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.
Highlights
Chemical Intolerance: International concern over intolerances to chemicals [1,2], foods [3,4], and drugs [5] is increasing
We developed the “Brief Environmental Exposure and Sensitivity Inventory” (BREESI), comprised of three questions derived from the Quick Environmental Exposure and Sensitivity Inventory (QEESI)
Our earlier study of 293 primary care patients [14] showed that the BREESI exhibited good positive and negative predictive values, as well as sensitivity and specificity, when evaluated against the QEESI reference standard [14]
Summary
Chemical Intolerance: International concern over intolerances to chemicals [1,2], foods [3,4], and drugs [5] is increasing. Up to one-quarter of the U.S population report being either “especially” or “unusually” sensitive to certain chemicals [6]. Katerndahl et al [9] found that 20% of patients in a university family medicine clinic reported chemical intolerances. At least one in ten US adults have well-documented food allergies, and one in five report food intolerances [10,11]. A large US electronic medical records study showed that 2.1% of health plan patients reported three or more drug intolerances [12]. A UK medical records study showed that among more than 25,000 inpatients with documented drug intolerances, 4.9% had Multiple Drug Intolerance Syndrome, defined as 3 or more adverse reactions to drugs, suggesting cross-intolerances [13]
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