Article References: Multiple Sensitivities

MULTIPLE SENSITIVITIES

1.AUTHOR	Nethercott-J-R, Davidoff-L-L, Curbow-B, Abbey-H.
INSTITUTION	Department of Environmental Health Sciences, School of Hygine and Public Health, Johns Hopkins University, Baltimore, Maryland.
TITLE	Multiple chemical sensitivities syndrome: toward a working case definition.
SOURCE	Arch-Environ-Health 1993 Jan-Feb, VOL: 48 (1), P: 19-26, ISSN: 0003-9896.
Abstract	A study was conducted to identify clinical diagnostic criteria that experts regarded as major for categorizing patients as having multiple chemical sensitivities (MCS) syndrome. A cross-sectional survey of 148 medical practitioners with an interest in, or familiarity with, the condition was performed scoreable questionnaires were returned by 60.1% of those surveyed. The following five criteria, all based on self-reports, were selected as major for diagnosing the syndrome by more than 50% of the respondents: (1) symptoms are reproducible with exposure; (2) condition is chronic; (3) low levels of exposure result in manifestations of the syndrome; (4) symptoms resolve with removal of incitants; and (5) responses occur to multiple, chemically unrelated substances. It is proposed that the major criteria accepted by the majority of survey respondents be used provisionally as the basis for categorizing cases in investigations of MCS syndrome. Author.

2 .AUTHOR	Simon-G-E, Daniell-W, Stockbridge-H, Claypoole-K, Rosenstock-L.
INSTITUTION	Group Health Cooperative of Puget Sound, Seattle, Washington.
TITLE	Immunologic, psychological, and neuropsychological factors in multiple chemical sensitivity. A controlled study (see comments).
SOURCE	Ann-Intern-Med 1993 Jul 15, VOL: 119 (2), P: 97-103, ISSN: 0003-4819.
CM	Comment in: Ann-Intern-Med 1993 Jul 15; 119(2):163-4.
Abstract	OBJECTIVE: To examine the role of immunologic, psychological, and neuropsychological factors in multiple chemical sensitivity. DESIGN: Case-control comparison. SETTING: Community allergy practice (cases), university-based clinics for musculoskeletal injuries (controls). PARTICIPANTS: Forty-one patients with chemical sensitivity and 34 control patients with chronic musculoskeletal injuries. MAIN OUTCOME MEASURES: Immunologic measures included autoantibody titers, lymphocyte surface markers, and interleukin-1 generation by monocytes. Psychological evaluation included standardized measures of anxiety, depression, and somatization. RESULTS: Immunologic testing did not differentiate patients with chemical sensitivity from controls. The only difference noted (lower interleukin-1 generation among cases) appeared attributable to laboratory methods. Patients with chemical sensitivity reported greater prevalence of current anxiety or depressive disorder (44% versus 15%, P = 0.006). This difference, however, did not appear to precede the onset of chemical sensitivity, and 25% of chemically sensitive patients showed no significant current psychological disturbance. Cases reported significantly more "medically unexplained" physical symptoms before and after the onset of chemical sensitivity. When considering only symptoms that preceded chemical sensitivity, 25% of cases (and no controls) satisfied criteria for somatization disorder. Neuropsychological testing revealed no significant case-control differences. CONCLUSIONS: Immunologic testing failed to confirm findings from earlier uncontrolled studies, militating against proposed immunologic mechanisms. The decreased memory and concentration frequently described in multiple chemical sensitivity were not confirmed by brief neuropsychological testing. Psychological symptoms, although not necessarily etiologic, are a central component of chemical sensitivity. Author.

3 .AUTHOR	Davidoff-A-L, Fogarty-L.
INSTITUTION	Department of Environmental Health Sciences, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland.
TITLE	Psychogenic origins of multiple chemical sensitivities syndrome: a critical review of the research literature.
SOURCE	Arch-Environ-Health 1994 Sep-Oct, VOL: 49 (5), P: 316-25, ISSN: 0003-9896 52 Refs.
Abstract	The purpose of this review was to critically evaluate research on the psychogenic origins of multiple chemical sensitivities (MCS) syndrome. Using as keywords environmental illness, multiple chemical sensitivities, and clinical ecology, two databases--PsychLit and Medline--were searched by computer; reference lists of all articles located were also searched manually. Ten articles meeting three criteria were selected for review. Five sample selection problems, seven measurement problems, and three study design problems were common in all but one of the articles reviewed. Current studies investigating psychogenic hypotheses of MCS syndrome are methodologically problematic and their conclusions questionable. Studies of psychiatric profiles observed in MCS syndrome need to be designed to differentiate between competing psychogenic and biogenic hypotheses. Author.
4.AUTHOR	Amundsen-M-A, Hanson-N-P, Bruce-B-K, Lantz-T-D, Schwartz-M-S, Lukach- B-M.
INSTITUTION	Division of Preventive Medicine and Internal Medicine, Mayo Clinic Rochester, Minnesota 55903, USA.
TITLE	Odor aversion of multiple chemical sensitivities: recommendation for a name change and description of successful behavioral medicine treatment.
SOURCE	Regul-Toxicol-Pharmacol 1996 Aug, VOL: 24 (1 Pt 2), P: S116-8, ISSN: 0273-2300.
Abstract	Patients with odor-triggered symptoms, meeting the case definition of multiple chemical sensitivities (MCS), continue to be seen in our institution and other health science centers (Amundsen, Mayo Clinic Dept. Intern. Med. Newslett. 9(1) (1986)). The term MCS, unfortunately, feeds the thesis that symptoms are allergic-immune system in origin, a theory that has not withstood scientific scrutiny (American College of Physicians, Ann. Intern. Med. 111, 168-178 (1989); Terr, Ann. Intern. Med. 119, 163-164 (1993)). It has been proposed that some of these cases may be examples of classical (Pavlovian) conditioning: many MCS patients meet diagnostic criteria for psychiatric illnesses, especially mood, anxiety, and somatoform disorders. Attention is turning to the complex relationship between olfactory stimulation, memory, and mood (psyche) in an attempt to understand why some individuals develop odor aversion symptoms and how to best manage these, frequently, severely disabled patients. Two subjects with typical odor-triggered symptoms have been treated, using behavioral medicine techniques, with marked improvement in both cases. The term "odor aversion" is proposed rather than MCS to describe patients with these symptoms. Author.
5.AUTHOR	Binkley-K-E, Kutcher-S.
INSTITUTION	Saint Michael's Hospital, Department of Medicine, University of Toronto, Ontario, Canada.
TITLE	Panic response to sodium lactate infusion in patients with multiple chemical sensitivity syndrome (see comments).
SOURCE	J-Allergy-Clin-Immunol 1997 Apr, VOL: 99 (4), P: 570-4, ISSN: 0091-6749.
CM	Comment in: J-Allergy-Clin-Immunol 1997 Apr; 99(4 ):434-7.
Abstract	BACKGROUND: Many patients who are first seen with what has been called multiple chemical sensitivity syndrome (MCS) experience symptoms suggestive of panic disorder including chest tightness, shortness of breath, palpitations, paresthesias, light-headedness, and mental confusion. Although such patients are often convinced that these symptoms reflect toxic effects of environmental "chemicals, " direct evidence of this is lacking. To the contrary, a previous study has shown that some of these individuals exhibit hyperventilation responses on exposure to non-noxious stimuli, and it has been suggested that the resulting hypocarbia accounts for their symptoms. We postulated that some patients with self-identified MCS had an underlying condition similar to panic disorder and would therefore demonstrate similar responses to provocative challenges, such as sodium lactate infusion. METHODS: Patients referred to an allergy and clinical immunology service for evaluation of "chemical sensitivity" were investigated to rule out underlying medical conditions, including asthma, as a cause of their symptoms and were enrolled for study after giving informed consent. After a standardized psychiatric assessment was performed, patients underwent single-blind intravenous infusions of normal saline solution (placebo) and sodium lactate (which reproduces symptoms in individuals with underlying panic disorder). All patients were referred for independent psychiatric assessment. RESULTS: The standardized psychiatric assessment identified four of five patients as meeting DSM III-R diagnostic criteria for panic disorder along with other depressive and/or anxiety-related disorders. All five patients with self-identified chemical sensitivity exhibited a positive symptomatic response to sodium lactate compared with placebo infusion. Independent psychiatric assessment confirmed the diagnosis of panic disorder on the basis of DSM III-R criteria in each of the five patients. CONCLUSION: These results suggest that MCS may have a neurobiologic basis similar, if not identical, to that of panic disorder. We speculate that treatments with demonstrated efficacy in panic disorder may also be of benefit in MCS, and conversely, treatments that reinforce anticipatory anxiety and avoidance behavior in patients with MCS may be detrimental. Author.