Profile of Patients with Chemical Injury and Sensitivity
Grace Ziem1 and James McTamney2
1 Occupational and Environmental Medicine, Baltimore, Maryland
2 Clinical Psychologist, Lutherville, Maryland
Abstract
Patients reporting sensitivity to multiple chemicals at levels usually tolerated by the healthy population were administered standardized questionnaires to evaluate their symptoms and the exposures that aggravated these symptoms. Many patients were referred for medical tests. It is thought that patients with chemical sensitivity have organ abnormalities involving the liver, nervous system (brain, including limbic, peripheral, autonomic), immune system, and porphyrin metabolism, probably reflecting chemical injury to these systems. Laboratory results are not consistent with a psychologic origin of chemical sensitivity. Substantial overlap between chemical sensitivity, fibromyalgia, and chronic fatigue syndrome exists: the latter two conditions often involve chemical sensitivity and may even be the same disorder. Other disorders commonly seen in chemical sensitivity patients include headache (often migraine), chronic fatigue, musculoskeletal aching, chronic respiratory inflammation (rhinitis, sinusitis, laryngitis, asthma), attention deficit, and hyperactivity (affected younger children). Less common disorders include tremor, seizures, and mitral valve prolapse. Patients with these overlapping disorders should be evaluated for chemical sensitivity and excluded from control groups in future research. Agents whose exposures are associated with symptoms and suspected of causing onset of chemical sensitivity with chronic illness include gasoline, kerosene, natural gas, pesticides (especially chlordane and chlorpyrifos), solvents, new carpet and other renovation materials, adhesives/glues, fiberglass, carbonless copy paper, fabric softener, formaldehyde and glutaraldehyde, carpet shampoos (lauryl sulfate) and other cleaning agents, isocyanates, combustion products (poorly vented gas heaters, overheated batteries), and medications (dinitrochlorobenzene for warts, intranasally packed neosynephrine, prolonged antibiotics, and general anesthesia with petrochemicals). Multiple mechanisms of chemical injury that magnify response to exposures in chemically sensitive patients can include neurogenic inflammation (respiratory, gastrointestinal, genitourinary), kindling and time-dependent sensitization (neurologic), impaired porphyrin metabolism (multiple organs), and immune activation. -- Environ Health Perspect 105(Suppl 2):417-436 (1997)
Key words: multiple chemical sensitivity, fibromyalgia, chronic fatigue syndrome, neuropsychological tests, toxic encephalopathy, autoimmunity (or autoimmune diseases), immune activation, acquired disorders of porphyrin metabolism (or porphyria), chemically induced, pesticides, solvents, respiratory inflammation
This paper is based on a presentation at the Conference on Experimental Approaches to Chemical Sensitivity held 20-22 September 1995 in Princeton, New Jersey. Manuscript received at EHP 6 March 1996; manuscript accepted 26 November 1996.
The authors gratefully acknowledge the assistance of B. Cook with record retrieval, G. Smith and C. Prigg with typing and data entry, and A. Donnay with editing and designing tables and figures. Donnay also provided many invaluable suggestions and assistance with the content of the manuscript.
Address correspondence to Dr. G. Ziem, 1722 Linden Avenue, Baltimore MD 21217. Telephone: (410) 462-4085. alternate phone (410) 448-3319. Fax: (410) 462-1039.
Abbreviations used: AAL, Antibody Assay Laboratory; ALA-D, aminolevulenic acid dehydratase; CD, cluster of differentiation; CFS, chronic fatigue syndrome; conA, concanavalin A; CpgO, coproporhyrinogen oxidase;; EEGs, electroencephalograms; ISL, Immunosciences Laboratory; MCS, multiple chemical sensitivity; NK, natural killer cell; PbgD, porphobilinogen deaminase; PHA, phytohemagglutinin; SPECT, single photon emission computed tomography; WAIS-R, Wechsler adult intelligence scale-revised.
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Last Update: March 19, 1997