Multiple Chemical Sensitivity 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 effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: A systematic review of human experimental studies

BackgroundThe technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s exposing large proportions of the population. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF. ObjectivesTo systematically assess the effects of exposure to RF-EMF on self-reported non-specific symptoms in human subjects and to assess the accuracy of perceptions of presence or absence of RF-EMF exposure. MethodsEligibility criteria: experimental studies carried out in the general population and in individuals with idiopathic environmental intolerance attributed to EMF (IEI-EMF), in any language.Information sources: Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos, Embase and EMF portal, searched till April 2022.Risk of Bias (ROB): we used the RoB tool developed by OHAT adapted to the topic of this review.Synthesis of results: we synthesized studies using random effects meta-analysis and sensitivity analyses, where appropriate. ResultsIncluded studies: 41 studies were included, mostly cross over trials and from Europe, with a total of 2,874 participants.Synthesis of results: considering the primary outcomes, we carried out meta-analyses of 10 exposure-outcomes pairs. All evidence suggested no or small non-significant effects of exposure on symptoms with high (three comparisons), moderate (four comparisons), low (one comparison) and very low (two comparisons) certainty of evidence. The effects (standard mean difference, where positive values indicate presence of symptom being exposed) in the general population for head exposure were (95% confidence intervals) 0.08 (−0.07 to 0.22) for headache, −0.01 (−0.22 to 0.20) for sleeping disturbances and 0.13 (−0.51 to 0.76) for composite symptoms; and for whole-body exposure: 0.09 (−0.35 to 0.54), 0.00 (−0.15 to 0.15) for sleeping disturbances and −0.05 (−0.17 to 0.07) for composite symptoms. For IEI-EMF individuals SMD ranged from −0.19 to 0.11, all of them with confidence intervals crossing the value of zero.Further, the available evidence suggested that study volunteers could not perceive the EMF exposure status better than what is expected by chance and that IEI-EMF individuals could not determine EMF conditions better than the general population. DiscussionLimitations of evidence: experimental conditions are substantially different from real-life situations in the duration, frequency, distance and position of the exposure. Most studies were conducted in young, healthy volunteers, who might be more resilient to RF-EMF than the general population. The outcomes of interest in this systematic review were symptoms, which are self-reported. The available information did not allow to assess the potential effects of exposures beyond acute exposure and in elderly or in chronically ill people. It cannot be ruled out that a real EMF effect in IEI-EMF groups is masked by a mix with insensitive subjects. However, studies on symptoms reporting and/or field perceptions did not find any evidence that there were particularly vulnerable individuals in the IEI-EMF group, although in open provocation studies, when volunteers were informed about the presence or absence of EMF exposure, such differences were consistently observed.Interpretation: available evidence suggests that acute RF-EMF below regulatory limits does not cause symptoms and corresponding claims in the everyday life are related to perceived and not to real EMF exposure status.

Current understanding of nociplastic pain.

Nociplastic pain by the "International Association for the Study of Pain" is defined as pain that arises from altered nociception despite no clear evidence of nociceptive or neuropathic pain. Augmented central nervous system pain and sensory processing with altered pain modulation are suggested to be the mechanism of nociplastic pain. Clinical criteria for possible nociplastic pain affecting somatic structures include chronic regional pain and evoked pain hypersensitivity including allodynia with after-sensation. In addition to possible nociplastic pain, clinical criteria for probable nociplastic pain are pain hypersensitivity in the region of pain to non-noxious stimuli and presence of comorbidity such as generalized symptoms with sleep disturbance, fatigue, or cognitive problems with hypersensitivity of special senses. Criteria for definitive nociplastic pain is not determined yet. Eight specific disorders related to central sensitization are suggested to be restless leg syndrome, chronic fatigue syndrome, fibromyalgia, temporomandibular disorder, migraine or tension headache, irritable bowel syndrome, multiple chemical sensitivities, and whiplash injury; non-specific emotional disorders related to central sensitization include anxiety or panic attack and depression. These central sensitization pain syndromes are overlapped to previous functional pain syndromes which are unlike organic pain syndromes and have emotional components. Therefore, nociplastic pain can be understood as chronic altered nociception related to central sensitization including both sensory components with nociceptive and/or neuropathic pain and emotional components. Nociplastic pain may be developed to explain unexplained chronic pain beyond tissue damage or pathology regardless of its origin from nociceptive, neuropathic, emotional, or mixed pain components.

Metagenomic gut microbiome analysis of Japanese patients with multiple chemical sensitivity/idiopathic environmental intolerance

BackgroundAlthough the pathology of multiple chemical sensitivity (MCS) is unknown, the central nervous system is reportedly involved. The gut microbiota is important in modifying central nervous system diseases. However, the relationship between the gut microbiota and MCS remains unclear. This study aimed to identify gut microbiota variations associated with MCS using shotgun metagenomic sequencing of fecal samples.MethodsWe prospectively recruited 30 consecutive Japanese female patients with MCS and analyzed their gut microbiomes using shotgun metagenomic sequencing. The data were compared with metagenomic data obtained from 24 age- and sex-matched Japanese healthy controls (HC).ResultsWe observed no significant difference in alpha and beta diversity of the gut microbiota between the MCS patients and HC. Focusing on the important changes in the literatures, at the genus level, Streptococcus, Veillonella, and Akkermansia were significantly more abundant in MCS patients than in HC (p < 0.01, p < 0.01, p = 0.01, respectively, fold change = 4.03, 1.53, 2.86, respectively). At the species level, Akkermansia muciniphila was significantly more abundant (p = 0.02, fold change = 3.3) and Faecalibacterium prausnitzii significantly less abundant in MCS patients than in HC (p = 0.03, fold change = 0.53). Functional analysis revealed that xylene and dioxin degradation pathways were significantly enriched (p < 0.01, p = 0.01, respectively, fold change = 1.54, 1.46, respectively), whereas pathways involved in amino acid metabolism and synthesis were significantly depleted in MCS (p < 0.01, fold change = 0.96). Pathways related to antimicrobial resistance, including the two-component system and cationic antimicrobial peptide resistance, were also significantly enriched in MCS (p < 0.01, p < 0.01, respectively, fold change = 1.1, 1.2, respectively).ConclusionsThe gut microbiota of patients with MCS shows dysbiosis and alterations in bacterial functions related to exogenous chemicals and amino acid metabolism and synthesis. These findings may contribute to the further development of treatment for MCS.Trial registrationThis study was registered with the University Hospital Medical Information Clinical Trials Registry as UMIN000031031. The date of first trial registration: 28/01/2018.

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.

Do somatic symptom distress and attribution predict symptoms associated with environmental factors?

ObjectiveNot much is known on the development of symptoms associated with environmental factors (SAEF), also known as (idiopathic) environmental intolerances. Findings from qualitative studies suggest that appearance of symptoms might be the first step, followed by the acquisition of a specific attribution. The current study investigated cross-sectional and longitudinal (three years) associations between attribution and symptoms with respect to symptoms associated with chemical substances, certain indoor environments (buildings), sounds, and electromagnetic fields (EMFs). MethodsWe used data from the first two waves of the population-based Västerbotten Environmental Health Study (n = 2336). Participants completed the Patient Health Questionnaire Somatic Symptom Scale (PHQ-15), the Environmental Symptom-Attribution Scale, and answered single questions on the four aforementioned SAEFs. ResultsUsing binary logistic regression analyses, all four SAEFs showed significant cross-sectional associations with somatic symptom distress and the respective attribution. In the longitudinal analysis, development of SAEF-Sound and SAEF-Chemicals were predicted by both somatic symptom distress and attribution. SAEF-EMFs was predicted only by attribution, whereas neither somatic symptom distress nor attribution forecasted SAEF-Buildings. ConclusionOverall, these findings suggest that attribution (i.e., a specific expectation) plays a substantial role in the development and maintenance of many SAEFs.

Efficacy of aquatic vs land-based therapy for pain management in women with fibromyalgia: a randomised controlled trial

ObjectiveTo determine the efficacy of two physiotherapeutic interventions – aquatic therapy (AT) and land-based therapy (LBT) – for reducing pain in women with fibromyalgia. DesignSingle-blind, randomised controlled, equivalence trial. SettingFibromyalgia, Chronic Fatigue Syndrome and Multiple Chemical Sensitivity Association in A Coruña, Spain. ParticipantsForty women with fibromyalgia were assigned at random in a 1:1 manner to two groups: AT (n = 20) and LBT (n = 20). InterventionsTwo therapeutic exercise programmes, with 60-min sessions, were undertaken three times per week for 12 weeks. Sessions were carried out in groups by a trained physiotherapist. OutcomeThe primary outcome was pain intensity (visual analogue scale). The secondary outcomes were pressure pain threshold (algometer), quality of life (Revised Fibromyalgia Impact Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), fatigue (Multidimensional Fatigue Inventory) and physical ability (6-Minute Walk Test). Patients were evaluated at baseline, 12 weeks (post-treatment) and 18 weeks (follow-up). The statistical analysis was per-protocol. P < 0.05 was considered to indicate significance. Effect size was calculated. ResultsThe mean age was 50 [standard deviation (SD) 9] years, with median body mass index of 27 [interquartile range (IQR) 25–30] kg/m2 and median symptom duration of 11 (IQR 6–15) years. No differences were observed between the groups post-treatment, but differences in favour of AT were found in pain intensity [2.7 (IQR 1.5-4.9) vs 5.5 (IQR 3.3-7.6); p= 0.023; large effect, Cohen's d= 0.8; 95% confidence interval (CI) 0.1-1.5] and sleep quality [12.0 (IQR 7.3-15.3) vs 15.0 (IQR 13.0-17.0); p= 0.030; large effect, Cohen's d= 0.8; 95% CI 0.1-1.5] at follow-up. ConclusionsThe results suggest that AT is better than LBT for reducing pain intensity and improving sleep quality after 6 weeks of follow-up. AT may be a good treatment option for women with fibromyalgia. Clinical Trials Registration NumberClinicalTrials.gov NCT02695875 Contribution of the paper•This paper provides evidence that aquatic therapy is an effective intervention for reducing pain and improving sleep quality of women with fibromyalgia.•The matched protocols designed for this study highlighted the influence of the environment on symptom management in women with fibromyalgia.

Molecular biomarkers in Electrohypersensitivity and Multiple Chemical Sensitivity: How They Can Help Diagnosis, Follow-Up, and in Etiopathologic Understanding.

Electrohypersensitivty (EHS) and multiple chemical sensitivity (MCS) are new worldwide emerging neurologic disorders in the framework of sensitivity-related environmental pathology. We have recently extended and confirmed our previous observation showing that EHS and MCS share clinically identical symptoms and may co-exist as a unique, common, sensitivity-related neurologic syndrome in 25% of the cases. There is presently no published biological study of these disorders, except the one we have previously published as preliminary. In the present study, we show that EHS and MCS and the combined syndrome share identical biochemical changes. More precisely, by measuring levels of peripheral blood and urine molecular biomarkers in a cohort of 2,018 consecutive cases, we show that both disorders and the combined syndrome can be objectively characterized, in about 90% of the cases, by a decrease in the production of 6-hydroxymelatonin sulfate in urine, while in 30-50% they are characterized by increased levels of histamine and of heat shock proteins (HSP) 27 and/or 70, and of protein S100B and nitrotyrosine in the peripheral blood. Increased levels of histamine and HSP are indicators of low grade inflammation while increased levels of protein S100B and nitrotyrosine are indicators of blood-brain barrier disruption/opening. In addition, we show that in about 15% of the cases anti-myelin autoantibodies can be detected in the peripheral blood, accounting for the occurrence of an autoimmune response. Sensitivity, specificity and reproducibility of the biochemical tests are discussed, as well as the role of these indicators used as biomarkers for the diagnosis and follow-up of patients. We also discuss cases with undetectable biological change for which they can be nevertheless diagnosed by cerebral neurotransmitters analysis in urine and brain imaging. On the basis of these biological data it is suggested that EHS and/or MCS are new brain disorders, generated via a common etiopathogenic mechanism.

Multiple Chemical Sensitivity: Catching up to what kind of science?

Multiple Chemical Sensitivity: Catching up to what kind of science?

Sensibilidad química múltiple en una niña de 8 años. Seguimiento durante 6 años

Multiple chemical sensitivity (MCS) is a controversial little understood entity. MCS is a multisystem and poly-symptomatic syndrome. MCS subjects display a complex symptomatology due to the intolerance of chemical agents. Symptoms include general discomfort, cardiovascular instability, sensory organs irritation, breath disorders, hypersensitivity affecting the skin and epithelial lining of the gut, throat and lungs. We report the case of an 8 years old female, assessed in medical consultation for chemical sensitization when presenting inhalation and pharyngeal symptoms, conjunctivitis, dysphonia, coughing spells and respiratory distress. A 6-year follow-up was carried out and the provocation inhaler test which was performed twice among that period obtained the same conclusive results for the diagnosis of MCS. The case submitted meets the criterion of MCS, being exceptional a debut of the symptons at such an early age.

Combined Neurological Syndrome in Electrohypersensitivity and Multiple Chemical Sensitivity: A Clinical Study of 2018 Cases

From a cohort of 2018 evaluable consecutive cases issued from the European Clinical Trial Database, we describe the complete clinical symptomatic presentation of electrohypersensitivity (EHS) and multiple chemical sensitivity (MCS) and their association in the framework of a unique, sensitivity-related environmental neurologic syndrome. Eligibility criteria are those of the Atlanta consensus meeting for MCS, and those of WHO for EHS. There were 1428 EHS, 85 MCS and 505 EHS/MCS evaluable cases, so EHS was associated with MCS in 25%. Women appeared to be much more susceptible to EHS and/or to MCS than men, with no statistical significance between the EHS and MCS groups (p = 0.07), but the combined group revealed a more significant female sex ratio of 80.4% (p &lt; 0.0001). All symptoms except emotional behavior were significantly more frequent in EHS patients than in healthy controls (p &lt; 0.0001). We found no pathognomonic symptoms to establish the diagnosis of both disorders or to distinguish EHS from MCS. The three groups of patients were found to share identical symptoms, while several symptoms were found to be more significantly frequent in EHS/MCS than in EHS (p &lt; 0.0001). From these data, we suggest that EHS and MCS are new brain disorders, generated via a common etiopathogenic mechanism.

Functional Somatic Syndromes Are Associated With Varied Postoperative Outcomes and Increased Opioid Use After Spine Surgery: A Systematic Review.

Systematic Review. To perform a systematic review assessing the relationship between functional somatic syndromes (FSSs) and clinical outcomes after spine surgery. A systematic review of online databases (PubMed and Web of Science) through December 2021 was conducted via PRISMA guidelines to identify all studies investigating the impact of at least one FSS (fibromyalgia, irritable bowel syndrome (IBS), chronic headaches/migraines, interstitial cystitis, chronic fatigue syndrome, multiple chemical sensitivity) on outcomes after spine surgery. Outcomes of interest included patient reported outcome measures (PROMs), postoperative opioid use, cost of care, complications, and readmission rates. A total of 207 records were identified. Seven studies (n = 40,011 patients) met inclusion criteria with a mean MINORS score of 16.6 out of 24. Four studies (n = 21,086) reported postoperative opioid use; fibromyalgia was a strong risk factor for long-term opioid use after surgery whereas the association with chronic migraines remains unclear. Two studies (n = 233) reported postoperative patient reported outcome measures (PROMs) with mixed results suggesting a possible association between fibromyalgia and less favorable PROMs. One study (n = 18,692) reported higher postoperative complications in patients with fibromyalgia. Patients with fibromyalgia and possibly migraines are at higher risk for prolonged postoperative opioid use and less favorable PROMs after spine surgery. There is limited research on the relationship between other Functional somatic syndromes (FSSs) and outcomes following spine surgery. Growing evidence suggests the variation in outcomes after spine procedures may be attributed to non-identifiable organic patient factors such as FSSs.

Are Sexual Assaults Related to Functional Somatic Disorders? A Cross-Sectional Study.

An increasing number of sexual assaults (SAs) are being reported. This study investigated associations between SA and FSD, conceptualized as bodily distress syndrome (BDS), and five functional somatic syndromes (FSSs): chronic widespread pain (CWP), irritable bowel (IB), chronic fatigue (CF), multiple chemical sensitivity (MCS), and whiplash-associated disorder (WAD). Participants (n = 7493) from the population-based cohort Danish Study of Functional Disorders (DanFunD) completed questionnaires on FSD, emotional distress, SA, and sociodemographics. Risk ratios (RRs) for each FSD and emotional distress were calculated in nine models with SA as the primary exposure using generalized linear models with binomial family and log link and were adjusted for other potential risk factors. The results showed that SA was associated with single-organ FSD (RR = 1.51; 95% CI = 1.22-1.87), multi-organ FSD (RR = 3.51; 95% CI = 1.89-6.49), CWP (RR = 1.28; 95% CI = 0.83-1.98), IB (RR = 2.00; 95% CI = 1.30-3.07), CF (RR = 1.81; 95% CI = 1.42-2.32), WAD (RR = 2.62; 95% CI = 1.37-5.03), MCS (RR = 3.04; 95% CI = 1.79-5.17), emotional distress (RR = 1.75; 95% CI = 1.21-2.54), and health anxiety (RR = 1.65; 95% CI = 1.10-2.46). Overall, SA victims experienced significantly more somatic symptoms than individuals not exposed to SA. Adjusting for physical and emotional abuse did not change the observed associations. Our results suggest a large impact of SA on the overall somatic and mental health of SA victims. Due to the cross-sectional study design, further studies are required.

National representative prevalence survey on idiopathic environmental intolerance attributed to electromagnetic fields in Taiwan

National representative prevalence survey on idiopathic environmental intolerance attributed to electromagnetic fields in Taiwan

Prospective study on health status of patients with idiopathic environmental intolerance attributed to electromagnetic fields after a provocation test

Prospective study on health status of patients with idiopathic environmental intolerance attributed to electromagnetic fields after a provocation test

Multiple Chemical Sensitivity/Idiopathic Environmental Intolerance: A Practical Approach to Diagnosis and Management

Patients with multiple chemical sensitivity, now called idiopathic environmental intolerance, frequently present to clinical immunologists and allergists for diagnosis and treatment. Patients report a plethora of respiratory and multisystem problems attributed to a wide variety of unrelated, otherwise non-noxious, triggers. They may go to extreme, often seemingly bizarre lengths to avoid contact with everyday exposures and may become housebound, unable to work or function socially. Often beginning with exposure to odors, triggers can multiply to involve foods, clothing, medications, and even electromagnetic radiation. The condition cannot be explained by IgE-mediated or other immune processes, and clinical immunologists and allergists may feel unprepared to care for such patients. In this article, a paradigm to understand the probable mechanisms underlying this condition and a practical approach to diagnosis and management will be presented.

Multiple chemical sensitivity scoping review protocol: overview of research and MCS construct

IntroductionMultiple chemical sensitivity (MCS) has been characterised by reported adverse responses to environmental exposures of common chemical agents (eg, perfumes, paint, cleaning products and other inhaled or ingested agents) in...

Sick building syndrome and its impacts on health, well-being and productivity: A systematic literature review

People’s well-being, health and productivity in indoor environments are crucial areas of investigation, particularly concerning sick building syndrome (SBS). Sick building syndrome encompasses symptoms resulting from exposure to harmful factors associated with building use. Headaches, fatigue, malaise and nausea are amongst the complaints associated with SBS. A literature review was conducted, examining studies from Scopus and Web of Science to identify the major impacts of SBS on health, well-being and productivity. Out of 3601 initially identified articles, 134 were analyzed after applying predefined criteria. Three research questions (RQs) were formulated, leading to the following findings: (i) most studies focused on offices (35.48%), highlighting common respiratory symptoms that range from mild to severe based on individual sensitivity, indoor conditions and predictive factors; (ii) indoor air quality (IAQ) emerged as the primary factor influencing SBS, especially within the post-pandemic context. Increasing air circulation and ventilation are viable alternatives to enhance IAQ. (iii) Understanding SBS proves complex, with indications of potentially higher symptom frequencies in women due to historical factors, social roles, lower cold tolerance, limited understanding of female physiology and multiple chemical sensitivity.

Prevalence and correlation of multiple chemical sensitivity and electromagnetic hypersensitivity with age, sex, and depression in the Japanese population: a retrospective study

BackgroundIn Japan, there are currently no definitive conclusions regarding the characteristics of multiple chemical sensitivity (MCS) and electromagnetic hypersensitivity (EHS). This study aimed to determine the prevalence and correlation of MCS and EHS with age, sex, and depression in the Japanese population.MethodsAn anonymous self-report questionnaire was distributed to 2,007 participants. Variables such as MCS, EHS, depression score, and demographic characteristics were individually evaluated using the U-test, chi-squared test, and correlation analyses. Moreover, we performed a covariance structure analysis to build a structural equation model.ResultsOlder individuals and women were more likely to exhibit MCS and EHS symptoms. Moreover, depression was correlated with MCS and EHS.ConclusionsAlthough MCS and EHS are strongly correlated, they exhibit distinct characteristics and symptoms, indicating that they can be regarded as separate conditions.

Factors affecting multiple chemical sensitivity (MCS) in newly constructed apartments of Indonesia

In Indonesia, sick building syndrome (SBS) and related health problems possibly caused by chemicals are suspected among residents in newly constructed urban houses, in which modern building materials are used without sufficient material standards and the minimum ventilation rates. This paper analyzes the causal relationships of factors affecting multiple chemical sensitivity (MCS) in urban houses in Indonesia. The measured IAQ data from three major cities of Indonesia (n = 207) were calibrated, and a structural equation modeling (SEM) was performed to identify the factors affecting MCS from a questionnaire survey in apartments and Kampong (n = 896). The results showed that the respondents living in a higher concentration of either formaldehyde or TVOC tended to have higher MCS risk, especially in the apartments. Overall, the apartments exhibited poor air quality rates, with the average maximum values of 0.172 ppm formaldehyde and 1.64 mg/m3 TVOC, potentially resulting in allergic problems and MCS risk among residents. In Kampongs, the building age was observed to increase the dampness, thereafter possibly causing allergies and MCS among residents. The results of this study implied that higher MCS in the apartments was majorly affected not only by their allergic conditions but also by additional factors concerning building attributes and occupant behavior.