Sandra K. McDonald Colorado State University Multiple Chemical Sensitivity An increased sensitivity to chemicals in the environment attributed to prior chemical exposure Multiple Chemical Senstivity
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Transcript Sandra K. McDonald Colorado State University Multiple Chemical Sensitivity An increased sensitivity to chemicals in the environment attributed to prior chemical exposure Multiple Chemical Senstivity
Sandra K. McDonald
Colorado State University
Multiple Chemical Sensitivity
An increased sensitivity to chemicals in the
environment attributed to prior chemical
exposure
Multiple Chemical Senstivity
Other names:
Environmental illness (EI)
Ecological illness
Total allergy syndrome
The 20th century disease (Hileman, 1991)
Idiopathic environmental intolerances (IPCS, 1996)
Multiple Chemical Sensitivity
Term most commonly applied to a condition
that challenges patients, health-care providers
& health & environmental agencies alike
Multiple Chemical Sensitivity
In broad terms it means an unusually severe sensitivity or
allergy-like reaction to many different kinds of pollutants
including :
Solvents
VOC's (Volatile Organic Compounds)
Perfumes
fuels
Smoke
"chemicals" in general
MCS – Do We Understand?
The idiopathic or "not understood" nature of MCS means
that doctors & others are often highly skeptical about the
reality of – and nature of - the MCS condition
Many features of MCS and it’s effects and the way it’s
effects are described by the sufferer seem altogether
unrealistic, impossible or implausible to a conventional &
scientifically trained consultant or General Practitioner
MCS First Report
Theron Randolph, 1952
Physician trained in allergy & immunology
Reported a number of patients reacted
adversely to chemicals in their environment
MCS First Report
Linked the adverse effects of this
"petrochemical problem" to contact with
chemicals found in commonly encountered
substances
i.e., cosmetics, auto fuels, exhaust fumes &
food additives
MCS First Report
Observed that many patients reacted to
many industrial solvents found in small
amounts in manufactured products such
as construction materials, newspaper &
other ink-related products, furniture &
carpet
American Academy of
Environmental Medicine
Randolph, 1965, founded Society for Human
Ecology
In response to this lack of acceptance
within his specialty
1985, name changed to the American
Academy of Environmental Medicine
Environmental physicians
MCS Definitions
Cullen’s (1987) definitions is widely used – four elements:
syndrome is acquired after a documentable
environmental exposure that may have caused objective
evidence of health effects;
2. symptoms are referable to multiple organ systems and
vary predictably in response to environmental stimuli;
3. symptoms occur in relation to measurable levels of
chemicals, but the levels are below those known to harm
health; and
4. no objective evidence of organ damage can be found.
1.
MCS Definitions
Cullen’s definition has the practical advantage
of describing a syndrome without specifying
individual symptoms or mechanisms of disease
Multiple Chemical Sensitivity
Wide variety of symptoms have been
reported
(Terr, 1986; Lax & Henneberger, 1995)
Symptoms of MCS
Extreme fatigue
Headache
Gastrointestinal problems
Muscle & joint pain
Depression
Memory & concentration difficulties
Anxiety
Upper airway irritation
Multiple Chemical Sensitivity
Patients have associated their
symptoms with many substances
(Ziem, 1992; Lax & Henneberger, 1995)
Exposures linked to MCS
Carpet & upholstery
materials
Construction materials
Deodorizers
Disinfectants
Fabrics
Newspapers
Paint
Perfumed ‘personal’
products
Pesticides
Petroleum products
Plastics
Wood preservatives
Multiple Chemical Sensitivity
Persons reported as suffering from MCS
present with outcomes that range from minor
discomfort to severe disability
Americans with Disability Act
In 1991, multiple chemical sensitivity was defined as a
disability under the act
Resulted in the demand for accommodation at work, at
school and in housing for those with a diagnosis of MCS
In some states, MCS is recognized under workers'
compensation laws as a disability resulting in free health
care for persons with symptoms related to the
phenomenon, as well as payment for lost wages
Because a major treatment recommendation is avoidance
of chemical exposure, the worker may never return to
active employment
OSHA’s View on MCS
www.osha.gov/SLTC/multiplechemicalsensitivities/index.
html
MCS is a highly controversial issue
In theory, MCS is an adverse physical reaction to low
levels of many common chemicals
Chemical sensitivity is generally accepted as a reaction to
chemicals but debate continues as to whether MCS is
classifiable as an illness
Proposed Mechanisms
Theories of the etiology of MCS can be
grouped into four broad categories:
Physical
Stress
Misdiagnosis
Illness belief
Sparks 1994
Physical
Three basic physical mechanisms have
been proposed to explain MCS:
Allergy
Direct toxic effects
Neurobiologic sensitization
Simon 1993
Allergy
Chemical ecology movement believes chemical
exposure causes the development of allergy to
low levels of many chemicals, not just the
initiating one
Supporters point to a spectrum of immune
system tests that have been found to be
abnormal in patients with MCS
Multiple Chemical Sensitivity
Patients react to extremely tiny amounts
of chemicals
Only mechanism which is now known to
cause reaction to tiny amounts is
antibody formation (i.e., allergy)
Some MCS patients react to chemicals
which do not induce formation of
antibodies
Multiple Chemical Sensitivity
True allergies - where the underlying mechanisms of the
problem are relatively well understood widely accepted
MCS , is generally regarded as "idiopathic" - meaning that it
has no known mechanism of causation & it's processes are not
fully understood
The problem here is made more difficult still, due to the
variable nature of Multiple Chemical Sensitivity from one
patient to the next & this often makes treatment with
conventional medicine & practices ineffective or
inappropriate; for most sufferers with Multiple Chemical
Sensitivity, the avoidance of pollutants/toxicants is the key.
True Allergy
An acquired reaction caused by
an immune system response to
one SPECIFIC excitant that has
already been encountered at least
once before
Miniscule Dose of a Toxicant
Sensitization is a true allergic reaction to one chemical or
irritant and is caused by involvement within the body of
mast cells and IgE antibodies
Once sensitized to a particular irritant, a subsequent
exposure to even a tiny amount of the same irritant
even parts per million – ppm – or parts per billion – ppb can
cause an extreme allergic reaction
one ppm = 0.0001 %
Toxicological Effects
Others propose a toxicological effect of low-
dose exposure -- poisoning
Objective evidence for such an effect is lacking
Patients with MCS experience symptoms at
levels of chemical exposure far lower than
those considered toxic
Multiple Chemical Sensitivity
Miller et al. (1997)
Theory of "toxicant-induced loss of tolerance" (TILT)
Acute or chronic chemical exposures might cause
certain susceptible persons to lose their tolerance
for previously tolerated chemicals, drugs & foods
Subsequently, even minute quantities of these &
other substances may trigger symptoms
Neurobiological Sensitization
Affected persons develop increasing neurologic
sensitivity to the adverse effects of chemicals
Animal models for such neurologic changes include
limbic kindling and time-dependent neurologic
sensitization
These events have been documented only with
pharmacologic doses and only in animals, not in
humans and not at the low doses purported to cause
MCS
Sensitivity
This sensitivity, in the case of MCS, to unrelated toxicants
does, however, have several unproven, but seemingly
sound theories to explain it including:
Enzyme depletion
Conditioning
Immune system disorders
Enzyme Depletion
Enzymes are also used to detoxify a wide range of
synthetic chemicals
If the enzymes are depleted or damaged by health
problems, then they are unable to metabolize these
toxicants efficiently, so leading to the problems
associated with MCS
Many types of enzyme deficiency can be inherited
Some (fairly tentative) evidence to suppose that MCS
may affect other members of the same family
Conditioning
Two unrelated events occur at the same time and one event
becomes associated with the other
When the first event is later repeated, the second event also
manifests itself for the sufferer
For example, if on a particular day the patient is already feeling
slightly unwell and if, coincidentally, the patient is exposed to
(say) paint fumes, then the paint fumes may genuinely make the
patient feel unwell and possibly nauseous
A subsequent exposure to the same paint fumes - or a similarly
strong solvent odor - may produce a strong feeling of nausea for
the patient, who, moments before, felt perfectly well
Immune System Damage
Some researchers are of the opinion that MCS is due to
immune system damage or malfunction, which could give
rise to a sensitivity to all sorts of triggers rather than a
specific reaction to one toxicant
Another important and debilitating feature of MCS - and
which tends to complicate MCS diagnosis & treatment
still further - is it's ability to apparently augment the
effects of other problems experienced by the patient problems such as common allergies, asthma, depression,
food intolerances etc, & these problems of augmentation
are reported by about half of all MCS sufferers
Sensitively Scepticism
Main aspect of MCS sensitivity that is NOT fully
understood is that the MSC sufferer reacts similarly and in
an allergic fashion to a whole range of completely
unrelated toxicants
"chemicals“
Solvents
Perfumes
VOCs
Odors
etc.
MCS Triggers
Can change over time
A person who was not reactive to a
particular substance may or may not react
when exposed to the same substance at a
later time
Vary between people
Not all people react to all triggers
MCS Epidemiology
Most patients (85 -90 %) complaining of MCS syndrome
are women
Most present between the ages of 30 and 50 years
The question of whether MCS is becoming more or less
common is unanswered
As is the question of whether it is preventable
Avoidance of “Triggers”
Patients often significantly alter their behavior in an
attempt to avoid presumed precipitants of symptoms
97 % of the patients had stopped activities outside the
home
91 % had limited their travel
89 % had limited their contact with friends
77 % had left a job
Lax 1995
Avoidance of “Triggers”
Many changed home routines:
97 % had stopped using cleaning compounds
69 % removed home furnishings
63 % limited their contact with family members
In their personal care:
94 % stopped using fragrances
91 % changed their diet
86 % changed the type of clothing they wore
Lax 1995
MCS Debate
Validity of MCS as a distinct disease entity
What role, if any, the biochemical
mechanisms of specific chemicals have in
the onset of this condition
Multiple Chemical Sensitivity
No diagnostic criteria for it
No set of signs and symptoms which are
always found in persons who believe they
are chemically sensitive
No objective blood or other laboratory
test for MCS
Who gets MCS?
5% of U.S. population has severe MCS
Greatly reduced quality of life
15-30% have less severe problems
Women four times as likely to be affected
as men
Average age of onset is during 40’s
Coping with MCS
No cure at present
Treatment – avoid exposure
Isolation
General lack of acknowledgment of MCS
within medical community
MCS & Society
Multiple chemical sensitivity is not simply
a medical concern of diagnosis and
treatment, but it is becoming a major
social and economic issue with a strong
activist agenda
Chemical Sensitivity: The Truth About
Environmental Illness (Barrett and Gots
1998)
MCS & Society
Advocates of multiple chemical sensitivity have successfully
sought sympathy and support by attacking the chemical
industry and others as the source of their plight
Numerous activist organizations publish newsletters and
maintain Web sites that identify physicians and lawyers who
support the chemical causality of their illnesses
A newsletter reports legislative, public policy and court
decisions that support multiple chemical sensitivity as a
legitimate disease or disability -- Our toxic times. Chemical
Injury Information Network, White Sulphur Springs, Montana
Debated Topics
Whether MCS is a distinct disease entity
Its etiology (or etiologies)
Its pathophysiology
How to define the condition
How it should be treated
How it should be approached in legal &
legislative arenas
Questions?