Toxicity versus Hypersensitivity = knowing the difference can save lives

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Steve, you and I are not talking about the same things so we will not come to any agreement on this. Which is fortunate for me because I would be dead had I relied upon your interpretation of the science of indoor air quality when I had to select professionals to consult after becoming seriously ill on numerous occasions. Toxicity usually precedes hypersensitivity but goes unnoticed. If your concerns are legal, you may need to pass on certain jobs instead of telling people NOT to test because it may weaken their case to get negative findings OR if positive results will hurt if they intend to sell out. Acertaining the facts is what professionals do. Are you representing a property or the tenants? If it is an owner, then don't make statements about tenant health - just your test results. Tenants can test too. If you are testing for occupants, it is up to them to decide how far you will go. You aren't promising any smoking guns if nothing shows

up. We have to recognize when we are offering advice outside of our areas of certification. When I was a speech pathologist, I couldn't start doing voice therapy with a client until they had an ENT eval where the vocal cords were visualized and a prescription for treatment was made. The treatments varied widely for different problems of the larynx. On the other hand, I was licensed to decide if a a referral to certain medical specialists was required based upon various behaviors and not making the right referral at the right time could have led to a failure to diagnose cancers, choking, brain tumors etc. in a timely fashion. I learned these things slowly, over time and by seeing what was happening around me. I wish I had had internet access back then and groups of other therapists to acquire knowledge before it was needed...and perhaps not available. You have the qualifications to

assess certain things about environments but not to assure people complaining of symptoms that these symptoms are, or are not, caused by those environments unless you have toxicological and medical training. You have the right to refer your clients to appropriate specialists if they are worried about things beyond your ability to assess. I am alive because of my medical knowledge and because of West Nile Virus hitting NYC. I met toxicologists at that point who educated me. You speak to hypersentivity and I speak to toxicity. They are not equivalent althought someone who is hypersensitive to chemicals will become gravely ill and possibly die (or worse), if certain chemicals exist in their residences and/or offices to which they are susceptible. That will happen regardless of whether you consider the concentrations to be significant. It isn't up to your judgement, It is up to medical facts and the needs of every

person who is unwell in specific environments to find out what is present. But you don't have to be the one to look for them if you don't want to, as long as people know it is an option. Example I: I became ill after moving into an apartment. Already disabled by damage done to me from pesticides (a long story I won't go into here), I decided to find out if pesticides were responsible for my being so unwell there. I had serious symptoms that might progress to life threatening levels. On the other hand, I didn't want to leave a good residence unless I was sure it was the place and not some illness unrelated to the location. a. My physician (at my request) tested me for acetylcholinesterase inhibition. The levels were so low that the lab was required to report the results to the NYS health department as it constitutes evidence of poisoning. b. I

then tested my apartment for the kinds of pesticides which cause this biochemical depletion. A baseline taken for that same enzyme in prior years had shown high levels were present so something was wrong. The results of testing an air purifier filter showed concentrations of chlorpyrifos were in my apartment, circulating in my air space, likely from some outside source based on amounts found. c. I left that apartment and my symptoms abated (cardiac, respiratory, gastrointestinal with the potential to increase brain damage already suffered from prior insults). Within a few months, my AChE levels rose to levels still low but just within normal limits. Because of my fragility and the risks of continued exposure to AChE inhibiting chemicals, I left behind my belongings. This was not a sensitivity except to the extent measured by the rapidity with which I became ill over another person. My

ailments might have been given many separate diagnoses from specialists in each area - pulmonary, gastro, cardio etc. But they had one source and it was only my knowledge of my body and toxicology that allowed me to discover and mitigate the damage. Had I been given beta blockers for the heart rate problems or acid blockers for the gut or asthma meds increasing the amount of junk I took into my lungs, problems would have increased exponentially. How do you decide for your clients that they are hypersensitive and not suffering some form of toxicity? What expertise allows you to determine that levels of VOCs or pesticide panels might not reveal single items of acutely high amounts or numerous items within lower levels indicating chronic exposure, which correlates with their complaints? I filed a complaint with the EPA since that substance had been banned several years before and there was reason

to believe it might be in use in the next lot where a new house was being built. The EPA refused to investigate despite all these test results and did not dispute the facts at all. They merely said it might be resides from prior legal use of the chemcals and not of interest to them. So much for investigation of possible illegal use of a banned substance. No one ever even visited the site. Someone else moved in later I am sure. They may have begun with high or normal levels of AChE and no health problems. That was surely not going to be the case down the line. That chemical reduced AChE in everyone. If they have further exposures at work, failure to know they are also exposed at home might be the straw that breaks... How quickly it takes them to become ill depends upon their individual levels and other environments. Example II a. I move into an

apartment and it is good for me. Cold weather comes and I begin to smell and taste oil. I start feeling sick. Owner says furnace is new and he installed it himself but feels it isn't efficient. Next year, maybe one that has better rate of combustion. Uh-Oh. b. I test an air filter for petroleum hydrocarbons. In the meantime, I stop being able to digest food and feel very weak so I leave. Symptoms abate over time. The results come in and I get a call from the chemist who asks if I have been living in the middle of a highway. No, Dr. _____, I am living in an apartment on a residential street on Long Island. "Get out of there. I have never seen such high indoor levels before for this substance." The test results allow me to get out of my lease and my doctor doesn't give me dangerous drugs for conditions which clear up spontaneously. Toxicity, not

hypersensitivity. You can't get oil out of fiber though and I couldn't keep any of my belongings made of fabric. Hypersensitivity meant I couldn't keep my clothing or bedding. Toxicity meant I lost my apartment and a realty fee. I had to threaten legal action to get my security deposit back and had no way to recoup hotel costs after fleeing that place. Someone else moved in though. And breathed in poison. I likely became ill before another person might because I became sensitive to petrochemicals from over exposure to them in solvents used to deliver pesticides. But I was still being poisoned. However, now the owner knew he shouldn't wait to replace that furnace. Did he? Maybe not but the next tenant's health may depend upon that choice. Example III: a. I now have low-normal levels of AChE at this point and move into a five year old duplex, Within 48 hours, I am bleeding

from every orifice among other symptoms and leave. Testing shows severe suppression of that enzyme (reportable levels again). b. Testing of the apartment shows mid-range levels of contamination according to the toxicologist. Of chlordane, banned two decades before this place was built and lower levels of three other highly toxic pesticides (two banned, one in current use). None of these had ever been applied to the structure but occured incidentally from exterior use on other properties but mainly from contamination through the soil when the foundation was dug and continued to steadily enter the home. I find out the owners wife who had lived there in the first three years post construction had become chemically sensitive there. I let them know but lost $3,000 since chlordane contamination was not the owner's problem. Just mine. I would have died there had I stayed or again been subjected to innapropriate medical

interventions with most physicians. My history and a good doc and a lab chemist saved me. Responsible professionals understand what may lurk in many residences. I have more of my own stories, and those of others. I am not special, unique or otherwise different from the average person except that I know what others suspect. I thought I was being poisoned. I was. Those of you who call your clients paranoid have no right to do so unless you have assessed their environments based upon a number of factors. Unless you are medically qualified to do so, you have no right to assume they are fine and their environments aren't affecting their health. You do have the right to counsel them about how you view their situations and what services you feel comfortable providing. I have dead friends who found out too late what 'got' them and I met them at the tail end

of their lives. Before I was disabled I worked in a building that had a roof leak and the ceiling turned to moldy mess. Two of us were asthmatics and couldn't cope. We were relocated during remediation after I had the owners test the place, They concurred with the need to remediate rather than just paint over the damage. Happy ending for all involved with no casualties. Not everything has to be a tragedy. A friend of mine with severe allergies bought a fence and the mold on it made her sick. Testing the fence cost her a couple of hundred dollars but the results forced the company to take back the bad moldy wood and she saved $1100. And could go into her yard again without getting sick. Maybe I have more experience than you do in recognizing human health issues which indicate the need to acquire laboratory data via environmental sampling. It is

possible to reduce the numbers of things you seek based upon educated guesses in concert with clients. VOCs PAHs Pesticides,Formaldehyde, Mold etc. These do act differently on systems and simple observation and knowledge of building history can narrow the focus a great deal. Lots of results? That's okay. A toxicologist can look them over with client's symptoms and decide what could be significant. You don't have to do that. Formaldehyde as low as 100 ppb can be injurious. OSHA doesn't care until the ppm levels are reached. It doesn't make lower levels insignificant for the patient and their doctors to know about. Without such findings, doctors will never learn to look around the patient instead of just at the patient. And I will go around and teach people to request assessments of their environments. You will either help them do it or decline to do it. Sometimes you may urge them to do it and they

decline. But please don't take such choices out of their hands wtih false assurances. You never know. Barb Rubin ====================================== > Let's not pretend that offending VOCs and CNS disrupting toxinsaren't> measurable and work to make such things more accessible.Barb,The problem isn't that they aren't measurable. The problem is thatwhen youget IH lab results from SUMMA canister testing or multisorbent tubeGC/MSanalysis, you get TOO MANY environmental chemicals that may or maynot be thecause of a hypersensitivity reaction. This is why I don't testunless I can testsomething very specific (head space

analysis) that is confirmed tocontain thesubstance that causes symptoms. And even then, you get a list ofpossiblecausative agents. The only way to confirm the cause of symptoms isto use theindividual as a test instrument. And even then you need to exposethe personto a sample of the "pure" chemical.I agree with your portrayal of the larger picture of chemical injuryandillness. I disagree with your emphasis on testing. Maybe I havemore experiencethan you do in interpreting laboratory data from environmentalsamples. Manyyears ago I learned that GC/MS identification of ppb concentrationsof indoorchemicals raises more questions than it can answer. The air in thebest ofmodern indoor environments where no one is getting sick containslots ofchemicals. How can this be used to "prove causation"? It candocument exposure.But so is everyone else who is not getting sick similarly

exposed.It proves(maybe for the defendants) that the levels of exposure were "nothigh". Howdoes that help?Steve Temes

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