Multiple Chemical Sensitivity Syndrome- from chemicals in BI 's

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Multiple Chemical Sensitivity Syndrome

is marked by multiple symptoms in multiple organ systems (usually the neurological, immune, respiratory, skin, "GI," and/or musculoskeletal) that recur chronic-ally in response to multiple chemical exposures.MCS usually starts with either an acute or chronic toxic exposure,after which this initial sensitivity broadens to include many otherchemicals and common irritants (pesticides, perfumes and other scentedproducts, fuels, food additives, carpets, building materials, etc.).

MCS Symptoms

commonly include difficultybreathing, sleeping and/or concentrating, memory loss, migraines,nausea, abdominal pain, chronic fatigue, aching joints and muscles, andirritated eyes, nose, ears, throat and/or skin. In addition, some withMCS show impaired balance and increased sensitivity not just to odorsbut also to loud noises, bright lights, touch, extremes of heat andcold, and electromagnetic fields.

MCS Studies

show about 2/3 of those with ChronicFatigue Syndrome and Fibromyalgia also have MCS (and vice versa), as do1/2 of those with allergies. Like CFS, MCS is more common in women andcan start at any age, but usually begins in late puberty to mid-life.There is no unique test for MCS, but immune, porphyrin, EEG, balance,and SPECT scan abnormalities are common.

MCS Treatments

and outcomes vary greatly but--consistent with basictoxicology--the frequency and severity of symptoms usually can bereduced through the environmental control and avoidance of exposuresthat them. A nutritional assessment also is recommended.

Multiple Chemical Sensitivity

A Chronic Condition Characterized by:

multiple symptoms

(many and variable)

in multiple organs (min. 2, usually 4+)

affecting multiple senses (usually 2 to 4)

triggered by multiple chemicals

(and often also by other stressors & stimuli)

waxing and waning

with exposures

at or below levels

previously tolerated

Multiple Symptoms

acute abdominal pain

asthma, headaches, rashes

chronic fatigue & weakness

concentration & memory loss

muscle & joint pains

numbness, tingling, twitching

sore eyes, ears, nose & throat

Multiple Organs

Central Nervous System

Eye, Ear, Nose & Throat

Gastrointestinal

Musculoskeletal

Peripheral Nervous System

Respiratory

Skin

Multiple Senses

hypersensitive to smells

photosensitive,

blurred vision

intolerant of loud noises

bothered by abnormal tastes

hypersensitive to touch & temperature extremes

impaired "senses" of balance, coordination & concentration

Multiple Exposures

alcohol & medications

caffiene & food additives

raw fuels & engine exhaust

new carpet & furnishings

paint & renovation materials

perfume & scented products

pesticides & herbicides

solvents & other VOCs

( Breast Implants ) added by me.........

Multiple Overlapping Disorders:

CN LINK: For more info, see: Overlapping Disorders of CFS, FMS, MCS and GWS

17% to 34% of Americans report symptoms of chemical sensitivity

(Bell et al 1993, CA Dept of Health 1995, Meggs et al 1996)

6.3% of Californians report being given MCS diagnosis by a doctor

(CA Dept of Health 1995, random survey of 4,000 adults)

over 85% also have disorders of porphyrin metabolism

(Ziem and McTamney 1997, five others unpublished)

up to 80% also have Chronic Fatigue Syndrome

(Buchwald et al 1994, Ziem 1995)

55% to 65% also have Fibromyalgia

(Clauw et al 1995, Ziem unpublished)

50% also have traditional (IgE) allergies and vice versa

(Meggs et al 1996)

Multiple Theories About MCS:

1. Chemical Allergy (a 1960s concept, since disproven)

2. Neurologic / Toxic Encephalopathy

3. Autoimmune Illness (under JHU study)

4. Limbic Kindling (via limbic control of sensory pathways)

5. Neurogenic Inflammation (via the olfactory nerve)

6. Porphyrin Disorder(via heme synthesis)

7. Toxicant-Induced Loss of Tolerance (most recent)

8. Subconscious Reaction to Early Childhood Abuse

9. Iatrogenic (a "belief-system" induced by doctors!)"Belief System"

10. Psychogenic Illness (invented by the patients!)

BIOMARKERS of MCS and MUSES Syndrome

Abnormal Medical Tests and Physical Signs Associated with Multi-Sensory Sensitivity

Oxygen Uptake:unlike people with chemical sensitivity alone, people with MUSESSyndrome have impaired oxygen uptake. Their arterial blood showsnormal levels of oxygen going into their body, but they cannot absorbit well and so show higher than normal levels in their veins. This canbe measured via non-invasive VO2max or VO2 resting, or via invasivearterial and venous blood gases. Our recommended threshold forconsidering oxygen therapy is when the gap between arterial and venousdissolved oxygen (PaO2-PvO2) is less than 60mmHg.

Abnormal Medical Tests and Physical Signs Associated with Multiple Chemical Sensitivity

Listed below are themedical tests physical signs that have been found to be abnormal insome studies of MCS patients. They are listed alphabetically and thecited references are listed the below. Some of these biomarkers areused to confirm the diagnosis of other disorders that commonly overlapwith MCS (such as methacholine challenge testing for asthma, punchbiopsy for mast cell disorders, blood enzyme testing for porphyrindisorders).

No single one of thesetests is considered "diagnostic" of MCS, but if abnormalities arereported or suspected in any of these areas, they should be fullyevaluated and appropriately treated. Some of these biomarkers may beabnormal at all times while others wax and wane with exposure. Giventhat MCS by definition is a disease provoked by chemical exposure,physicians should evaluate MCS cases both before (at baseline) andafter an offending chemical exposure Ð either accidentally encounteredor deliberately arranged under a doctor's supervision, preferably as a"blinded' exposure to an odorless gas like CO2 if inhaled or atasteless liquid if ingested. Subcutaneous injections and dermalpatches may also be used to test "blinded" reactions to certainchemicals.

Allergy: increased risk of IgE allergies to mold, pollen, dust, dander, etc (Baldwin 1998b)

Blood:lhigh 2,3-DPG, low red blood cell mass, low plasma volume, high plasmalactate, some cases involve a genetic pyrvate kinase deficiency inwhich the carrier state is symptomatic (Wilcox 1996),

Breath: elevatedcarbon monoxide after standard 23 second breath hold, over 3ppm. Thisis a sensitive but not specific marker as elevated CO also has beenreported in breath of smokers, 2nd hand smokers, people wholive with gas appliances or attached garages, and people with chronicdiseases of the heart, lungs, blood and brain.

Cardiac: tachycardia, other arrhythmia, mitral valve prolapse (Ziem 1997), abnormal echocardiogram (Bell 1998a, Baldwin 1998a)

Cerebral: reduced blood flow on SPECT (Callender 1993, Heuser 1994), increased resting alpha on qEEG (Bell 1998b)

Circulatory:small vessel vasculitis (punch biopsy of fingertip), nontraumaticthrombophlebitis (Rea 1976, Rea 1977), neurally mediated hypotension(in undifferentiated CFS patients)

Detoxification:impaired function of Phase I (cP450) and/or Phase II detox pathway(Ziem 1997); caffeine clearance, salicylic acid conversion, paracetamolconversion (Monro 1997); low sulphoxidation and low glutathione(Scadding 1988, McFadden 1996, Ziem 1997), low superoxide dismutase andglutathione peroxidase (Ziem, unpublished)

Ears: abnormal brain stem auditory evoked potentials (Cary 1997); tinnitus is commonly reported but not quantifiable

Endocrine: variable hyper or hypo function in thyroid, adrenals and HPA axis (Levin 1987)

Eyes: photophobia as measured by reaction time; dry eyes or weeping tear glands in response to exposure

Gastrointestinal:esophagitis, 'nutcracker' esophagus, increased intestinal permeability,lactose breath test, bacterial overgrowth breath test (Monro 1997)

Immune: chronicT-cell activation, impaired NK cell function, variable auto-immunityespecially elevated ANA (McGovern 1983, Heuser 1992, Ziem 1997),reduced secretory IgA and other Ig (Ziem 1999)

Mast Cells:increased number on punch biopsy (Heuser 1996), increased sensitivityto stimuli seen with scratch test, variably abnormal serum tryptaseduring reactions (Schwartz 1987) Mast cell punch biopsy has 80% SENSITIVITY (second highest of any MCS report), SPECIFICITY > 99%

Minerals: numerousdeficiencies, especially magnesium, molybdenum, manganese, zinc,selenium and copper. (Galland 1987, Ziem unpublished).

Musculoskeletal: fibromyalgia tender points (Donnay 1999)

Neurocognitive: impairedlearning and/or retention in short-term memory (visual and verbal),attention span and reaction times (Ziem 1997). Abnormalities seen inPASAT, WAIS-R (Ziem 1997), computerized Divided Attention Test (Bell1995), STROOP tests (Little 1999), Knox Cubes, and in non-dominant handon Tactual Performance Test

Nose: degraded nasal epithelium, chronic inflammation, rhinitis and sinusitus (Meggs 1993b)

Oxygen Uptake:unlike people with multi-sensory sensitivity, aka MUSES Syndrome,people with MCS alone do not have abnormally low oxygen uptake (andthey cannot be cured by oxygen therapy)

Porphyrin Metabolism: multiple blood enzyme deficiencies, especially ALA-D, PBG-D, UPG-D (Ziem 1997),

Porphyrin enzyme abnormalities have 86% SENSITIVITY (highest of any MCS report), SPECIFICITY > 99%

Respiratory: inflammation in larynx & trachea; abnormal methacholine challenge (Bell 1998a)

Sensory Nerves: altered somatosensory potentials (Hummel 1996), peripheral neuropathy (Ziem 1997)

Skin: rash in response to chemicals and irritants, hypersensitive to touch, vibration, and cold; "loose" skin if pinched

Sleep: frequently disrupted with abnormal EEG (Bell 1996)

Vestibular: impaired Romberg and other balance testing (Ziem 1997)

Vitamins: numerous deficiencies, especially in the B series (Galland 1987, Ziem 1997)

Xenobiotics: variousmarkers of poisoning by heavy metals (lead, mercury, depleted uranium)and pesticides (chlorinated or organophosphate) may be detected inurine, stool, blood, hair and/or fat (Heuser 1992)

REFERENCES (abstracts for most of these articles are available free via PubMed)

Compiled by Albert Donnay, 2/1999, rev'd 8/2000

Baldwin, CM and Bell, IR.1998a. Increased cardiopulmonary disease risk in a community-basedsample with chemical odor intolerance: implications for women's healthand health- care utilization. Arch Environ Health 53: 347-353.

Baldwin CM, Bell IR,O'Rourke M, Nadella S, and Lebowitz MD. 1998b. Allergen risk ratios fora community sample with and without self-reports of multiple chemicalsensitivity. Chem Senses 20: 661-662.

Bell I.R. Baldwin, C.M.and Schwartz, G.E. 1998a. Illness from low levels of environmentalchemicals: relevance to chronic fatigue syndrome and fibromyalgia. Am J Med 105: 74S-82S.

Bell, I.R., Schwartz,G.E., Baldwin, C.M., Hardin, E.E. and Kline, J.P. 1998b. Differentialresting quantitative electroencephalographic alpha patterns in womenwith environmental chemical intolerance, depressives, and normals. Biol Psychiatry 43: 376-388.

Bell, I.R., Bootzin, R.R.,Ritenbaugh, C., Wyatt, J.K., DeGiovanni, G., Kulinovich, T., ,J.L., Kuo, T.F., Rider, S.P., , J.M., Schwartz, G.E. and, K.A. 1996. A polysomnographic study of sleep disturbance incommunity elderly with self-reported environmental chemical odorintolerance. Biol Psychiatry 40: 123-133.

Bell, I.R., Wyatt, J.K.,Bootzin, R.R. and Schwartz, G.E. 1995. Slowed reaction time performanceon a divided attention task in elderly with environmental chemical odorintolerance. Int.J Neurosci. 84: 127-134.

Callender, T.J., Morrow,L.A. and Subramanian, K. 1993. Evaluation of chronic neurologicalsequelae after acute pesticide exposure using SPECT brain scans. J.Toxicol.Ind.Health 41: 275-284.

Cary, R., e, S. andDelic, J. 1997. Effects of combined exposure to noise and toxicsubstances--critical review of the literature. Ann Occup Hyg 41: 455-465.

Donnay A. and Ziem G.1995. Protocol for diagnosing disorders of porphyrin metabolism inchemically sensitive patients. Baltimore, MD: MCS Referral & Resources

Donnay A. and Ziem, G.1999. Prevalenceand overlap of chronic fatigue syndrome and fibromyalgia syndrome among100 new patients with multiple chemical sensitivity syndrome. J.Chronic Fatigue Syndrome. 5:2 [in press]

Galland, L. 1987. Biochemical abnormalities in patients with multiple chemical sensitivities. Occup.Med. 2:713-720.

Heuser, G. and Kent, P. 1996. Mast cell disorder after chemical exposure. 124th nnual Meeting of the American Public Health Association, New York NY, 20 November 1996 [abstract and presentation]

Heuser, G., Mena, I. and Alamos, F. 1994. NeuroSPECT findings in patients exposed to neurotoxic chemicals. Toxicol.Ind.Health 10: 561-571.

Heuser G., Wodjani A. and Heuser S. 1992. Diagnostic markers in chemical sensitivity. In Multiple Chemical Sensitivities: Addendum to Biologic Markers in Immunotoxicology, 117-138. Washington DC: National Academy Press

Hummel, T., Roscher, S.,Jaumann, M.P. and Kobal, G. (1996) Intranasal chemoreception inpatients with multiple chemical sensitivities: a double-blindinvestigation. Regul Toxicol Pharmacol 24: Pt 2):S79-86

Levin, A.S. and Byers, V.S. 1987. Environmental illness: a disorder of immune regulation. Occup.Med. 2: 669-681.

McFadden, S.A. (1996)Phenotypic variation in xenobiotic metabolism and adverse environmentalresponse: focus on sulfur-dependent detoxification pathways. Toxicology 111: 43-65.

McGovern, J.J., Jr.,Lazaroni, J.A., Hicks, M.F., Adler, J.C. and Cleary, P. 1983. Food andchemical sensitivity. Clinical and immunologic correlates. Arch Otolaryngol. 109: 292-297.

Meggs W.J., ClevelandC.H., Jr. 1993b. Rhinolaryngoscopic examination of patients with themultiple chemical sensitivity syndrome. Arch.Environ.Health 48:14-18.j

Meggs, W.J. 1993a. Neurogenic inflammation and sensitivity to environmental chemicals. Environ Health Perspect 101:234-238.

Monro J.M. 1997.Laboratory tests found to be effective in the evaluation of chemicalsensitivity: derived from 12,000 patient evaluations. 32nd Annual Meeting of the American Academy of Environmental Medicine, La Jolla CA, 24-27 October 1997 [abstract and presentation]

Rea, W.J. 1976. Environmentally triggered thrombophlebitis. Ann.Allergy 37: 101-109.

Rea, W.J. 1977. Environmentally triggered small vessel vasculitis. Ann.Allergy 38: 245-251.

Schwartz, L.B., Metcalfe,D.D., , J.S., Earl, H., and Sullivan, T. 1987. Tryptase levels asan indicator of mast-cell activation in systemic anaphylaxis andmastocytosis. N.Engl.J.Med. 316:1622-26

Ziem, G. and McTamney, J. 1997. Profile of patients with chemical injury and sensitivity. Environ Health Perspect 105: 417-436.**************Get fantasy football with free live scoring. Sign up for FanHouse Fantasy Football today. (http://www.fanhouse.com/fantasyaffair?ncid=aolspr00050000000020)