Does improving indoor air quality lessen symptoms associated with chemical intolerance?

Roger B Perales,Raymond F Palmer,Tatjana Walker,Jacqueline N Viramontes,Rudy Rincon,Carlos R Jaén,Claudia S Miller

doi:10.1017/s1463423621000864

Abstract

To determine whether environmental house calls that improved indoor air quality (IAQ) is effective in reducing symptoms of chemical intolerance (CI). 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. 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. 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. 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.

Highlights

Chemical intoleranceIncreased prevalence of chemical intolerance (CI) has recently been reported by Hojo et al (2018) and Steinemann (2019a). Katerndahl et al (2012) report that twenty percent of primary care patients report adverse reactions associated with low-level exposures to chemical inhalants, foods, and drugs – everyday exposures that do not bother most people and are not generally recognized as toxic
We investigate the effectiveness of environmental house calls (EHCs) in reducing the symptoms of individuals with CI
We developed the Environmental House Call (EHC) with three primary goals in mind: (1) assisting individuals who have CI with identification of potential home exposures, how to avoid them, and how to reduce or eliminate potential symptom triggers; (2) evaluating compliance through objective pre-/post-volatile organic compounds (VOCs) measurements provided by an independent lab; and (3) evaluating any symptom changes associated with changes in VOCs

Summary

Introduction

Chemical intoleranceIncreased prevalence of chemical intolerance (CI) has recently been reported by Hojo et al (2018) and Steinemann (2019a). Katerndahl et al (2012) report that twenty percent of primary care patients report adverse reactions associated with low-level exposures to chemical inhalants, foods, and drugs – everyday exposures that do not bother most people and are not generally recognized as toxic. Katerndahl et al (2012) report that twenty percent of primary care patients report adverse reactions associated with low-level exposures to chemical inhalants, foods, and drugs – everyday exposures that do not bother most people and are not generally recognized as toxic. These responses do not appear to be IgE-mediated (Ashford & Miller, 1998). Those affected typically report symptoms such as headaches, mood changes, fatigue, ‘brain fog’, and gastrointestinal problems – common complaints in family medicine practices (Finley et al, 2018; Katerndahl et al, 2012). Common symptom triggers for those with CI include indoor air contaminants such as combustion products from gas stoves and smoking, volatile and semi-volatile organic compounds (VOCs and SVOCs) from products like disinfectants, pesticides, air fresheners, fragrances, and chemicals outgassing from new furnishings, paint, carpeting, flooring, glues, and construction materials (Miller & Mitzel, 1997; Miller & Prihoda, 1999a; 1999b; Fanger, 2006; Norbäck, 2020)

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