Abstract
The Quick Environmental Exposure and Sensitivity Inventory (QEESI) is a validated questionnaire used worldwide to assess intolerances to chemicals, foods, and drugs, and has emerged as the gold standard for assessing chemical intolerance (CI). Despite a reported prevalence of 8–33%, epidemiological studies and routine primary care clinics rarely assess CI. To help address this gap, we developed the Brief Environmental Exposure and Sensitivity Inventory (BREESI)—a 3-item CI screening tool. We tested the BREESI’s potential to predict whether an individual is likely to be classified as chemically intolerant if administered the 50-item QEESI. We recruited 293 participants from a university-based primary care clinic and through online participation. The statistical sensitivity, specificity, and positive and negative predictive values of the BREESI were calculated against the validated QEESI. Ninety percent (90%) of participants answering “yes” to all three items on the BREESI fit the QEESI criteria for being very suggestive of CI based upon their chemical intolerance and symptom scores (positive predictive value = 90%). For participants endorsing two items, 93% were classified as either very suggestive (39%) or suggestive (54%) of CI (positive predictive value = 87%). Of those endorsing only one item, 13% were classified as very suggestive of CI, and 70% as suggestive. Of those answering “No” to all of the BREESI items, 95% were classified as not suggestive of CI (i.e., negative predictive value = 95%). The BREESI is a versatile screening tool for assessing potential CI useful for clinical and epidemiological applications, based upon individuals’ past adverse responses in a variety of settings. Just as health care professionals routinely inquire about latex allergy to prevent adverse reactions, the BREESI provides an essential screen for CI. Together, the BREESI and QEESI provide new diagnostic tools that may help predict and prevent future adverse reactions to chemicals, foods, and drugs.
Highlights
There is growing international concern over intolerances to chemicals [1, 2], foods [3, 4], and drugs [5]
The need for a useful epidemiological tool, we developed and tested the following three-item questionnaire, the Brief Environmental Exposure and Sensitivity Inventory (BREESI) (Box 1): The items on the BREESI help gauge an individual’s tendency to react adversely to diverse substances representing three major exposure categories covered by the Quick Environmental Exposure and Sensitivity Inventory (QEESI)
We investigate the sensitivity and specificity of the BREESI as well as its positive and negative predictive values for a clinical population referenced to the QEESI
Summary
There is growing international concern over intolerances to chemicals [1, 2], foods [3, 4], and drugs [5]. Population-based surveys estimate prevalence between 8% and 33% in several countries [6,7,8]. Among US children, the reported prevalence of food allergy is 38.7%, with peanut, milk, and shellfish among the top offenders [11]. A large US electronic medical records study showed that 2.1% of health plan patients reported three or more drug intolerances [12]. A UK survey of more than 25,000 inpatients with a documented drug intolerance, showed that 4.9% had Multiple Drug Intolerance Syndrome (MDIS), defined as 3 or more adverse reactions to drugs—suggesting cross intolerances [13]
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