Idiopathic environmental intolerances (formerly multiple chemical sensitivity) psychiatric perspectives

Department of Toxicology, II. Medical Department, Technische Universität München, Germany.
Journal of Internal Medicine (Impact Factor: 6.06). 11/2001; 250(4):309-21. DOI: 10.1046/j.1365-2796.2001.00870.x
Source: PubMed


Idiopathic environmental intolerances (IEI)/multiple chemical sensitivity (MCS) is characterized by various somatic symptoms which cannot be explained organically, but are attributed to the influences of toxic environmental chemicals in low, usually harmless doses. In the absence of a widely accepted definition of IEI, contradictory aetiological hypotheses and therapeutic suggestions are discussed. Some authors doubt the existence of IEI/MCS as a disease entity of its own. The label IEI does not implicate neither a diagnosis of somatic disease nor that it is caused by an avoidable exposure. Many IEI patients suffer from psychiatric diseases. A majority of them can be diagnosed as somatoform disorders. Consequently, psychiatric therapies could be effective. This review describes the current knowledge about IEI/MCS, outlines a diagnostic algorithm and a psychotherapeutic concept for variants of IEI understood as a somatoform disorder.

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    • "However, there is no convincing evidence for a causal dose– response association and a broadly accepted case definition for patients is missing [15] [16] [17] [18] [19] [20] [21] [22]. Although not well-established, there is the notion that self-reported sensitivity to EMF sources, described by the WHO as idiopathic environmental intolerance attributed to EMF (IEI-EMF) [23] and other diverse environmental sensitivities, such as those to odorous chemicals, food additives and noise, may constitute dimensions of just one condition; a generalized environmental sensitivity which is usually referred to as idiopathic environmental intolerance (IEI) [24] [25] [26] [27]. This "
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    ABSTRACT: Little is known about the potential clinical relevance of non-specific physical symptoms (NSPS) reported by patients with self-reported environmental sensitivities. This study aimed to assess NSPS in people with general environmental sensitivity (GES) and idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) and to determine differences in functional status and illness behavior. An epidemiological study was conducted in the Netherlands, combining self-administered questionnaires with the electronic medical records of the respondents as registered by general practitioners. Analyses included n=5789 registered adult (≥18years) patients, comprising 5073 non-sensitive (NS) individuals, 514 in the GES group and 202 in the IEI-EMF group. Participants with GES were about twice as likely to consult alternative therapy compared to non-sensitive individuals; those with IEI-EMF were more than three times as likely. Moreover, there was a higher prevalence of symptoms and medication prescriptions and longer symptom duration among people with sensitivities. Increasing number and duration of self-reported NSPS were associated with functional impairment, illness behavior, negative symptom perceptions and prevalence of GP-registered NSPS in the examined groups. Even after adjustment for medical and psychiatric morbidity, environmentally sensitive individuals experience poorer health, increased illness behavior and more severe NSPS. The number and duration of self-reported NSPS are important components of symptom severity and are associated with characteristics similar to those of NSPS in primary care. The substantial overlap between the sensitive groups strengthens the notion that different types of sensitivities might be part of one, broader environmental illness.
    Journal of psychosomatic research 05/2014; 76(5):405-13. DOI:10.1016/j.jpsychores.2014.02.008 · 2.74 Impact Factor
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    • "Therefore, different environment-associated multi-organ conditions, in most cases still lacking a consensus on clinical case definition, such as multiple chemical sensitivity (MCS), fibromyalgia (FM), chronic fatigue syndrome (CFS), sick building syndrome (SBS), hypersensitivity to electro-magnetic fields (EHS), and others, in most cases still lacking a consensus on clinical case definition, have been subjected in the last decade to clinical and laboratory studies [3]. These are aimed at proving any possible organic cause, or oppositely the psychogenic etiology, as proposed by part of the clinicians on the basis of the prevalent neurologic impairment [3,4]. Main difficulties towards a clinical consensus on disease classification lie in: (i) the wide array of symptoms and signs allegedly linkable to environmental triggers exposure, (ii) the diversity of the subjects affected, reacting on the basis of individual sensitivity and possibly genetic predisposition, (iii) the mere absence of proven pathogenic mechanisms and consequently of clear-cut diagnostic criteria, (iv) the wide spectrum of possible triggers [2] and the absence of clear dose-dependent reactions, generating methodological difficulties and bias in provocation studies. "
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    ABSTRACT: Whilst facing a worldwide fast increase of food and environmental allergies, the medical community is also confronted with another inhomogeneous group of environment-associated disabling conditions, including multiple chemical sensitivity (MCS), fibromyalgia, chronic fatigue syndrome, electric hypersensitivity, amalgam disease and others. These share the features of poly-symptomatic multi-organ cutaneous and systemic manifestations, with postulated inherited/acquired impaired metabolism of chemical/physical/nutritional xenobiotics, triggering adverse reactions at exposure levels far below toxicologically-relevant values, often in the absence of clear-cut allergologic and/or immunologic involvement. Due to the lack of proven pathogenic mechanisms generating measurable disease biomarkers, these environmental hypersensitivities are generally ignored by sanitary and social systems, as psychogenic or "medically unexplained symptoms". The uncontrolled application of diagnostic and treatment protocols not corresponding to acceptable levels of validation, safety, and clinical efficacy, to a steadily increasing number of patients demanding assistance, occurs in many countries in the absence of evidence-based guidelines. Here we revise available information supporting the organic nature of these clinical conditions. Following intense research on gene polymorphisms of phase I/II detoxification enzyme genes, so far statistically inconclusive, epigenetic and metabolic factors are under investigation, in particular free radical/antioxidant homeostasis disturbances. The finding of relevant alterations of catalase, glutathione-transferase and peroxidase detoxifying activities significantly correlating with clinical manifestations of MCS, has recently registered some progress towards the identification of reliable biomarkers of disease onset, progression, and treatment outcomes.
    International Journal of Environmental Research and Public Health 07/2011; 8(7):2770-97. DOI:10.3390/ijerph8072770 · 2.06 Impact Factor
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    • "The question whether multiple chemical sensitivity (MCS) and other medically unexplained syndromes such as fibromyagia, chronic fatigue, Persian Gulf War, sick building syndrome, etc.–now also collectively labelled " idiopathic environmental intolerances " –are clinically defined entities has remained unanswered so far. This is due to the broad symptom constellation, the lack of clear-cut diagnostic criteria and dose-dependency of clinical symptoms upon exposure, and the poor knowledge about pathogenic mechanisms (Bolt and Kiesswetter, 2002; Bornschein et al., 2001; Kipen and Fiedler, 2002). As the number of subjects affected by MCS in developed countries has been growing steadily, reaching up to 15% "
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    ABSTRACT: Multiple chemical sensitivity (MCS) is a poorly clinically and biologically defined environment-associated syndrome. Although dysfunctions of phase I/phase II metabolizing enzymes and redox imbalance have been hypothesized, corresponding genetic and metabolic parameters in MCS have not been systematically examined. We sought for genetic, immunological, and metabolic markers in MCS. We genotyped patients with diagnosis of MCS, suspected MCS and Italian healthy controls for allelic variants of cytochrome P450 isoforms (CYP2C9, CYP2C19, CYP2D6, and CYP3A5), UDP-glucuronosyl transferase (UGT1A1), and glutathione S-transferases (GSTP1, GSTM1, and GSTT1). Erythrocyte membrane fatty acids, antioxidant (catalase, superoxide dismutase (SOD)) and glutathione metabolizing (GST, glutathione peroxidase (Gpx)) enzymes, whole blood chemiluminescence, total antioxidant capacity, levels of nitrites/nitrates, glutathione, HNE-protein adducts, and a wide spectrum of cytokines in the plasma were determined. Allele and genotype frequencies of CYPs, UGT, GSTM, GSTT, and GSTP were similar in the Italian MCS patients and in the control populations. The activities of erythrocyte catalase and GST were lower, whereas Gpx was higher than normal. Both reduced and oxidised glutathione were decreased, whereas nitrites/nitrates were increased in the MCS groups. The MCS fatty acid profile was shifted to saturated compartment and IFNgamma, IL-8, IL-10, MCP-1, PDGFbb, and VEGF were increased. Altered redox and cytokine patterns suggest inhibition of expression/activity of metabolizing and antioxidant enzymes in MCS. Metabolic parameters indicating accelerated lipid oxidation, increased nitric oxide production and glutathione depletion in combination with increased plasma inflammatory cytokines should be considered in biological definition and diagnosis of MCS.
    Toxicology and Applied Pharmacology 11/2010; 248(3):285-92. DOI:10.1016/j.taap.2010.04.017 · 3.71 Impact Factor
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