Sandra K. McDonald Colorado State University. Multiple Chemical Sensitivity An increased sensitivity...
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Sandra K. McDonaldColorado State University
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Multiple Chemical SensitivityAn increased sensitivity to chemicals in the
environment attributed to prior chemical exposure
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Multiple Chemical SenstivityOther names:
Environmental illness (EI)Ecological illnessTotal allergy syndromeThe 20th century disease (Hileman, 1991)Idiopathic environmental intolerances (IPCS, 1996)
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Multiple Chemical SensitivityTerm most commonly applied to a condition
that challenges patients, health-care providers & health & environmental agencies alike
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Multiple Chemical SensitivityIn broad terms it means an unusually severe sensitivity or
allergy-like reaction to many different kinds of pollutants including :SolventsVOC's (Volatile Organic Compounds)PerfumesfuelsSmoke"chemicals" in general
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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
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MCS First ReportTheron Randolph, 1952
Physician trained in allergy & immunologyReported a number of patients reacted
adversely to chemicals in their environment
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MCS First ReportLinked 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
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MCS First ReportObserved 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
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American Academy of Environmental MedicineRandolph, 1965, founded Society for Human
EcologyIn response to this lack of acceptance
within his specialty1985, name changed to the American
Academy of Environmental Medicine Environmental physicians
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MCS DefinitionsCullen’s (1987) definitions is widely used – four elements:
1. 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.
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MCS DefinitionsCullen’s definition has the practical advantage
of describing a syndrome without specifying individual symptoms or mechanisms of disease
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Multiple Chemical Sensitivity
Wide variety of symptoms have been reported(Terr, 1986; Lax & Henneberger, 1995)
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Symptoms of MCSExtreme fatigueHeadacheGastrointestinal problemsMuscle & joint painDepressionMemory & concentration difficultiesAnxietyUpper airway irritation
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Multiple Chemical Sensitivity
Patients have associated their symptoms with many substances(Ziem, 1992; Lax & Henneberger, 1995)
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Exposures linked to MCSCarpet & upholstery
materialsConstruction materialsDeodorizersDisinfectantsFabricsNewspapersPaint
Perfumed ‘personal’ products
PesticidesPetroleum productsPlasticsWood preservatives
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Multiple Chemical SensitivityPersons reported as suffering from MCS
present with outcomes that range from minor discomfort to severe disability
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Americans with Disability ActIn 1991, multiple chemical sensitivity was defined as a
disability under the actResulted in the demand for accommodation at work, at
school and in housing for those with a diagnosis of MCSIn 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
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OSHA’s View on MCSwww.osha.gov/SLTC/multiplechemicalsensitivities/index.
htmlMCS is a highly controversial issueIn theory, MCS is an adverse physical reaction to low
levels of many common chemicalsChemical sensitivity is generally accepted as a reaction to
chemicals but debate continues as to whether MCS is classifiable as an illness
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Proposed MechanismsTheories of the etiology of MCS can be
grouped into four broad categories: PhysicalStressMisdiagnosis Illness belief
Sparks 1994
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Physical Three basic physical mechanisms have
been proposed to explain MCS: AllergyDirect toxic effects Neurobiologic sensitization
Simon 1993
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AllergyChemical 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
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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
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Multiple Chemical Sensitivity True allergies - where the underlying mechanisms of the
problem are relatively well understood widely acceptedMCS , 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.
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True AllergyAn acquired reaction caused by
an immune system response to one SPECIFIC excitant that has already been encountered at least once before
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Miniscule Dose of a ToxicantSensitization 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 reactionone ppm = 0.0001 %
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Toxicological EffectsOthers propose a toxicological effect of low-
dose exposure -- poisoningObjective evidence for such an effect is
lackingPatients with MCS experience symptoms at
levels of chemical exposure far lower than those considered toxic
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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
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Neurobiological SensitizationAffected persons develop increasing neurologic
sensitivity to the adverse effects of chemicalsAnimal 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
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SensitivityThis 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
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Enzyme DepletionEnzymes are also used to detoxify a wide range of
synthetic chemicalsIf 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
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ConditioningTwo unrelated events occur at the same time and one event
becomes associated with the otherWhen the first event is later repeated, the second event also
manifests itself for the suffererFor 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
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Immune System DamageSome 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
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Sensitively ScepticismMain 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“SolventsPerfumesVOCsOdorsetc.
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MCS TriggersCan 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 peopleNot all people react to all triggers
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MCS Epidemiology
Most patients (85 -90 %) complaining of MCS syndrome are women
Most present between the ages of 30 and 50 yearsThe question of whether MCS is becoming more or less
common is unansweredAs is the question of whether it is preventable
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Avoidance of “Triggers”Patients often significantly alter their behavior in an
attempt to avoid presumed precipitants of symptoms97 % of the patients had stopped activities outside the
home91 % had limited their travel89 % had limited their contact with friends77 % had left a job
Lax 1995
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Avoidance of “Triggers”Many changed home routines:
97 % had stopped using cleaning compounds69 % removed home furnishings 63 % limited their contact with family members
In their personal care:94 % stopped using fragrances91 % changed their diet 86 % changed the type of clothing they wore
Lax 1995
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MCS DebateValidity of MCS as a distinct disease
entityWhat role, if any, the biochemical
mechanisms of specific chemicals have in the onset of this condition
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Multiple Chemical Sensitivity
No diagnostic criteria for itNo 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
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Who gets MCS?
5% of U.S. population has severe MCS Greatly reduced quality of life
15-30% have less severe problemsWomen four times as likely to be
affected as menAverage age of onset is during 40’s
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Coping with MCSNo cure at presentTreatment – avoid exposure IsolationGeneral lack of acknowledgment of MCS
within medical community
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MCS & SocietyMultiple 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)
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MCS & SocietyAdvocates 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
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Debated TopicsWhether MCS is a distinct disease
entityIts etiology (or etiologies)Its pathophysiologyHow to define the conditionHow it should be treatedHow it should be approached in legal &
legislative arenas
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Questions?