Climate change anxiety and its association with somatic symptom distress and idiopathic environmental intolerances: A cross-sectional study.

CONTEXT: Individuals need greater climate change awareness in order to mitigate and adapt to climate changes but this awareness can lead to negative health outcomes including climate change anxiety. OBJECTIVE: To explore the associations between climate change anxiety, idiopathic environmental intolerances and somatic symptom distress, after accounting for modern health worries, anxiety and depression. METHODS: A non-representative sample of healthy volunteers completed a cross-sectional online survey that included the Climate Change Anxiety scale (CCA-13), single questions about idiopathic intolerance to five environmental agents, the Somatic Symptoms scale (SSS-8), the Modern Health Worries scale (MHW-12), and the Patient Health Questionnaire for symptoms of anxiety and depression (PHQ-4). Participants also reported their sex, age and subjective socioeconomic status. Bivariate analyses investigated associations between variables and path analyses explored potential mediating factors. RESULTS: 432 participants completed the questionnaire, 421 of whom were included in analyses (67 % women, mean age: 32.7 standard deviation: 12.4). Climate change anxiety, idiopathic environmental intolerances, somatic symptom distress, modern health worries, and symptoms of anxiety and depression were positively correlated in bivariate analyses (Pearson's ranging from 0.22 to 0.57, all p < 0.001). In path analyses, modern health worries (R2 = 9.9 %) partially mediated the relation between climate change anxiety (R2 = 20.3 %) and two correlated outcome variables, idiopathic environmental intolerances (R2 = 36.8 %) and somatic symptom distress (R2 = 32.4 %). CONCLUSIONS: Climate change anxiety may negatively affect perceived physical health. Stakeholders should aim at promoting climate change awareness while addressing modern health worries to avoid negative health outcomes.

The effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: A systematic review of human experimental studies.

BACKGROUND: The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s exposing large proportions of the population. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF. OBJECTIVES: To systematically assess the effects of exposure to RF-EMF on self-reported non-specific symptoms in human subjects and to assess the accuracy of perceptions of presence or absence of RF-EMF exposure. METHODS: Eligibility criteria: experimental studies carried out in the general population and in individuals with idiopathic environmental intolerance attributed to EMF (IEI-EMF), in any language. INFORMATION SOURCES: Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos, Embase and EMF portal, searched till April 2022. Risk of Bias (ROB): we used the RoB tool developed by OHAT adapted to the topic of this review. SYNTHESIS OF RESULTS: we synthesized studies using random effects meta-analysis and sensitivity analyses, where appropriate. RESULTS: Included studies: 41 studies were included, mostly cross over trials and from Europe, with a total of 2,874 participants. SYNTHESIS OF RESULTS: considering the primary outcomes, we carried out meta-analyses of 10 exposure-outcomes pairs. All evidence suggested no or small non-significant effects of exposure on symptoms with high (three comparisons), moderate (four comparisons), low (one comparison) and very low (two comparisons) certainty of evidence. The effects (standard mean difference, where positive values indicate presence of symptom being exposed) in the general population for head exposure were (95% confidence intervals) 0.08 (-0.07 to 0.22) for headache, -0.01 (-0.22 to 0.20) for sleeping disturbances and 0.13 (-0.51 to 0.76) for composite symptoms; and for whole-body exposure: 0.09 (-0.35 to 0.54), 0.00 (-0.15 to 0.15) for sleeping disturbances and -0.05 (-0.17 to 0.07) for composite symptoms. For IEI-EMF individuals SMD ranged from -0.19 to 0.11, all of them with confidence intervals crossing the value of zero. Further, the available evidence suggested that study volunteers could not perceive the EMF exposure status better than what is expected by chance and that IEI-EMF individuals could not determine EMF conditions better than the general population. DISCUSSION: Limitations of evidence: experimental conditions are substantially different from real-life situations in the duration, frequency, distance and position of the exposure. Most studies were conducted in young, healthy volunteers, who might be more resilient to RF-EMF than the general population. The outcomes of interest in this systematic review were symptoms, which are self-reported. The available information did not allow to assess the potential effects of exposures beyond acute exposure and in elderly or in chronically ill people. It cannot be ruled out that a real EMF effect in IEI-EMF groups is masked by a mix with insensitive subjects. However, studies on symptoms reporting and/or field perceptions did not find any evidence that there were particularly vulnerable individuals in the IEI-EMF group, although in open provocation studies, when volunteers were informed about the presence or absence of EMF exposure, such differences were consistently observed. INTERPRETATION: available evidence suggests that acute RF-EMF below regulatory limits does not cause symptoms and corresponding claims in the everyday life are related to perceived and not to real EMF exposure status.

Combined Neurological Syndrome in Electrohypersensitivity and Multiple Chemical Sensitivity: A Clinical Study of 2018 Cases.

From a cohort of 2018 evaluable consecutive cases issued from the European Clinical Trial Database, we describe the complete clinical symptomatic presentation of electrohypersensitivity (EHS) and multiple chemical sensitivity (MCS) and their association in the framework of a unique, sensitivity-related environmental neurologic syndrome. Eligibility criteria are those of the Atlanta consensus meeting for MCS, and those of WHO for EHS. There were 1428 EHS, 85 MCS and 505 EHS/MCS evaluable cases, so EHS was associated with MCS in 25%. Women appeared to be much more susceptible to EHS and/or to MCS than men, with no statistical significance between the EHS and MCS groups (p = 0.07), but the combined group revealed a more significant female sex ratio of 80.4% (p < 0.0001). All symptoms except emotional behavior were significantly more frequent in EHS patients than in healthy controls (p < 0.0001). We found no pathognomonic symptoms to establish the diagnosis of both disorders or to distinguish EHS from MCS. The three groups of patients were found to share identical symptoms, while several symptoms were found to be more significantly frequent in EHS/MCS than in EHS (p < 0.0001). From these data, we suggest that EHS and MCS are new brain disorders, generated via a common etiopathogenic mechanism.

Multiple Chemical Sensitivity/Idiopathic Environmental Intolerance: A Practical Approach to Diagnosis and Management.

Patients with multiple chemical sensitivity, now called idiopathic environmental intolerance, frequently present to clinical immunologists and allergists for diagnosis and treatment. Patients report a plethora of respiratory and multisystem problems attributed to a wide variety of unrelated, otherwise non-noxious, triggers. They may go to extreme, often seemingly bizarre lengths to avoid contact with everyday exposures and may become housebound, unable to work or function socially. Often beginning with exposure to odors, triggers can multiply to involve foods, clothing, medications, and even electromagnetic radiation. The condition cannot be explained by IgE-mediated or other immune processes, and clinical immunologists and allergists may feel unprepared to care for such patients. In this article, a paradigm to understand the probable mechanisms underlying this condition and a practical approach to diagnosis and management will be presented.

Time course of health complaints attributed to RF-EMF exposure and predictors of electromagnetic hypersensitivity over 10 years in a prospective cohort of Dutch adults.

BACKGROUND: Some individuals attribute health complaints to radiofrequency electromagnetic field (RF-EMF) exposure. This condition, known as idiopathic environmental intolerance attributed to RF-EMFs (IEI-RF) or electromagnetic hypersensitivity (EHS), can be disabling for those who are affected. In this study we assessed factors related to developing, maintaining, or discarding IEI-RF over the course of 10 years, and predictors of developing EHS at follow-up using a targeted question without the condition of reporting health complaints attributed to RF-EMF exposure. METHODS: Participants (n = 892, mean age 50 at baseline, 52 % women) from the Dutch Occupational and Environmental Health Cohort Study AMIGO filled in questionnaires in 2011/2012 (T0), 2013 (T1), and 2021 (T4) where information pertaining to perceived RF-EMF exposure and risk, non-specific symptoms, sleep problems, IEI-RF, and EHS was collected. We fitted multi-state Markov models to represent how individuals transitioned between states ("yes", "no") of IEI-RF. RESULTS: At each time point, about 1 % of study participants reported health complaints that they attributed to RF-EMF exposure. While this percentage remained stable, the individuals who reported such complaints changed over time: of nine persons reporting health complaints at T0, only one reported IEI-RF at both T1 and T4, and two newly reported health complaints at T4. Overall, participants had a 95 % chance of transitioning from "yes" to "no" over a time course of 10 years, and a chance of 1 % of transitioning from "no" to "yes". Participants with high perceived RF-EMF exposure and risk had a general tendency to move more frequently between states. CONCLUSIONS: We observed a low prevalence of IEI-RF in our population. Prevalence did not vary strongly over time but there was a strong aspect of change: over 10 years, there was a high probability of not attributing symptoms to RF-EMF exposure anymore. IEI-RF appears to be a more transient condition than previously assumed.

Multiple Chemical Sensitivity Syndrome: First Symptoms and Evolution of the Clinical Picture: Case-Control Study/Epidemiological Case-Control Study.

Multiple chemical sensitivity (MCS) is a chronic condition characterized by the appearance of symptoms caused by exposure to chemical compounds that are tolerable for the general population. It mainly affects middle-aged women. There are very few studies focusing on the most frequent symptoms of MCS considering age groups and gender. The main goal of this study was to find the most frequent symptoms both at the onset of the disease and at the present time describing them by age groups. The QEESI (Quick Environmental Exposure and Sensitivity Inventory) questionnaire, Scale 3 which assesses symptoms and their severity, was used as a diagnostic tool for the disease. A case-control study was conducted with the participation of 210 people. Of the cases, 94.3% were women. The symptoms that most often manifested first were airway and mucous membrane alterations (68.9%). In the development of the disease, we found cognitive alterations (OR = 31.25), heart or chest problems (OR = 22.49), neuromuscular problems (OR = 20.00) and head-related symptomatology (OR = 19.29). Identifying the most frequent pattern of symptoms by age group and sex will allow an early diagnosis of the disease to improve its prognosis and treatment.

Symptoms of Idiopathic Environmental Intolerance associated with chemicals (IEI-C) are positively associated with perceptual anomalies.

OBJECTIVE: Idiopathic Environmental Intolerance (IEI; i.e. the experience of somatic symptoms attributed to environmental agents) represents a functional somatic syndrome of unclear aetiology. Based on previous findings that suggest an association between IEI and perceptual anomalies, this study aimed to investigate the relationship between symptoms of IEI associated with chemicals (IEI-C) and facets of the schizotypy spectrum. METHODS: A cross-sectional study design was used with N = 410 (78.3% female) persons responding to an online survey in which chemical odor sensitivity (COS) and modern health worries (MHW) that are associated with IEI-C, as well as schizotypal personality traits (SPQ), hallucination proneness (LSHS) and delusional ideation (PDI) as core components of the schizotypy spectrum were assessed. RESULTS: Schizotypal traits were found to be significantly positively associated with MHWs (r = 0.20, p = .01), COS (r = 0.23, p = .01), and showed significant positive associations with hallucination proneness. Magical thinking was found to exhibit a significant positive relationship with both MHW (r = 0.17, p = .01) and COS (r = 0.21, p = .01). These small associations between IEI-C and facets of the psychosis spectrum remained significant even after statistically controlling for individual levels of trait anxiety and depression. CONCLUSION: Schizotypal personality traits, particularly magical thinking, and hallucination proneness, appear positively related to facets of IEI-C. The findings are of relevance for the advancement of theoretical models of IEI.

Physiological changes and symptoms associated with short-term exposure to electromagnetic fields: a randomized crossover provocation study.

BACKGROUND: The biological association between electromagnetic fields (EMF) and idiopathic environmental intolerance attributed to EMF (IEI-EMF) has not been established. To assess the physiological changes and symptoms associated with exposure to EMF, we conducted a randomized crossover provocation study. METHODS: We recruited 58 individuals with IEI-EMF (IEI-EMF group) and 92 individuals without IEI-EMF (control group). In a controlled environment, all participants received EMF signals mimicking those from mobile phone base stations in a randomized sequence under the blinded condition. During the course, participants reported their symptoms and whether they perceived EMF, and we monitored their physiological parameters, including blood pressure (BP), heart rate (HR), and HR variability. RESULTS: The IEI-EMF and control groups reported similar frequencies of symptoms during both the provocation and sham sessions. No participant could accurately identify the provocation. In both groups, physiological parameters were similar between the two sessions. The control group, but not the IEI-EMF group, had elevated HR when they perceived EMF exposure. CONCLUSIONS: No symptoms or changes in physiological parameters were found to be associated with short-term exposure to EMF, and no participant could accurately detect the presence of EMF. Moreover, the participants in the control group, but not those in the IEI-EMF group, had elevated HR when they perceived EMF.

Understanding Patient-Provider Interaction, Treatment Acceptance, and Outcomes in Medically Unexplained Symptoms.

INTRODUCTION: Medically unexplained symptoms (MUS) is an umbrella term used for chronic and often disabling health symptoms and conditions that remain unexplained after standard medical examinations, testing, and/or appropriate workup. Patients with MUS tend to receive little to no treatment but remain distressed, stigmatized, and disabled by symptoms and iatrogenic factors. METHODS: A qualitative phenomenological study was conducted to explore daily challenges and psychosocial and iatrogenic factors affecting the management of MUS. RESULTS: The analysis of the interviews revealed that MUS could cause significant distress to patients, impairing their functioning and leading to permanent disability. Conventional healthcare cannot meet the medical needs of these patients and might be a potential source of harm to them. It should be noted that confirmation of conditions associated with clinically significant psychiatric premorbidity was not provided. CONCLUSION: Inconsistent diagnostic criteria, lack of proper training and research, diagnostic overshadowing, and implicit bias in healthcare professionals can lead to negative patient outcomes and the overuse of alternative or non-evidence-based services. Guidance, practice-based improvement ideas, and suggestions specific to improving patient-provider relationships can be applied to generate positive health effects.

A randomized controlled trial protocol for persistent physical symptoms associated with indoor environment or chronic fatigue: Effectiveness of video-based functional case conceptualization and web-program for improving quality of life.

Introduction: Persistent physical symptoms (PPS) refer to symptoms that cannot be fully explained by structural bodily pathology or by environmental factors. Their impact on daily functioning varies from mild to severe disability. So far, evidence-based treatments for PPS have resulted in only small to moderate effects. Treatment protocols with a stronger orientation toward personalized approaches are needed to improve the efficacy and applicability of treatment. In this study, we aim to assess the effect of an online individual case conceptualization with web-based program for PPS. This study is conducted among two focus groups: patients with indoor air-related symptoms and patients with chronic fatigue syndrome. Methods and analyses: Using a randomized controlled design (RCT) with two parallel groups in a 1:1 ratio, we will compare individual video-based case conceptualization with a web-based program based on Acceptance and Commitment Therapy (ACT), combined with treatment as usual, with treatment as usual only. The web-based program consists of ten modules, each lasting 1 week and including training. The planned sample size is 124 eligible patients without attrition. The primary outcome will be the health-related quality of life as measured by the 15D questionnaire. The secondary outcome measures will include questionnaires on psychiatric and physical symptoms, illness perceptions, psychological flexibility, and work ability. We will also use national registers to obtain information on the use of healthcare and social benefits to complete patient-reported outcomes. Data collection began in August 2020 and will continue until 2023. Discussion: This trial will provide information on the effects and usefulness of an online administrated individual case conceptualization and an ACT-based web-program on PPS. Ethics and dissemination: The Ethics Committee of the Hospital District of Helsinki and Uusimaa, Finland, has granted approval for the study. The results will be published in peer-reviewed journals. Clinical Trial Registration: Clinicaltrials.gov, identifier NCT04532827 preresults.

The effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: A protocol for a systematic review of human experimental studies.

BACKGROUND: The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s across multiple sectors exposing large proportions of the population. This fact has raised concerns related to the potential consequences to people's health. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF and has carried out an international survey amongst experts, who have identified six priority topics to be further addressed through systematic reviews, whereof the effects on symptoms is one of them. We report here the systematic review protocol of experimental studies in humans assessing the effects of RF-EMF on symptoms. OBJECTIVE: Our objectives are to assess the effects of exposure to electromagnetic fields (compared to no or lower exposure levels) on symptoms in human subjects. We will also assess the accuracy of perception of presence of exposure in volunteers with and without idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF). ELIGIBILITY CRITERIA: We will search relevant literature sources (e.g. the Web of Science, Medline, Embase, Epistemonikos) for randomized trials (comparing at least two arms) and randomised crossover trials of RF-EMF exposure that have assessed the effects on symptoms. We will also include studies that have measured the accuracy of the perception of the presence or absence of exposure. We will include studies in any language. STUDY APPRAISAL AND SYNTHESIS: Studies will be assessed against inclusion criteria by two independent reviewers. Data on study characteristics, participants, exposure, comparators and effects will be extracted using a specific template for this review, by two independent reviewers. Discrepancies will be solved by consensus. Risk of bias (ROB) will be assessed using the ROB Rating Tool for Human and Animal Studies and the level of confidence in the evidence of the exposure-outcome relations will be assessed using the GRADE approach. For the perception studies, we will use adapted versions of the ROB tool and GRADE assessment. Where appropriate, data will be combined using meta-analytical techniques.

Transcriptomic Profiling of Adult-Onset Asthma Related to Damp and Moldy Buildings and Idiopathic Environmental Intolerance.

A subset of adult-onset asthma patients attribute their symptoms to damp and moldy buildings. Symptoms of idiopathic environmental intolerance (IEI) may resemble asthma and these two entities overlap. We aimed to evaluate if a distinct clinical subtype of asthma related to damp and moldy buildings can be identified, to unravel its corresponding pathomechanistic gene signatures, and to investigate potential molecular similarities with IEI. Fifty female adult-onset asthma patients were categorized based on exposure to building dampness and molds during disease initiation. IEI patients (n = 17) and healthy subjects (n = 21) were also included yielding 88 study subjects. IEI was scored with the Quick Environmental Exposure and Sensitivity Inventory (QEESI) questionnaire. Inflammation was evaluated by blood cell type profiling and cytokine measurements. Disease mechanisms were investigated via gene set variation analysis of RNA from nasal biopsies and peripheral blood mononuclear cells. Nasal biopsy gene expression and plasma cytokine profiles suggested airway and systemic inflammation in asthma without exposure to dampness (AND). Similar evidence of inflammation was absent in patients with dampness-and-mold-related asthma (AAD). Gene expression signatures revealed a greater degree of similarity between IEI and dampness-related asthma than between IEI patients and asthma not associated to dampness and mold. Blood cell transcriptome of IEI subjects showed strong suppression of immune cell activation, migration, and movement. QEESI scores correlated to blood cell gene expression of all study subjects. Transcriptomic analysis revealed clear pathomechanisms for AND but not AAD patients. Furthermore, we found a distinct molecular pathological profile in nasal and blood immune cells of IEI subjects, including several differentially expressed genes that were also identified in AAD samples, suggesting IEI-type mechanisms.

An Unusual Case of Multiple Food Allergies Comorbid with Multiple Chemical Sensitivity: A Case Report.

PURPOSE: To report the case of a patient with multiple food allergies comorbid with multiple chemical sensitivity (MCS) who was misdiagnosed on various occasions, resulting in a negative impact on the patient's personal and social life. CASE REPORT: We present the case of a 43-year-old Colombian women with multiple food allergies concomitant with MCS. Symptoms started with a mild reaction to insecticides, car exhaust smoke, and perfumes and gradually evolved into a severe reaction to her environment. She also presented recurrent episodes of clinical reactivity to foods and persistent elevated IgE levels, as well as several life-threatening anaphylactic reactions. Alternative and allopathic therapies were applied, but her symptoms persisted. Various diagnoses were made before the definitive diagnosis. CONCLUSION: MCS is an unusual entity of unknown pathophysiology that can, on rare occasions, coexist with food allergies. Early recognition and multidisciplinary treatment are required as these entities have a major impact on the patient's quality of life. We present the first Latin American case regarding the association of the two diseases.

Which sources of electromagnetic field are of the highest concern for electrosensitive individuals? - Questionnaire study with a literature review.

The primary goal of the study was to identify sources of electromagnetic field (EMF) which are attributed to negative health outcomes by a general population of electrohypersensitive (EHS) individuals. Secondary goal was to investigate the differences in indicated sources in subgroups distinguished based on gender, sex, place of living, place of work and the distance between place of living and the nearest mobile phone base station (MPBS). The cross-sectional study aiming to describe and analyze the population of EHS subjects was performed using a web-based questionnaire. The full survey consisted of 32 questions and concerned participants' baseline characteristics and details on sensitivity to electronic devices. Participants were regarded as EHS if they answered "yes" to the question "Do the electric/electronic/telecommunication devices negatively affect your well-being?" and indicated at least one device which in their opinion had such an impact. We identified 408 EHS subjects, out of which 288 (70.73%) were females and 120 (29.27%) were males. Phones, especially mobile devices, were attributed to negative health outcomes by the highest number of subjects (309, 75.74% and 267, 65.44% for phones and mobile phones, respectively). Additional subgroup analysis indicated that older participants and participants who live closer to MPBS more often complained of physical symptoms attributed to MPBS impact (p = .02 and p < .01, respectively). Phones, especially mobile devices, are the most important source of EMF influencing EHS subjects. People who self-reported living closer to MPBS and older individuals seem to be remarkably more concerned about MPBS health impact.

Prospective study of nocebo effects related to symptoms of idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF).

The exact causes of Idiopathic Environmental Intolerance Attributed to Electromagnetic Fields (IEI-EMF, i.e., experience of somatic symptoms attributed to low-level electromagnetic fields) are still unknown. Psychological causation such as nocebo effects seem plausible. This study aimed to experimentally induce a nocebo effect for somatic symptom perception and examined whether it was reproducible after one week. We also examined whether these effects were associated with increased sympathetic activity and whether interoceptive accuracy (IAcc) moderated these relationships. Participants were recruited from the general population and instructed that electromagnetic exposure can enhance somatosensory perception. They participated twice in a cued exposure experiment with tactile stimulation and sham WiFi exposure in 50% of trials. The two sessions were scheduled one week apart (session 1: N = 65, session 2: N = 63). Before session 1, participants watched either a 6-min film on adverse health effects of EMF or a neutral film on trade of mobile phones. IAcc was assessed with the heartbeat detection paradigm. Electrodermal activity served as a measure of sympathetic activation. Evidence for a nocebo effect (i.e., increased self-reported intensity and aversiveness and electrodermal activity) during sham WiFi exposure was observed in both sessions. IAcc moderated the nocebo effect, depending on stimulus intensity. Contrary to previous findings, no difference emerged between the health-related EMF and the neutral films. Based on negative instructions, somatic perception and physiological responding can be altered. This is consistent with the assumption that IEI-EMF could be due to nocebo effects, suggesting an important role for psychological interventions.

Co-Designed Exposure Protocol in the Study of Idiopathic Environmental Intolerance Attributed to Electromagnetic Fields.

The hypothesis of an electromagnetic origin of idiopathic environmental intolerance (IEI) attributed to electromagnetic fields (EMF) has been widely investigated by provocation studies, which consist of deliberately exposing people with IEI-EMF in laboratory settings to particular EMF to observe volunteers' reactions. In the majority of these studies, reactions have been found to be independent of exposure. However, most of these studies suffer from design and methodological limitations that might bias their findings or reduce their precision. As provocation studies are best suited for isolating the effects of EMF, innovative protocols should be applied. In the ExpoComm project (PNREST Anses, EST/2017/2 RF/19), several innovations have been introduced: the involvement of people with IEI-EMF in the development of the protocol, the attenuation of the anxiogenic nature of the tests, the individualization of the protocol, the validation of the neutral or normal reactivity state before the test, and the use of a cocktail of real, rather than artificially generated, sources. The objective of involving people with IEI-EMF was to increase the relevance and acceptability of the protocol, while respecting technical constraints and scientific quality requirements. This paper describes the protocol resulting from the collaborative process. Bioelectromagnetics. 2020;41:425-437. © 2020 Bioelectromagnetics Society.