Multiple Chemical Sensitivity Syndrome Research Articles

What effect do mycotoxins, cell wall components, enzymes and other mold components and metabolites have on our health?

AbstractThe AWMF (Association of the Scientific Medical Societies) mold guideline “Medical clinical diagnostics for indoor mold exposure”—Update 2023 [44] concludes that there is limited or presumed evidence of a link between indoor dampness/mold exposure and health problems. However, there is inadequate or insufficient evidence for an association between indoor dampness/mold exposure and the environmental medical syndromes sick building syndrome (SBS), multiple chemical sensitivity (MCS) and chronic fatigue syndrome (CFS). Newly coined terms, such as biotoxicosis and mold and vapor hypersensitivity syndrome (MDHS) or volatoxins, suggest a nosological specificity of a pathophysiological connection for which, however, there is no evidence to date. The background to this assessment is presented in this paper.

The effect of comorbid medical diagnoses on disturbed sleep in chronic fatigue syndrome

ABSTRACT Background Chronic fatigue syndrome [CFS] may occur alone or with fibromyalgia. This has led some to believe the two occur along a common illness spectrum. Evaluating whether this is the case is important as differences in burden or severity of CFS with fibromyalgia (FM) would suggest different underlying pathophysiological processes. Objective To determine if Insomnia Severity Index [ISI] scores differ between patients with CFS and those with CFS plus FM. In addition, we aim to determine if insomnia severity is impacted by other comorbid medically unexplained diagnoses. Methods 247 patients with CFS completed the ISI and the Centers for Epidemiological Study – Depression. Patient groups were stratified on CFS severity and the presence of FM. A secondary analysis was conducted to evaluate insomnia severity related to the number of comorbid medically unexplained diagnoses including, FM, multiple chemical sensitivity and/or irritable bowel syndrome. Results When controlling for depressed mood, ISI did not differ significantly across patient groups defined by CFS severity and FM status. However, independent of mood, ISI was sensitive to multiple diagnoses showing a significant increasing trend from CFS alone to CFS plus one, two or three comorbid diagnoses. Conclusion Although CFS severity and FM status do not impact insomnia severity, increased illness burden as manifested by multiple medically unexplained diagnoses does appear to influence insomnia. In contrast to our earlier studies, this study did not find that a comorbid diagnosis of FM in patients with CFS is related to a worse outcome in the variable of interest.

Undertreatment with Osimertinib in patient with multiple chemical sensitivity. A case report.

Multiple chemical sensitivity (MCS), is a syndrome characterised by increased sensitivity to the exposure of environmental chemicals (1). There are considerable difficulties in reaching a good estimate of the prevalence of disease and the main pathogenetic hypotheses take into account both the organic and psychiatric/psychological factors. Treatment with epidermal growth factor tyrosine kinase receptor inhibitors (tkis), like Osimertinib, results in improved progression-free survival (PFS) compared to chemotherapy, in Non-small-cell lung carcinoma (NSCLC) with epidermal growth factor receptor (EGFR) mutation (2). We describe the case of a 74 year old woman with history of MCS and fibromyalgia in treatment with Osimertinib for EGFR-mutated NSCLC. Patient initially refused any form of active therapy for lung cancer, but thanks to teamwork and the important support of the psychologist, the patient decided to start treatment with Osimertinib at a reduced dose, not 80 mg but 40 mg. Subsequently, after few days , of his own free will and without informing the staff physicians, the patient changed the treatment schedule by taking one quarter of the dose of the medicine every other day, justifying this choice in therapeutic modification because of her fear and intolerance to any type of medicine and/ or chemical substance, being influenced by MCS. Despite the changes in the treatment plan, a PET scan performed after two months showed a sigificative lung response and the stability of bone metastases. Discussion. Our case describes a significative response with Osimertinib despite the change in dosage and schedule in a patient with MCS. Our experience deserves to be considered in the light of its particularity and uniqueness as it shows an excellent response to treatment with Osimertinib despite the change made to the dosage and schedule, in a patient presenting in her medical history this rare pathological condition: MCS syndrome.

Sick Neighborhood Syndrome: Population with Multiple Chemical Sensitivity Adjacent to Bioethanol Distillery

The population of a neighborhood in the city of Córdoba presents general irritant symptoms since a bioethanol distillery began to operate there, from which formaldehyde, toluene, xylene mainly emanate. At the request of the community, collective environmental health was evaluated with a cross-sectional study of prevalence of these conditions. 53% of the residents reported respiratory disorders, conjunctivitis 31%, headaches 27%, dermatitis 23% and dyspepsia 22%. 57% of children aged 6 - 7 use bronchodilators (an indicator of asthma). 66% of the population has one of these conditions, 46% has two and 26% has three; children are the most affected. The results coincide with the Consensus on Multiple Chemical Sensitivity Syndrome in that it is reproducible by repeated chemical exposure, is chronic and does not improve without eliminating exposure, affecting multiple organs and systems. 14.8% of newborns feature malformations, while in the rest of the city, only 1.7% did. Similar to the Sick Building Syndrome, the collective health picture found suggests a “Sick Neighborhood Syndrome”.

Small Fiber Neuropathy in Patients with Chronic Pain and a Previous Diagnosis of Multiple Chemical Sensitivity Syndrome.

Small fiber neuropathy (SFN) is characterized by the involvement of Aδ and C fibers leading to sensory, mainly pain, and/or autonomic symptoms. Multiple chemical sensitivity syndrome (MCS) is an incompletely defined condition characterized by the onset of various symptoms in patients after exposure to several chemical substances. Pain is a common symptom in these patients. In this study, we report the histological and clinical data of a cohort of 21 patients who had been diagnosed as having MCS and who were referred to us with the suspicion of SFN because of chronic pain. All patients underwent neurological clinical examination, (including scales for pain and autonomic disorders), and a skin biopsy. Age-matched healthy subjects were used as controls for the skin biopsies. Nerve conduction studies and serum screening to exclude possible causes of peripheral neuropathy were also performed. Skin biopsies disclosed a somatic SFN in all patients. Although the majority (18 out of 21) of patients also had autonomic symptoms. we found sparing of autonomic innervation in the biopsies. These observations suggest that chronic pain in MCS could be secondary to the presence of somatic SFN, although more data are needed to confirm these observations.

OnabotulinumtoxinA Is an Effective Treatment for Chronic Migraine in Patients With Comorbid Fibromyalgia.

Introduction: Fibromyalgia (FM) is a frequent comorbidity in patients with chronic migraine (CM). PREEMPT trials, which demonstrated the efficacy of OnabotulinumtoxinA (OnabotA) on CM, excluded patients with FM. Our aim was to evaluate the effectiveness of OnabotA in a series of patients with CM and FM.Methods: We analyzed patients with a previous diagnosis of CM and FM who had received sessions of OnabotA quarterly between January 2014 and January 2020 in a specialized Headache Clinic. Primary endpoint was the reduction in moderate to severe headache days at 3, 6, 9, and 12 months.Results: Data were collected from 31 patients with CM and FM that received OnabotA (100% females). Mean age at first procedure was 50.2 ± 11.3 years. Depression (93.5%), other central sensitization syndromes (irritable bowel syndrome, interstitial cystitis, multiple chemical sensitivity, endometriosis, and chronic fatigue syndrome) (48.4%), and medication overuse headache (90.3%) were frequent comorbidities. 48.4% of patients had failed ≥3 preventives previously. The percentage of patients who achieved ≥30 and ≥50% moderate-severe headache reduction on the third month was 65.4 and 48.2%, respectively. Twenty-three patients completed four cycles of treatment, with 13.4 fewer headache days per month than at baseline (p < 0.001). By 1 year, 69.5% had ≥50% reduction of headache frequency and 39.1% had a ≥75% reduction. In 4 cases (21%), OnabotA was interrupted due to a lack of response. Only mild adverse effects were recorded.Conclusion: OnabotA is an effective treatment for CM in patients with FM.

Multiple Chemical Sensitivity Syndrome: A Principal Component Analysis of Symptoms.

Multiple Chemical Sensitivity (MCS) is a chronic and/or recurrent condition with somatic, cognitive, and affective symptoms following a contact with chemical agents whose concentrations do not correlate with toxicity in the general population. Its prevalence is not well defined; it mainly affects women between 40 and 50 years, without variations in ethnicity, education and economic status. We aimed to assess the core symptoms of this illness in a sample of Italian patients. Two physicians investigated different symptoms with a checklist compilation in 129 patients with MCS (117 women). We conducted a categorical Principal Component Analysis (CATPCA) with Varimax rotation on the checklist dataset. A typical triad was documented: hyperosmia, asthenia, and dyspnoea were the most common symptoms. Patients also frequently showed cough and headache. The CATPCA showed seven main factors: 1, neurocognitive symptoms; 2, physical (objective) symptoms; 3, gastrointestinal symptoms; 4, dermatological symptoms; 5, anxiety-depressive symptoms; 6, respiratory symptoms; 7, hyperosmia and asthenia. Patients showed higher mean prevalence of factors 7 (89.9%), 6 (71.7%), and 1 (62.13%). In conclusion, MCS patients frequently manifest hyperosmia, asthenia, and dyspnoea, which are often concomitant with other respiratory and neurocognitive symptoms. Considering the clinical association that is often made with anxiety, more studies are necessary on the psychosomatic aspects of this syndrome. Further analytical epidemiological studies are needed to support the formulation of aetiological hypotheses of MCS.

Functional symptoms in dermatology: Part 2.

Functional disorders within dermatology present as various constellations of skin symptoms, but without evidence of organic pathology. Examples can include mucocutaneous pain syndromes, functional pruritus, somatoform pain disorder and rarer entities, such as undifferentiated somatoform idiopathic anaphylaxis and multiple chemical sensitivity syndrome. These conditions can have a significant impact on a patient's quality of life, and can present challenges in communication, investigation and management. The aetiology of functional disorders is not fully understood, but with an effective collaborative approach, a psychological explanation for these symptoms is often found. A structured approach to assessment can lead to a confident diagnosis, and understanding a patient's belief system and the impact of symptoms on their functioning can give better grounding for successful management. Treatment is dependent on the level of the patient's engagement with healthcare professionals, and often takes a measured and rehabilitative approach. Psychological therapies have been shown to be effective, often alongside both psychopharmacological and topical medications.

Multiple chemical sensitivity syndrome is not caused by contact allergy.

Multiple chemical sensitivity syndrome is not caused by contact allergy.

De novo appearance of multiple chemical sensitivity syndrome in a patient affected with lateral meningocele syndrome: unlucky coincidence?

Although the coexistence of rare pathologies in the same patient is considered an exceptional event, the possibility to contend with a condition such like this may occur in clinical practice. In these cases, a multidisciplinary approach is required in order to find the most appropriate therapeutic strategy. Here we describe the clinical case of a 61 years old female affected with a rare genetic pathology known as lateral meningocele syndrome (LMS) who developed a pathological condition that could be framed in the context of a multiple chemical sensitivity syndrome (MCSS) characterized by intolerance to several drugs, foods as well as environmental and chemical agents.

Sevoflurane anaesthesia for nasal surgery in a patient with multiple chemical sensitivity

Multiple chemical sensitivity syndrome is a group of complex disorders that include psychiatric disorders, chronic fatigue and/or respiratory problems. This syndrome could be triggered by specific allergens and toxins that cause neurophysiological sensitization and appearance of clinical symptomatology. Anaesthesia for these patients always poses a challenge for anaesthetist, because they need to find and use drugs that do not trigger or aggravate symptoms of disease. Therefore, sevoflurane in these circumstances might be the ideal anaesthetic. Performing general anaesthesia with sevoflurane as sole anaesthetic agent, together with a series of environmental measures formed basis for successful anaesthesia and surgery in our patient with a multiple chemical sensitivity syndrome.

The Role of Neurogenic Inflammation in Chemical Sensitivity

Chemical sensitivity is an acquired disorder in which a specific set of diagnosable medical conditions involving the respiratory, cardiac, gastrointestinal, musculoskeletal, dermal, and nervous systems are exacerbated by exposure to chemicals found in the environment at levels that neither produce acute toxicity nor affect most individuals. An initiating exposure is often identified in association with the onset of disease. Neurogenic inflammation is a well-defined pathophysiological process in which chemical irritants trigger nerve fibers to release inflammatory mediators that lead to disease. The scientific evidence that neurogenic inflammation plays a role in chemical sensitivity is presented in this review article. Key Words: Neurogenic inflammation—Respiratory irritants—Chemical sensitivity—Multiple chemical sensitivity syndrome—Allergy.

History of the Rise and Fall of Environmental Medicine in the United States

The concepts and descriptions of chemical sensitivity in the United States emerged from the observations of a group of American allergists who were using elimination diets to find causes of diagnosable medical conditions. They observed that conditions distinct from traditional allergic diseases, including neuropsychological disorders, could go into remission when foods were eliminated from some patients' diets. When some patients reported that they could eat a food from noncommercial sources but had illness associated with the same food from commercialsources, reactivity to chemical residues such as pesticides and preservatives on foods was discovered. Further observations were made that chemical inhalants such as vehicle exhaust and industrial fumes could exacerbate some conditions. Dr. Theron Randolph pioneered the diagnostic tool he called a comprehensive environmental control unit, in which patients would be fed organic foods on a rotation diet in a facility with relatively clean air. As the field of environmental medicine emerged, commercial interests including the corporate food industry, chemical industry, pharmaceutical industry, and workers' compensation insurance companies were threatened. The same techniques used to suppress scientific discoveries that smoking cigarettes causes cancer and heart disease, burning fossil fuels deranges the biosphere, and using leaded gasoline damages children's brains were used to suppress that dietary and environmental exposures could cause disease. As a number of diseases ranging from obesity and diabetes to depression increase at devastating rates, a return to the principles of environmental medicine becomes imperative. Key Words: Chemical sensitivity—Multiple chemical sensitivity syndrome—Neurogenic inflammation—Respiratory irritants.

Role of polymorphisms of inducible nitric oxide synthase and endothelial nitric oxide synthase in idiopathic environmental intolerances.

Oxidative stress and inflammation play a pathogenetic role in idiopathic environmental intolerances (IEI), namely, multiple chemical sensitivity (MCS), fibromyalgia (FM), and chronic fatigue syndrome (CFS). Given the reported association of nitric oxide synthase (NOS) gene polymorphisms with inflammatory disorders, we aimed to investigate the distribution of NOS2A −2.5 kb (CCTTT)n as well as Ser608Leu and NOS3 −786T>C variants and their correlation with nitrite/nitrate levels, in a study cohort including 170 MCS, 108 suspected MCS (SMCS), 89 FM/CFS, and 196 healthy subjects. Patients and controls had similar distributions of NOS2A Ser608Leu and NOS3 −786T>C polymorphisms. Interestingly, the NOS3 −786TT genotype was associated with increased nitrite/nitrate levels only in IEI patients. We also found that the NOS2A −2.5 kb (CCTTT)11 allele represents a genetic determinant for FM/CFS, and the (CCTTT)16 allele discriminates MCS from SMCS patients. Instead, the (CCTTT)8 allele reduces by three-, six-, and tenfold, respectively, the risk for MCS, SMCS, and FM/CFS. Moreover, a short number of (CCTTT) repeats is associated with higher concentrations of nitrites/nitrates. Here, we first demonstrate that NOS3 −786T>C variant affects nitrite/nitrate levels in IEI patients and that screening for NOS2A −2.5 kb (CCTTT)n polymorphism may be useful for differential diagnosis of various IEI.

Anaesthesia Management in Patients with Multiple Chemical Sensitivity Syndrome

Multiple Chemical Sensitivity (MCS) is characterised by the appearance of numerous and sometimes severe symptoms, when subjects are in contact with various chemicals and medicinal substances. Currently there are no useful guidelines for managing clinical issues and, specifically, anaesthesia for patients with MCS. This case report describes anaesthesia management in a patient affected by clinically documented MCS and a latex allergy, a candidate for a laparoscopic cholecystectomy operation.

Intranasal Administration of Hyaluronan as a Further Resource in Olfactory Performance in Multiple Chemical Sensitivity Syndrome

Multiple chemical sensitivity (MCS) is a relatively common clinical diagnosis in western populations and its symptoms (i.e. dysosmia) are mainly triggered by chemical compounds, such as common odorants. The aim of this study was to test the effect of intranasal administration of hyaluronic acid (HA) on odour threshold and related quality of life in MCS syndrome. Two randomized groups of MCS patients received 30 days’ administration of either a nasal spray (Ialumar®) containing HA [HA group (HAG); n=29] or only physiological solution[PS group (PG); n=30]. Both groups were investigated using the Sniffin’ Sticks test (SST) battery, Questionnaire of Olfactory Disorder (QOD) and Zung Anxiety Scale (SAS) before randomization and after treatment. Paired t-test analysis found a statistically significant reduction in odour threshold (OT) and an improvement in QOD and SAS between pre- and post-treatment results only in the HAG. Furthermore, positive correlations were found between the OT reduction, SAS and QOD improvement. Thus, intranasal administration of HA could be suggested as a further well-tolerated resource in alleviating MCS olfactory discomfort.

Sensibilidad química múltiple: diferencias epidemiológicas, clínicas y pronósticas entre la de origen laboral y la de origen no laboral

The progressive increase in cases of multiple chemical sensitivity (MCS) syndrome and the lack of studies which associate the syndrome with possible occupational origins means that further research in this field is required. The objective of this study was to compare the epidemiological, clinical and prognostic aspects of cases of MCS of occupational and non-occupational origin. Observational study of patients diagnosed with MCS by the toxicology outpatients clinic of the Hospital Clinic of Barcelona between 2002 and 2007. The occupational and non-occupational origin of MCS was considered as an independent variable. The dependant variables were occupational activity, triggering agents of MCS, chemical agents associated with the development of clinical manifestations, severity of the symptoms, comorbidities and work disability. Percentages were compared between groups. A total of 165 patients were included: The mean age was 47.7 years and 90.9% were women. There were significant differences between patients of occupational and non-occupational origin with respect to comorbidities such as chronic fatigue syndrome (68.1% versus 88.5%; p=0.002) and fibromyalgia (49.3% versus 73.9%; p=0.002), temporary disability (60.9% versus 39.6%; p=0.006) and permanent disability (8.7% versus 22.9%; p=0.006). Cases of MCS attributed to an occupational origin had fewer comorbidities and less permanent disability than those of non-occupational origin.

Anaesthesia for patients with idiopathic environmental intolerance and chronic fatigue syndrome

BackgroundIdiopathic environmental intolerance syndrome (IEI), formerly known as multiple chemical sensitivity syndrome (MCSS), and chronic fatigue syndrome (CFS) are controversial diseases and there is little information in the literature regarding the appropriate conduct of anaesthesia in such patients. MethodsWe studied 27 patients referred to our anaesthetic allergy clinic with IEI and CFS and performed literature and web searches on anaesthesia in these disorders. ResultsThe patients had a significant incidence of adverse events related to anaesthesia which were not allergic in nature. The adverse effects usually occurred postoperatively and were self limiting. Patients with IEI and CFS are not at risk of anaphylaxis and there is no scientific evidence that any drug or technique is excessively hazardous. Neither our patients nor the review of the scientific literature supported available web-based recommendations for the anaesthetic management of patients with IEL and CFS. ConclusionsWe suggest that the anaesthetist may be best to use the technique they would use if the patient did not have CFS or IEI but avoid drugs to which there is a history of adverse response. Anaesthesia is likely to be associated with adverse effects in these patients but the effects are not likely to be severe. A series of recommendations for the safe and harmonious conduct of anaesthesia in patients with CFS and IEI are provided.

Management of oral focal infection in patients with asthmatic symptoms

Asthma is commonly related to allergic diseases, nevertheless only 40% of asthma patients are related to allergy or atopy. There are some unknown etiologies of asthma that are still in researches. One of the possible causes of asthma is the multiple chemical sensitivity syndrome (MCS) which related to the “neurogenic switching hypothesis”. Since rhinitis, sinusitis and asthma are closely related, treatments which are successfully reduce or eliminate the rhinitis and sinusitis symptoms should also be advantageous to asthma management. There were a lot of sinusitis treatments which reduced asthma symptoms such as nasal corticosteroid, diathermy and surgery. It was also been reported that oral focal infection might cause sinusitis. However, the involvement of oral focal infection in the etiopathogenesis of asthma was seldom discussed. The objective of this study is to propose a mechanism of the relationship between oral focal infection and asthma which is explained by the “neurogenic switching hypothesis”. Two asthmatic patients who also had periodontal disease, pulpal and periapical infection were treated with conventional and/or surgical dental treatments. After the dental and periodontal treatments were completed, the usual triggers of severe asthma attacks such as cold and house dust did not elicit the asthma symptoms. It concluded that regarding to the disappearing of asthma symptoms, the elimination of oral focal infection had a beneficial effect in reducing asthma symptoms.

Use of QEESI© questionnaire for a screening study in Japan

QEESI© (Miller and Prihoda, 1999a: Toxicology and Industrial Health, 15, 370) was applied to 498 subjects, recruited from the general population of Miyagi prefecture, Japan, who had not been diagnosed previously as having multiple chemical sensitivity (MCS) or sick building syndrome. Seventeen (3.8%) of 440 subjects who returned valid completed questionnaires were classified as having symptoms ‘very suggestive’ of MCS using the four-classification system of Miller and Prihoda (1999a). We conducted detailed telephone interviews with these 17 individuals. All were visiting local hospitals on an outpatient basis with diagnoses other than MCS and had either current or previous presumed chemical exposure. Therefore, we recommended they undergo a medical check by MCS medical experts and indoor air quality assessment. Seven subjects participated in both the medical check and indoor air quality monitoring, six subjects participated in indoor air quality monitoring only and four subjects participated in neither. The seven subjects who participated in both the medical check and monitoring were diagnosed as having MCS by the above expert physicians. In nine houses of 13 subjects who participated in indoor environmental quality (IEQ) survey, acetaldehyde (9/9), formaldehyde (8/9), total volatile compounds (TVOCs) (6/9) and paradichlorobenzene (3/9) levels were above the respective guideline values for indoor air concentrations, outlined by the Ministry of Health, Labor and Welfare of Japan and were presumed to act as factors contributing to the subjects’ hypersensitivity and onset or development of symptoms. These results suggested that there might still be a population of patients not properly diagnosed as having MCS by clinicians in Japan. Therefore, we verified the efficacy of QEESI (Japanese version) for screening of MCS patients. The results of indoor air quality analysis suggested the manifestation and deterioration of MCS in Japan might be precipitated by indoor air pollutants, such as formaldehyde, acetaldehyde, volatile compounds (VOCs) and paradichlorobenzene.