[A new classification code is available in the Danish health-care classification system for patients with symptoms related to chemicals and scents].

From July 2012, a classification code for multiple chemical sensitivity has been available in the Danish healthcare classification system. The overall purpose is to register hospital contacts in Denmark. The diagnostic code is labelled "Symptoms related to chemicals and scents", DR688A1, and classified as a subcategory to "Medically unexplained symptoms", DR688A, which is a specialization of the ICD-10 code "R68.8 Other specified general symptoms and signs". The classification was decided with reference to the present lack of scientific understanding.

Phenotypes of individuals affected by airborne chemicals in the general population.

OBJECTIVE: To characterise the chemical exposures and symptoms affecting individuals with subsequent adjustments of social life or occupational conditions, and further characterise these severely affected individuals. METHODS: All individuals (n = 1,134) who reported symptoms from airborne chemical exposures in a population-based questionnaire study of 6,000 individuals were included and dichotomised according to severity. Logistic regression models were used to characterise the group of severely affected individuals. RESULTS: Severely affected individuals reported more symptoms and exposures related to symptoms than less severely affected individuals, and the number of symptoms was more predictive for severity than the number of exposures. Most predictive for the severity of reported symptoms were CNS-symptoms other than headache (OR = 3.2, P < 0.001) and exposure to freshly printed papers or magazines (OR = 2.0, P = 0.001). CONCLUSION: CNS-symptoms except from headache were a main characteristic of individuals severely affected by common chemical exposures in a general population-based sample.

Classification of patients complaining of sick house syndrome and/or multiple chemical sensitivity.

Sick house syndrome (SHS) is a Japanese concept derived from sick building syndrome (SBS), however SHS includes a broader scope of sickness than does SBS. Symptoms of SHS/SBS disappear after leaving the sick house/building, while symptoms of multiple chemical sensitivity (MCS) are elicited by the chance of chemical exposure after leaving the sick house/building. To establish the concept of SHS, we propose to introduce a new classification for SHS. A total of 214 patients complaining of SHS and/or MCS were independently classified using a new classification by clinical ecologists who are experienced physicians with expert knowledge of clinical ecology and general physicians according to disease pathogenesis from clinical records. The classification is as follows: type 1 (symptoms of chemical intoxication), type 2 (symptoms developed possibly due to chemical exposure), type 3 (symptoms developed not because of chemical exposure but rather because of psychological or mental factors), and type 4 (symptoms developed due to allergies or other diseases). The agreements on the classification made by clinical ecologists and general physicians reached 77.1% (Cohen's kappa=0.631), suggesting that this new classification was both apt and accurate. Relations between SHS and allergy/MCS were also studied. The cases classified as SHS type 4 more frequently had allergic past histories than did other types. The proportion of possible MCS cases was higher in the chemical induced SHS group (types 1 and 2) than in other types among male patients. For the universal use in clinical practice, it is necessary to prepare helpful diagnostic criteria of this SHS classification based on pathogenesis and carry our study forward all over the country.

Subgrouping outpatients of an environmental medicine unit using SCL-90-R and cluster analysis.

Between 1999 and 2003 all consecutive outpatients of the environmental medicine unit of the Charité hospital in Berlin were invited to participate in a study on environmentally related disorders. One hundred and sixty-nine of the patients completed a psychosocial questionnaire which comprised SCL-90-R and 14 other tests. When compared with clinical controls, SCL-90-R mean scores of the environmental patients (EP) were found to lie in between those of inpatients of a psychosomatic clinic and melanoma aftercare patients; but they were, with exception of the somatisation dimension, much closer to the latter. Application of the TwoStep Cluster component of SPSS resulted in three subgroups with high, moderate and low scores which were significantly different (p<0.001) although separation was incomplete (87% correct identification; cross-validated discriminant analysis). With all subgroups, scores for somatisation, depression and obsessive compulsion were highest and those for phobic anxiety and psychoticism were lowest. SCL-90-R scores correlated well with results of the Freiburg Personality Inventory, Whiteley Index of hypochondriasis, the short form health questionnaire (SF-36), and the Composite International Diagnostic Interview (CIDI). Hierarchical grouping (average linkage between groups), performed with involvement of SCL-90-R data from literature, resulted in a dendrogram with three distinct groups and three outliers. EP with low SCL-90-R scores were assigned to a group which comprised also general populations (USA, Germany), allergy patients, and melanoma controls. Those with moderate SCL-90-R scores were placed in a group together with chronic pain patients, and 26 'environmentally ill' subjects. The third subgroup of EP formed a cluster with our psychosomatic controls, psychosomatic patients from another study, depressed people, and patients undergoing psychotherapy. The three outliers of the dendrogram, however, were SCL-90-R profiles obtained from persons with toxic waste exposure, neurotoxic workplace exposure or with solvent-induced chronic toxic encephalopathy.

[Trial of isolation of sick house syndrome and unclassified multiple chemical sensitivities--Definition of sick house syndrome, and symptoms].

PURPOSE: This study was designed to clarify the definition of sick house syndrome (SHS). METHODS: SHS was defined based on the disease related to habitation as follows. 1. The cause of the onset of a disease relates to house. 2. Symptoms appear within house. 3. Symptoms will be less serious or disappear if patient away from house. 4. If patient goes into house, symptoms will appear repeatedly. When it corresponded to all above, it was defined to SHS, and it classified as MCS (multiple chemical sensitivities) without above conditions. Even if SHS is isolated from similar disease completely, characteristic symptoms of MCS are hard to be detected because MCS are combination of two or more diseases. Based on this working hypothesis, the logistic regression by setting MCS as reference was performed so that characteristic symptoms of SHS show odds ratios with exceeding one. RESULTS: The odds ratios with more than two of characteristic symptoms in SHS were "nausea or vomiting" "Troublesome in everything" and the causative substances to which symptoms get worse was "The smell of a perfume and cosmetics". Characteristic symptoms of an allergy disease were detected by comparison with the allergic conjunctivitis, allergic rhinitis, and bronchial asthma, respectively. CONCLUSION: These results showed that the classification method was appropriate. This definition is not fundamentally differed from the definition of the sick-building syndrome of WHO.

Evidence for overlap between idiopathic environmental intolerance and somatoform disorders.

OBJECTIVE: Idiopathic environmental intolerance (IEI), also known as multiple chemical sensitivity, is a chronic, polysymptomatic condition that cannot be explained by an organic disease. Physical and psychological complaints are believed to be sustained by low levels of chemically unrelated substances in the environment. At present, it is unclear whether IEI is an environmental illness or a variant of somatoform disorders (SFD). This study examined whether IEI can be distinguished from SFD with respect to self-reported symptoms, trait anxiety, body-related cognitions, and symptom attributions. METHODS: We compared 54 subjects with IEI, 54 subjects with SFD but without IEI, and 44 subjects with neither IEI nor SFD on symptom scales, psychological questionnaires, and structured interviews for IEI, depression, anxiety, and SFD. RESULTS: More than half of the IEI subjects met Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria of SFD. This group shared both symptoms and psychological features of somatization with the SFD group. IEI subjects who did not fulfill criteria for a specific SFD were less impaired by their chemical sensitivity but differed nevertheless from nonsomatoform controls by significantly higher symptom scores, higher trait anxiety, a focus on autonomic sensations, and more pronounced somatic symptom attributions. These psychological features were significantly associated with the burden of somatic symptoms in both SFD and IEI. Furthermore, self-reported allergy but not total immunoglobulin E correlated with symptom burden in the total sample. CONCLUSIONS: The similarity of IEI and SFD regarding symptoms and psychological features of somatization support the hypothesis that IEI is a variant of SFD.

Contact and chemical sensitivities in the hospital environment.

As surgeons, otolaryngologists tend to most be interested in operative procedures and leave the hospital environment to the care of administrators and the nursing staff. Given the dangers that are present, it would seem prudent to spend some time considering the agents that used in patient care and in operating suites, to minimize the risk to patients and co-workers.

[Medical classification of foci of multiple and unknown chemical affections]. / Meditsinskaia sortirovka v ochagakh polikhimicheskikh i neizvestnykh khimicheskikh porazhenii.

The purpose of this work was to define the diagnostic methods in unspecific syndromes of exogenous intoxication and their use for conduction of medical classification in the foci of polychemical and unknown chemical affections. Detection of unspecific syndromes of extreme pathologic process in persons affected by dangerous chemical substances will contribute to organization of two-stage medical support, will facilitate the conduction of medical classification, determination of type and volume of medical assistance.

Psychiatric inferences from data on psychologic/psychiatric symptoms in multiple chemical sensitivities syndrome.

When abnormal psychologic/psychiatric symptom data are obtained on personality tests or psychiatric interviews administered to patients who report symptoms of Multiple Chemical Sensitivities Syndrome, investigators typically attribute these to either psychiatric traits or to psychogenic origins of illness. The primary purpose of these studies was the evaluation of the plausibility of nonpsychiatric explanations of psychologic/psychiatric symptom data. In Study 1, patients with Multiple Chemical Sensitivities Syndrome used the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) to describe which items had changed after they developed the condition. In Study 2, three diverse groups of professionals predicted which items on the MMPI-2 might change after a mentally healthy person developed the Syndrome or a condition resembling it. In Study 3, a second sample of Multiple Chemical Sensitivities Syndrome patients completed the MMPI-2 and other questionnaires by mail, which allowed the authors to ascertain whether these patients showed more or different psychopathology than was described by patients and hypothesized by professionals. Data from Study 1 patient informants indicated that developing the syndrome might result in a psychopathological MMPI-2 profile, characterized by abnormal Hypochondriasis and Hysteria scale scores. Professionals in Study 2 showed a consensus about hypothesized MMPI-2 changes following the development of the syndrome. These changes likely elevated the Hypochondriasis, Hysteria, Psychasthenia, Depression, and Schizophrenia scale scores. In Study 3, the patients taking the MMPI-2 showed elevations on the Hypochondriasis, Hysteria, Depression (women only), and Schizophrenia scales. Abnormal scores were associated closely with greater severity of illness and greater adjustment to illness. The strategy of administering psychometric tests to ill populations for the purposes of evaluating psychiatric illness or traits, and/or psychogenic origins of illness was shown to be potentially misleading.

"Eco-syndrome" ("multiple chemical sensitivity"--MCS).

In the physicians's practice in past decades, an increasing number of patients suffering from polysomatic complaints with a subjective feeling of allergy against environmental noxious agents have been seen. Various names for this condition include "Eco-Syndrome" or "Multiple Chemical Sensitivity" (MCS), "Multiorgan Dysesthesia" or "Idiopathic Environmental Intolerances". The uncertainty in the nomenclature reflects the deficiency in the knowledge of the etiopathophysiology and accordingly the diagnostic and therapeutic procedures. Most patients have completed an odyssey of visiting various specialists including psychiatrists and undergone many kinds of so-called alternative or parascientific procedures. We studied such patients since the early 1980s performing intensive interdisciplinary and allergological investigations. In about two third of the patients psychiatric or psychosomatic disturbances were obvious, but in one third of the patients somatic pathophysiological conditions were regarded as predominant cause of the present complaints. Many patients exhibited various pathophysiological patterns including somatic and psychosomatic alterations. Measurements of indoor air pollutants in the dust or in the air showed in some cases increased values of aromatic hydrocarbones, terpenes etc., without, however, explaining the main complaints. We conclude from our experience that patients presenting with hypersensitivity phenomena related to indoor air pollution are a heterogeneous group. There is no evidence, that "MCS" really exists, often it is diagnosed by the patients themselves. The term "eco-syndrome" describes a "working diagnosis" in order to apply careful interdisciplinary investigations for this heterogeneous group of patients. For the practical management of these patients mutual confidence is a prerequisite for success. The role of indoor air pollutants in triggering unspecific complaints beyond the exclusively toxicological field remains to be elucidated by future studies.

Successful use of a selective serotonin reuptake inhibitor in a patient with multiple chemical sensitivities.

A 53-year-old man with multiple chemical sensitivities (MCS) received the selective serotonin reuptake inhibitor (SSRI) citalopram for treatment of depression. The treatment was successful and, in parallel to the remission of the depressive symptoms, all MCS symptoms vanished. This suggests that a subgroup of MCS patients may have an atypical depression, that they should be psychiatrically evaluated, and that antidepressive pharmacological treatment may be considered in cases of MCS.

Multiple chemical sensitivities--a syndrome of pseudotoxicity manifest as exposure perceived symptoms.

The history of and nomenclature of the multiple chemical sensitivities are reviewed. The author's definition of multiple chemical sensitivity is a symptom complex 1) triggered by odor or a perceived exposure; 2) occurring at exposure levels below those of allergic sensitivity or irritation; 3) analogous to the symptoms of panic disorder as defined by DSM-IV-R; 4) lacking objective clinic pathologic criteria; and 5) responsive to panic disorder management.

White paper: Chemical sensitivity: history and phenomenology.

Nearly everyone has heard something about chemical sensitivity, either from personal experience with someone who has the condition or from the media. The television series Northern Exposure recently featured a chemically sensitive attorney who lived in a geodesic dome in Alaska, and L.A. Law depicted the struggles of a Persian Gulf veteran with chemical sensitivities who lost his case against the Veterans Administration, but may appeal later in the season. Television news programs and the printed media have showcased patients living spartan existences in remote areas or in aluminum foil-lined rooms. Our views of the illness no doubt are colored by our own personal experiences of it. While some discount or make jokes about chemical sensitivity or these patients, physicians who have seen a number of them are discovering that many appear to be credible individuals with prior good work records who say they became ill following an identifiable exposure to chemicals.