multiple Chemical Sensitivity
 Multiple Chemical Sensitivities (MCS) is a highly controversial issue. In theory, MCS is an adverse physical reaction to low levels of many common chemicals. Chemical sensitivity is generally accepted as a reaction to chemicals but debate continues as to whether MCS is classifiable as an illness. There are a number of synonyms for MCS, including 20th century disease, environmental illness, total allergy syndrome, idiopathic environmental illness, and chemical AIDS.

Proposed theories to explain the cause of MCS include allergy, dysfunction of the immune system, neurobiological sensitization, and various psychological theories. There is insufficient scientific evidence to confirm a relationship between any of these possible causes and symptoms. Due to the lack of definite information an evaluation must be performed by a physician knowledgeable of the symptoms of this condition.

Multiple chemical sensitivity (MCS) is a chronic condition, which belongs to the group of medically unexplained syndromes. Patients (men as well as women) complain of many subjective symptoms such as:
- nose and mouth irritation, 
- sore throat, 
- dyspnea, 
- tiredness, 
- dizziness, 
- headache and 
- concentration difficulties.
 Patient typically report at least four or five symptoms occurring when they are exposed to particular substances, at a very low concentration that usually does not cause symptoms or harm in normal individuals.
The common feature of products that appear to be responsible (either occupational or domestic) is that they have a strong smell and include: solvent, paint, glue, tar, oil, pesticides, perfume, cosmetics and spray products. MCS is nowadays considered to be one aspect of idiopathic environmental intolerance (IEI) whose other main aspect is hypersensitivity to electromagnetic fields. If the diagnosis is suspected clinically it can be confirmed using the Quick Environmental Exposure and Sensitivity Inventory (QEESI(©)) self-questionnaire.

MCS is often misdiagnosed as asthma or an allergic conditions which means that patients are frequently referred to respiratory and allergy specialists. Misdiagnosis can lead to many futile medical investigations. Psychotherapy can improve quality of life in some cases. Preventive measures are often ineffective and do not stop the condition worsening: hypersensitivity can spread to common environmental odors so that a few people become severely disabled and limited in their workplace as well as in private life.

Evaluation and Management
Limited information is available on effective control measures, exposure assessments, and regulations dealing with multiple chemical sensitivities (MCS).
Many physicians are uncertain how to approach the evaluation and care of persons who have multiple symptoms attributed to low-level chemical exposure. The identification of MCS is based largely on the patient's description of the symptoms and the relationship of these symptoms to environmental exposures. The following references provide information about the clinical evaluation process and management of MCS.
A Report on Multiple Chemical Sensitivity (MCS)
Case Studies in Environmental Medicine: Taking An Exposure History



Workplace Safety & Health Topics

Personal exposure to ultrafine particles. 

Improving Indoor Environmental Quality for Public Health: Impediments and Policy Recommendations

Multiple Chemical Sensitivity 

Transcranial pulsed electromagnetic fields for multiple chemical sensitivity

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