CHEMICAL INJURY

May 21, 2006

http://www.asehaqld.org.au/Chemical%20Sensitivity/chemical_injury_issues_paper.h\

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CHEMICAL INJURY

Abstract

This paper attempts to draw together information from

medical toxicology/teaching texts, occupational Health

standards, and review of past and current medical

literature to demonstrate the existence of chemical

injury. From this information it could be concluded

that denial of the existence of chemical injury by

Government, Medical and other Institutions contradicts

(in many cases) their own standards, research and

medical findings. Solvents are recognised to have the

potential to cause detrimental effects on human

health. Why then is the potential for adverse health

effects not recognised when these same solvents are

used in common compounds such as perfumes and perfumed

products. Overseas research is now beginning to

identify the adverse effects that perfume chemicals

can have in our environment, contributing to Sick

Building Syndrome (SBS), Indoor air pollution and

chemical sensitivity.

Perfume is a common product used by most of the

population in one form or another and is extremely

difficult to avoid in a public indoor environment.

Perfumes and perfumed products contain a large array

of chemicals such as aromatic oils (both natural &

synthetic), solvents, preservatives etc that add to

indoor air pollution. In this way it is analogous to

the issue of cigarette smoke in public environments in

that those most severely affected by it are exposed

‘passively’ and have no choice in the matter. It was

only through extensive campaigning and intervention by

the medical profession that cigarette smoking was

banned in many public areas.

The various sections of this paper are summarised

below:

1. Industry Standards and Solvent Sensitivity:

Demonstrates that the potential for chemical injury,

sensitisation and subsequent low level harm is

recognised within Worksafe’s Occupational Standards.

Provides a definition for solvent sensitivity.

2. Perfume sensitivity, Indoor Air Pollution and SBS:

Highlights the problems associated with solvents and

other chemicals when used in common everyday

substances such as perfumes & perfumed products.

Demonstrates that indoor air pollution is a major

health problem and how it is contributing to SBS.

There is also reference to the relationship between

SBS and MCS.

3. Definitions and Models of MCS: Provides definitions

of Multiple Chemical Sensitivity from

Cullen’s 1987 overview of Workers with MCS published

in the Occupational Medicine Journal

Ashford & s definition published in a 1992

US Dept of Health & Human Services description

published in 1998 and

The 1999 Consensus statement published in Archives of

Environmental Health and Lists the current models of

MCS

4. Medical models of solvent/perfume/odour

sensitivity/intolerance: Provide reference to medical

models that are intended to explain how ‘chemicals’

and odours can produce systemic symptoms, and explain

terms such as neurogenic inflammation and Cacosmia.

5. Concerns, Rights and Health Issues: These issues

raise concerns for the health of children,

particularly when the chemicals used for fragrance are

also used as flavourings in medications and processed

foods. A major concern is that toxicology risk

assessment for chemicals is flimsy and can only

measure what is currently known. Even scent free or

fragrance free labelling does not guarantee that the

product is suitable for susceptible individuals. This

then raises the question of the right to clean air,

free of perfume odours and chemicals.

6. Recognition of perfume/scent sensitivity in the US:

This sections give examples of sectors within the US

community that are taking the issue of air pollution

by perfumed products seriously enough to ban their use

in certain situations.

7. Chemical Sensitivity prevalence and recognition:

Gives the prevalence figures for chemical sensitivity

in the US, and a list of National & International

bodies that accept MCS as a valid illness.

Introduction

Chemical injury

Many members of ASEHA Qld Inc and other similar

organisations have been injured as the result of an

acute, high level occupational exposure. Following

such an exposure, there is little assistance to

diagnose and effectively treat the resultant health

damage. Once chemical injury has occurred there is no

acknowledgment of the damage caused to organ systems

such as skin, liver, respiratory or Central Nervous

System. In many cases chemically injured people are:

misdiagnosed and mistreated;

subject to discrimination and human rights abuses;

they cannot access appropriate care in a timely

manner;

they cannot access care in a 'safe' environment in

spite of statements made that we are entitle to 'high

quality, safe, appropriate health care delivered in an

environment in which you feel safe…' (Queensland

Health. Leaflet). We define 'safe' as low in volatile

organic compounds and perfume free.

As many chemically injured persons cannot find the

expertise to assist them with necessary health care,

they lose the ability to work and support themselves.

Proving chemical injury is difficult, as people either

do not have access to biological testing that could

establish harm, or testing does not exist. (Worksafe

Standard section 8.3) As a result compensation for

damage caused by workplace exposure is difficult to

obtain and many people who have paid for and should be

supported by insurance payments, are on social welfare

and dependent on the public health care system for

necessary health care.

1. Industry Standards and Solvent Sensitivity

WORKSAFE STANDARDS (Back to Hospitalisation Article)

The existence of chemical injury/sensitivity is

validated by Worksafe standards.

ASEHA is concerned about the ability of the health

care system to provide safe facilities and appropriate

assistance to those injured by chemicals. The Worksafe

Standard for air levels of contaminants in the

occupational environment is clear that chemical injury

as an organic disease state does occur with sections

devoted to sensitisers, solvents and odours.

Some points of interest in the Worksafe Standard are

as follows:

Introduction p. 5

1.2 exposure standards are based only on current

knowledge;

1.4 exposure standards do not guarantee protection

for every worker because of individual susceptibility

and biological variation, and it is inevitable that

some workers will suffer adverse health impacts;

1.6 atmospheric exposure standards only consider

absorption by inhalation and are only valid on the

assumption that skin absorption cannot occur.

Most substances used are untested/lack data

Chapter 2. Unlisted substances p. 6

2.1 most substances used in industry have not been

assigned exposure standards. This does not imply that

the substances are safe or non-hazardous;

2.2 there is a lack of data on health effects of some

substances to assign a standard.

Lack of biological tests

Chapter 8. Biological monitoring p. 13

8.3 there is limited knowledge of suitable and

definitive biological tests for most substances.

Odour and chemical interactions validated

Chapter 9 Odour thresholds p.14

9.1 odours can serve as a useful warning signal as to

the presence of a substance in the environment;

9.2 there may be interference from other substances;

Avoidance validated

Chapter 11 Effects on the skin p. 16

11.1 some substances can readily penetrate the skin

and this method of exposure can pose a far greater

danger than inhalation exposure;

11.3 some substances such as solvents can accelerate

or alter the rate of skin absorption;

11.6 it is 'good practice' to avoid any unnecessary

contact with all chemical substances.

Sensitisation and low level exposures validated

Chapter 12 Sensitisers p. 17

12.1 Some substances (TDI, Formaldehyde) can cause a

specific immune response in some people. This is known

as 'sensitisation';

12.2 Following sensitisation 'an affected individual

may subsequently react to exposure to minute levels of

that substance'. Although low values have been

assigned the exposure standard may not be adequate to

protect a hypersensitive individual and persons who

are sensitised to a particular substance should not

further be exposed to that substance. (NOHSC. 1995)

Chapter 15 Mixtures of substances p. 28

15.12 At present the understanding of interaction

effects is incomplete. The knowledge that such effects

occur is reason to maintain the concentrations of

individual substances as low as is practicable under

complex exposure conditions.

Part 2 Interpretation p. 70

'Exposure Standard' means an airborne concentration of

a particular substance in the workers breathing zone,

especially to which according to current knowledge,

should no cause adverse health effects nor cause undue

discomfort to nearly all workers .

It is unethical to ignore the perceived small

percentage to which these standards cannot be applied.

Why are we having so much trouble gaining recognition

of the organic disease state induced by chemicals when

Worksafe clearly acknowledges the problem exists and

confirms the need for avoidance - even to low levels?

The basis of chemical induced illness has always been

in teaching toxicology texts such as Casarett &

Doull's Toxicology: A basic science of poisons. More

proven evidence of toxicity can be found in substance

abuse such as glue and petrol sniffing.

Solvent sensitivity

Solvent sensitivity is acquired following exposure to

a solvent or solvents that results in sensitisation or

injury. While this is thought to occur only in an

occupational setting following a single acute

exposure, chronic exposure to solvents can cause the

same spectrum of effects as a single acute exposure.

(Amdur, MO et al. 1991). Because organic solvents have

a special affinity for lipid-rich tissues, including

brain tissue, they have been implicated in producing a

wide range of CNS symptoms. These same solvents may be

used as an ingredient in perfumes and perfumed

products.

2. Perfume Sensitivity, Indoor Air Pollution and SBS

Perfume and Chemical Sensitivity

A search of the US National Institutes of

Environmental Health Sciences (NIEHS) database for

articles on solvent and perfume sensitivity revealed

the same search with thousands of articles on Multiple

Chemical Sensitivity (MCS) - too many to read. The

number of entries on that section of the database

searched was 10,741. Of these approximately 20%

related to solvent sensitivity, 14% to perfume

sensitivity and 50% to multiple chemical sensitivity.

The American President has charged the US NIEHS with

the responsibility for research into chemical

sensitivity and there is a large body of recent

research on their database.

Throughout history humans have drawn fragrances from

the natural environment. The first synthetic perfuming

ingredient was introduced in the late 1800's and since

then chemicals have been used extensively to mimic

perfumes from nature. It is estimated that there are

3,000 chemicals used in the manufacture of fragrances

with synthetic organic chemicals constituting 80-90%

of the raw materials. A single fragrance may contain

as few as 10 chemicals or as many as several hundred.

Like many other chemicals and chemical mixtures in

widespread use today, perfumes are ubiquitous in the

environment and unavoidable. Little is known about the

impact fragrances have on human health. Because of

intellectual property rights, ingredients are trade

secrets and this makes it difficult to link claims of

adverse reactions to particular chemicals. The secrecy

also makes it difficult for researchers to study

health effects of perfumes.

Chemicals in perfumes, colognes, deodorants, cosmetics

etc worn by individuals, combine with chemical

mixtures in the indoor environment and exacerbate

'sick building syndrome'. A study by the US EPA

investigated the effects of 31 perfumed products in

indoor air and a total of 150 chemicals were

identified. Of the main chemicals identified, few have

been tested for carcinogenicity although some are

known mutagens, carcinogens, and others have toxic

effects at high concentrations. (Wallace. 1991). Some

chemicals found in perfumes e.g. butyl phthalate

accumulate in fatty tissue, they exhibit weak

oestrogenic action and recent research indicates that

these may affect the male reproductive system or cause

breast cancer.

Mixtures of volatile organic compounds used in

perfumes is cause for concern as, individually, these

are extremely potent chemicals. Given the large number

of compounds in an individual perfume, the likelihood

of these combinations enhancing carcinogenic,

mutagenic or oestrogenic activity is high. As health

impacts of perfumes such as migraine and asthma have

already been noted, and the percentage 'at risk'

individuals i.e. those in the population with allergic

disease is high, we can only conclude that using

perfume does not constitute a low-level exposure - but

is a major public health hazard.

Indoor Air Pollution and Sick Building Syndrome (SBS)

Indoor air quality has traditionally been an issue in

the industrial sector where standards have been

established in an effort to limit worker exposure to

airborne contaminants. While low levels of indoor air

contaminants in the workplace have been assigned, it

is important to realise that measured levels of

contaminants in buildings may be misleading as these

may vary over time or from one part of a building or

another. A given measurement may reflect a 'best case'

scenario that is not necessarily representative of

usual exposures. Some other problems include:

additive effects of pollutants on each other;

the absorption of VOCs by particulate matter;

excess heat can add to the central nervous system

effects of VOCs, enhancing symptoms such as headaches

and fatigue. There seems to be an interaction between

chemosensory receptors in the body and thermosensory

neuroreceptors so that cooler temperatures are

associated with less reactivity. (Oliver and

Shackleton. p. 6)

While exposure levels established by regulatory

authorities apply to the industrial sector, lower

levels can cause problems. However, it is now also

recognised that poor air quality is a broader health

problem in offices, schools, homes, institutional

settings and most of the population is potentially at

risk. Poor indoor air quality can cause or contribute

to the development of chronic diseases such as asthma,

multiple chemical sensitivity, hypersensitivity

pneumonitis, while causing a broader array of

conditions such as headache, nausea, dry eyes, nasal

congestion, fatigue. While asthma, hypersensitivity

pneumonitis and MCS are signs of SBS, MCS and SBS can

overlap. (Oliver and Shackleton p.3) Those with

certain existing medical conditions such as asthma,

allergy, connective tissue disorders or are

immunosuppressed by medications such as steroids or

chemotherapeutic agents are at greater risk than the

general population. (Oliver and Shackleton p.1/2)

Some causes of SBS are poor ventilation, indoor air

contaminants such as volatile organic compounds,

pesticides, lead, carbon monoxide, carbon dioxide,

nitrogen dioxide, biological contaminants such as

moulds or dust, ozone, environmental tobacco smoke,

polycyclic aromatic hydrocarbons, asbestos, wood

resins. Some 250 VOCs have been identified in office

air including air contaminants that were previously

thought only to be found outdoors. (Baker. 1997)

Health effects from poor indoor air quality is

becoming an important public health issue. This is

particularly relevant given the high percentage of the

population with allergic disease such as asthma.

Prevention strategies need to be implemented to either

prevent or reduce indoor air contaminants. Some of

these strategies could include;

building materials/furnishings low in VOCs;

odourless cleaning compounds which have also been

chosen for their low toxic effects;

a no smoking ban within a specific radius around

buildings so that smoke cannot be drawn back into the

building;

a ban on the wearing of perfume and perfumed personal

products in the work environment;

a ban on freshly dry cleaned clothing in public

buildings.

a ban on indoor air deodorisers

Oliver and Shackleton in their article The Indoor Air

We Breathe; a public health problem of the 90s state

that " Multiple chemical sensitivities and sick

building syndrome are complex issues that are often

reduced to ideological and political positions that

are not constructive to their resolution'. (Oliver &

Shackleton. p. 13)

3. Definitions and Models of MCS

A wide array of names has been given to syndromes

suffered by individuals with a heightened reaction to

chemicals, each with its own specific implications as

to the underlying cause, mechanism, or manifestations

of the disease. Sometimes these overlap. A major

hindrance in achieving recognition of chemical

sensitivity and appropriate assistance for the

chemically sensitive is the difficulty in gaining

agreement on a definition. Working case definitions

for MCS since 1987 are similar.

Case Definitions:

Cullen 1987

The main working case definition for chemical

sensitivity by Cullen in 1987 remains applicable

today. He defined chemical sensitivity as 'an acquired

disorder characterised by recurrent symptoms,

referable to multiple organ systems, occurring in

response to demonstrable exposure to many chemically

unrelated compounds at doses far below those

established in the general population to cause harmful

effects. No single widely accepted test of physiologic

function can be shown to correlate with symptoms'. The

seven major diagnostic features distinguished are:

The disorder is acquired in relation to some

documentable environmental exposure, insult, or

illness.

Symptoms involve more than one organ system

Symptoms occur and abate in response to predictable

stimuli.

Symptoms are elicited by exposures to chemicals of

diverse structural classes and toxicological modes of

action.

Symptoms are elicited by exposures that are

demonstrable

Exposures that elicit symptoms are very low (many

standard deviations below 'average; exposures)

No single widely available test of organ system

function can explain symptoms. (Cullen. 1987)

Ashford and 1992

Ashford and in 1992 proposed the following

definition for diagnostic purposes 'The patient with

multiple chemical sensitivity can be discovered by

removal from the suspected offending agents and by

rechallenge, after an appropriate interval, under

strictly controlled environmental conditions.

Causality is inferred by the clearing of symptoms with

removal from the offending environment and recurrence

of symptoms with specific-challenge'. (Ashford. 1991)

US Dept Of Health and Human Services 1998

The United States Department of Health and Human

Services in its Public Health Reports, Sept-Oct. 1998

also gave a clinical definition of chemical

sensitivity that is as follows:

symptoms are reproducible on exposure;

the condition is chronic;

symptoms occur following low-level exposure;

removal of precipitating exposures results in

resolution of improvement in symptoms;

the condition is acquired;

there is an acute inciting event, followed by a

chronic component;

there are no objective tests to adequately explain

the symptoms.(Oliver and Shackleton. 1998)

1999 Consensus statement

More recently (1999) a consensus statement by eminent

occupational medicine practitioners was printed in

Environmental Health Perspectives (Bartha et al.

1999). In this, the signatories to the consensus

statement called for MCS to be formally recognised and

diagnosed using the following criteria from a study by

Nethercott et al that was funded by the US NIOSH and

the US NIEHS:

The symptoms are reproducible with repeated chemical

exposure

The condition is chronic

Low levels of exposure result in manifestations of the

syndrome

The symptoms improve or resolve when incidents are

removed

Responses occur to multiple chemically unrelated

substances

Symptoms involve multiple organ systems.

The Consensus Statement agreed with the 1994 statement

of the American Lung Association, American Medical

Association, US EPA, and US Consumer Product Safety

Commission, that " complaints " of MCS should not be

dismissed as psychogenic, and a thorough work-up is

essential'. (Bartha et al. 1999)

Models of Chemical Sensitivity

There are many models of chemical sensitivity and

these may overlap:

Reactive airways dysfunction syndrome (RADS);

Reactive upper airways dysfunction syndrome (RUDS);

Sick Building Syndrome (SBS);

Multiple Chemical Sensitivity (MCS);

A further model called reactive intestinal

dysfunction syndrome (RIDS) was recently noted

(Lieberman and Craven. 1998);

A paper summarising the clinical phenomena of MCS

outlines the concepts and evidence for the

olfactory-limbic, neural sensitisation model was

published in 1997 (Bell. 1997).

4. Medical Models Of Solvents/Perfume/Odour

Sensitivity/Intolerance

Sensory/neurogenic inflammation

Testing of perfumes show that these can cause dermal

allergic reactions, but this is not the only route of

absorption. Perfumes can be inhaled and absorbed via

the olfactory bulb. Little is known about the

olfactory system but the nasal passage offers a unique

route of exposure for chemicals to be absorbed

directly into the brain indicating a need for more

research on neurogenic inflammation. A study recently

to hand indicated that exposure to perfume via the

eyes can elicit symptoms. In this particular study

researchers found that symptoms arising from eye

exposure were similar to 'sick building syndrome and

multiple chemical sensitivity. Their findings point to

the importance of studying the sensory nervous system,

not only in the airways, but in other systems as well.

(Allergy. 1999)

Studies by the Laboratory in Vermont (USA)

have shown the following symptoms experienced from

exposure to perfumes from fair fresheners, colognes,

fabric softeners: some combination of eye, nose and/or

throat irritation; respiratory difficulty; possibly

bronchoconstriction or asthma-like reaction; central

nervous system reactions such as dizziness,

incoordination, confusion, fatigue. In a study of

emissions from disposable diapers, mixtures of

chemicals were found that could cause or exacerbate

asthmatic conditions. ( C and J.

1999) .

Odour intolerance or Cacosmia

Chemical odor intolerance or cacosmia is a symptom

that involves a sensory response or illness from the

odour of common chemicals such as new carpet,

newsprint, disinfectant, paint, natural gas, perfume,

tar, pesticide, car exhausts, tobacco smoke. 'Cacosmia

is defined by a population subset, with or without

occupational xenobiotic exposures or disability, that

has distress and symptom amplification and

neuropsychiatric and somatic symptoms, none of which

are explained fully by psychological measures.

Prospective clinical studies are possible with such

individuals. The data are also consistent with a

time-dependent sensitisation model for illness from

low-level chemical exposures'. (Bell. 1996)

Cacosmia - effects on learning and memory

A study in the American Journal of Psychiatry examined

the interrelationships among occupational exposure to

mixtures of organic solvents, neurobehavioural

functioning and complaints of cacosmia. In this study,

cacosmia was defined as nausea, headaches and

subjective distress in individuals exposed to neutral

environmental exposures. A battery of cognitive tests

was administered to men with and without a history of

solvent exposure and exposed workers were found to

have a wide range of cognitive impairment. There was a

highly significant relationship between a history of

cacosmia and performance decrements on measures of

learning and memory. ( 1988)

Symptoms noted from odour intolerance include nausea,

headaches, forgetfulness, difficulty concentrating,

depressed effect, heightened irritability, dizziness,

motor incoordination, weakness in the extremities.

While it is believed these symptoms will spontaneously

disappear, some individuals complain that the symptoms

have not disappeared in spite of the fact that the

last exposure occurred several months earlier. (

1988)

Professor Kaye Kilburne (Ralph Edgington Professor of

Medicine, Los Angeles) set out to address the dilemma

of a test to demonstrate neurologic dysfunction on

humans exposed to chemicals in the workplace

environment. Comparison measurements of exposed and

unexposed individuals showed that many brain functions

were slowed and diminished, including balance,

reaction times, colour, discrimination and visual

fields. It was clear from the sampling that ten

classes of common chemicals caused adverse effects on

human brain function.

Most exposures were to mixtures of common chemicals

although one chemical usually predominated, indicating

that effects of individual chemicals interact and many

synergise for a total effect that exceeds an additive

effect. Chemicals included classes of insecticides and

mixtures such as chemical waste. Pesticides were

organochlorines, organophosphates, pyrethroids. Gases

included ammonia, chlorine, formaldehyde, hydrogen

sulphide, carbon monoxide. Among these chemicals are

solvents - chlorinated and nonchlorinated - such as

toluene, PCBs, plastic monomers (PVC, styrene). Some

of these were from combustion products of diesel

exhausts, incineration of industrial and domestic

waste and yielded PCBs and toxic metals. The effects

of chemicals on the brain were generalised and Prof

Kilburne stressed that prevention by avoidance is the

only practical and safe strategy. (Kilburne 1999)

Another form of brain injury caused by solvents is

substance abuse as in paint sniffing, glue sniffing,

petrol sniffing and more recently perfume sniffing.

This has become a problem in some sections of the

community. However, while this form of solvent

exposure is voluntary, the use of solvent laden

perfume is like tobacco smoke - a public health hazard

- it is inflicted upon the community unnecessarily and

is now ubiquitous in the environment. Those sensitive

to solvents/perfumes are exposed against their will,

and to the detriment of their health and wellbeing.

Recent studies showing levels of synthetic musk

compounds in ambient air and human body fat are

indicative that these substances do constitute a

public health problem that needs to be addressed.

(Gutterman. 1999)

5. Concerns, Rights And Health Issues

Child health a concern

We now find perfumes in a multitude of 'personal'

products with more than 1000 body fragrances;

commercial products ranging from cleaning compounds,

air fresheners, laundry products, paper products,

candles and nappies. In fact, it is difficult now to

find unperfumed products and perfume has become

ubiquitous in the environment. Of major concern is the

effect of perfumes on child health and the developing

Central Nervous System. Children are at greater risk

of such products because of their smaller size, higher

respiratory rate and thinner skin. Little research has

been done on this issue.

Flimsy toxicology exposed

It is clear that the science base for risk assessment

of most chemicals is not very strong. Toxicology and

medical science are limited in their scope and

knowledge and can only deal with what is known at the

time chemicals are evaluated. In 1991, the US National

Research Council estimated that only 2% of around

60,000 chemicals that are widely used have been

comprehensively studied for toxic effects. Of that 2%

many were studied in animals, few in humans. Those

compounds that have been studied for chronic,

low-level effects have rarely been evaluated for

neurologic (central, peripheral, autonomic),

neurobehavioural, immune, endocrine, reproductive and

pulmonary effects. Rarely have these been studied in

combined exposures that actually exist in the real

world. (Ziem and off. 1992)

Chemicals used for fragrance are also used for

flavouring

Many people do not realise that perfume sensitivity is

a serious public health risk. The issue of detectable

levels of synthetic musk compounds in the air we

breathe is cause for concern as they build up in the

food chain in much the same way as Polychlorinated

biphenyls (PCBs) and DDT. Synthetic musk compounds

have been found in fish, mussels, human fat, milk and

blood. (Gutterman. 1999) It is also worth noting that

the same chemicals that are used to produce perfumes

are used in the food and pharmaceutical industry to

produce flavourings. As many of these are not

adequately tested we are concerned about their effects

on the population. In particular, we are concerned

about effects of the mixtures of flavourings with

medications, pesticides, and other chemicals natural

and added in food. While these are individually

subject to risk assessment, the reality is that food

is a mixture of chemicals and adding solvents to this

mixture may result in a dangerous, high level exposure

with enhanced carcinogenic, neurogenic or oestrogenic

potential - especially to children.

Labelling deceptive

Product labelling such as unscented or fragrance free

does not necessarily mean the product contains no

fragrance materials. Sometimes manufacturers add

masking chemicals to cover those containing scent.

However, some people exhibit a heightened sense of

odour and can detect fragrance in products labelled

unscented or fragrance free.

While some individuals enjoy perfumed products, there

is a growing outcry from those in the community who

claim that exposure to perfume impacts adversely on

their health. Many report that exposure to perfume

incapacitates them so much that they have to forego

their usual activities and/or wear an odour mask in an

effort to avoid exposure.

The right to breathe clean air

The fragrance issue will become as controversial as

the cigarette smoke issue, i.e. people's right to wear

perfume over the right of another to breathe clean

air.

6. Recognition Of Perfume/Scent Sensitivity In Us

Californian legislation regulates fragrance inserts in

printed material

The Californian State Government passed a regulation

in 1992 that fragrance advertising inserts in

magazines or printed material shall contain only

microencapsulated oils. Some magazines in the USA now

offer a 'scent free' version on request. (Fisher.

1998)

Minnesota school urges students and teachers to be

fragrance free

Faculty and students of the University of Minnesota

School of Social Work are now banned from using

perfume following a ban on scented body products. The

ban was instituted because fragrances trigger allergic

reactions in some people. This has been dubbed

multiple chemical sensitivity. Officials of the school

say the ban has been well received and as the school

shares its building with several other departments,

students and faculty in those departments are also

being asked to observe the ban. (Fisher. 1998)

7. Chemical Sensitivity Prevalence and Recognition

While the physiology of Chemical Sensitivity has not

been fully investigated, it is generally believed that

MCS occurs as a result of effects on the limbic

system, immune system and the respiratory tract. The

increasing importance of Chemical Sensitivity as a

public health problem is attested to by the fact that

it has now been recognised by many reputable

organisations, including the US EPA.

Chemical Sensitivity Prevalence

Chemical Sensitivity has emerged in the last 20 years

with growing numbers in the population affected. The

number of people diagnosed with MCS in the American

population is unknown. However, in a 1996 survey of

4000 adults in California carried out by the

California Health Services Department, 6.3% of

respondents report a diagnosis of MCS. An additional

15.9% reported 'chemical sensitivity' associated with

multiple reactions, without a specific diagnosis of

MCS. (American Journal of Epidemiology. 1999)

Bell et al reported a substantial proportion of

various populations presenting to an occupational

medicine setting reported cacosmia:

approximately 60% of solvent exposed workers (mainly

blue-collar workers)

30% of a sample of almost 4,000 office workers

(mainly female, professional, white collar workers)

15-30% of college students and active, retired,

elderly individuals (Bell et al. 1997)

et al state that more than 20 million people in

the USA are exposed to toxic substances in the home or

workplace. For the vast majority of those people,

mixtures of organic solvents are the most frequent

source of exposure ( et al. 1988)

, Associate Professor of Environmental

and Occupational Medicine at the University of Texas

Health Sciences Centre in San , says that

several studies indicate:

15-30% of the population report sensitivity to

chemicals, including fragrances;

4-6% report that chemical intolerance has a major

impact on their quality of life and of these

80% report that exposure to fragrances is bothersome.

Many Gulf War Veterans report chemical intolerances

since the war, including sensitivity to fragrances.

(Fisher. 1998)

State Health Department surveys of civilians in New

Mexico and California showed that 2-6% have been

diagnosed as having chemical sensitivity while a

further 16% reported 'unusual sensitivity to everyday

chemicals. (American Journal of Epidemiology. 1999)

In a random telephone survey of a US rural population

(North Carolina) in 1993, questions were asked about

allergy and sensitivity. Of the 1446 households

contacted, 1027 (71%) agreed to participate. 35%

reported allergy with thirty percent reporting

symptoms once per week, 61% reported symptoms of

allergy once per month. Daily allergy symptoms were

reported by 5.3% of the total population. Chemical

sensitivity was reported by 33%, with 35% of those

reporting symptoms once per week, 53% reported

symptoms once or less per month and 3.9% of the total

population reporting symptoms on a daily basis. Both

allergy and chemical sensitivity were distributed

widely across age, income, race and educational

groups. Simultaneous allergy and chemical sensitivity

were reported by 16.9% of the population, allergy

without chemical sensitivity by 16%, chemical

sensitivity without allergy by 18.2% and neither

condition by 48%. The conclusion of the survey was

that if the prevalence of sensitivity to chemical

irritants is equivalent to that of allergy, as was

found in the study, then support for the scientific

investigation of chemical sensitivity is justified.

(Meggs et al 1996)

A report to the n Health Minister entitled

'Strategies to manage the rising epidemic of allergic

diseases in Australia' noted that one in three

Europeans suffer with allergy and that the incidence

of allergic disease is higher in Australia. Figures

suggest that 41% of the population suffer with

hayfever. If we can conclude from the study by Meggs

et al that the prevalence of sensitivity to chemical

irritants is equivalent to that of allergy,

sensitivity to chemical irritants represents a very

significant percentage of the general population, and,

therefore should be high on the list of service

provision in the health system with suitable low VOC,

perfume free areas set aside for those needing care.

Some highlights from the activities of the Swedish

Allergy Program 1995 are as follows:

1/3 of all adults suffer with allergic disease

60% of women and 40% of men suffer from sick building

syndrome in their working environment

In Sweden the cost of health care and loss of

production from allergic disease cost SEK 5,600

million per year…

and that cost doubled in 10 years (National Institute

of Public Health, Sweden. 1995)

Recognition of Chemical Sensitivity

When first described in the 1950s, Chemical

Sensitivity was met with great scepticism by medical

practitioners until the 1980s and 1990s when it began

to move into the mainstream of clinical practice in

the USA. (Oliver and Shackleton. 1998). The

International Organisations that recognise MCS are

listed in Appendix 1.

The ways in which these bodies are recognising MCS are

many and include

Initiation of research, clinical studies, reviews,

reports and workshops into the mechanisms and etiology

of chemical injury

Initiation and funding of building projects for

environmental modifications to

Public Housing

The workplace

Public buildings

Recognition of MCS within Disability Acts and

legislation Requests to refrain from wearing scented

products, to their ban in public indoor environments

Integration of MCS into mainstream medical databases

Recognition of MCS as a medical diagnosis Issuing of

safety standards for consumer products, such as

carpets, suspected of causing MCS and other illnesses

Provision and establishment of Environmental Health

Clinics Prior notification schemes for pesticide use

in the local environment and within flats and units,

including warning signs on building where hazardous

products are being used. Temporary discontinuation of

use of specific cleaning chemicals etc in order to

provide safe access to public places Decisions by US

Federal and State Courts that affirm MCS as a handicap

or disability.

Conclusion and Issues

From the information contained within the Worksafe

Standards we must conclude that chemical injury does

exist and that injury can occur at levels lower than

workplace standards because of 'individual

susceptibility and biological variation'. Worksafe

standards further tell us that many substances used in

industry have not been assigned any exposure standards

and that 'there is limited knowledge of suitable and

definitive biological tests for most substances'. They

also tell us that 'at present the understanding of

interaction [of chemicals] effects is incomplete and

'the knowledge that such effects occur is reason to

maintain concentrations of individual substances as

low as is practicable under complex exposure

conditions'. So it comes as a shock each time a

representative of government, Industry or the Medical

Profession tells us almost the exact opposite.

Research into Sick Building Syndrome in the US is

demonstrating that the indoor air can contain a

complex and large number of chemical substances that

can cause ill health in the general population. For

those individuals with pre-existing allergies or

medical conditions the risks or injury are greater.

Finding a solution, or the resolve to finding a

solution to the problem of widespread illness due to

the chemical load in our environment, seems to be a

contributing factor in the non-acceptance of chemical

injury. Chemicals are widespread in our environment

and have become an integral part of modern living. To

accept chemical injury is to accept that our

environment is potentially dangerous and to accept

that means something has to be done to change it. In

some sectors of the US and overseas, they are doing

something about it by performing meaningful research

into the area, or resolving to reduce the overall

burden of pollutants by banning perfumed substances or

using alternative building materials, or providing

acceptable housing and health care facilities for the

chemically injured. According to research into SBS,

the effects on individuals are basically diminished

physical capacity and mental/cognitive skills. In a

recent UK study perfumes have been shown to produce

headaches and a range of other health problems.

(, Rob. 1999). This means decreased

productivity and therefore it is in the best interests

of government and industry to reduce the cause of the

problem.

Chemical injury, MCS and SBS are extremely

controversial areas. Oliver and Shackleton's comment

that " MCS and SBS are complex issues that are often

reduced to ideological and political positions that

are not constructive to their resolution " says it all.

While all this controversy rages about names and

degrees of severity there are people with chemical

sensitivity who are suffering. There is a lack of

adequate perfume/chemical free health care facilities,

a lack of practitioners willing and able to assist,

and a lack of political will to provide the necessary

funding.

References

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