Exploring the contributing factors to multiple chemical sensitivity in patients with migraine.

OBJECTIVE: Multiple chemical sensitivity (MCS) is a form of chemical intolerance in which various systemic symptoms are triggered by exposure to a variety of chemical substances. Although migraine has been associated with central sensitivity syndrome, the relationship between MCS and migraine has not been studied. We assessed the frequency of MCS and its related factors in patients with migraine. METHODS: We performed a cross-sectional study that included 95 patients (14 M/81 F; age, 45.4 ± 12.4 years) out of 100 consecutive patients with migraine from our outpatient headache clinic. MCS was defined as having a combination of Q1 ≥ 30, Q3 ≥ 13, and Q5 ≥ 17 on the quick environment exposure sensitivity inventory (QEESI; Japanese version). Central sensitization inventory-A scores >40 were considered an indication of central sensitization. Headache-related disability and psychological distress were evaluated with the Migraine Disability Assessment score (MIDAS) and Kessler Psychological Distress Scale (K6), respectively. RESULTS: MCS was identified in 20% of patients with migraine; however, none had previously been diagnosed with MCS. The MCS-positive group had higher rates of photophobia, osmophobia, visual aura, sensory aura, and central sensitization and higher MIDAS and K6 scores than the MCS-negative group. A logistic regression analysis showed that osmophobia, sensory aura, and central sensitization were significant contributors to MCS. CONCLUSION: We showed that MCS was observed in 20% of patients with migraine, and our study results may indicate a possible association of MCS with central sensitization and hypersensitivity-related symptoms in patients with migraine.

[Multiple chemical sensitivity and recurrent lower urinary tract symptoms (LUTS). Contribution with an illustrative urological case.] / Sensibilidad química múltiple y síntomas recurrentes del tracto urinario inferior (STUI). Contribución con caso urológico ilustrativo.

INTRODUCTION AND OBJECTIVES: Multiple chemical sensitivity (MCS) is a disease due to a disproportionate systemic response to chemical agents presentin the environment. ts urinary manifestations are rare and poorly understood. We present a case with recurrent lower urinary tract symptoms (LUTS) and review these symptoms in Spanish and foreign publications. CLINICAL CASE: A 30-year-old woman was referred for study of recurrent lower urinary tract symptoms of 17 years of evolution, triggered by food, perfumes, cleaning products, cosmetics and bleach. Repeated analytical, radiological and functional tests were normal. We suspected that she might suffer from MCS and advised a study in Preventive Medicine. The patient consulted an Environmental Medicine Center, and was diagnosed as having gradeIII-IV/IV MCS. CONCLUSIONS: This is the first case of MCS diagnosed from urinary clinical manifestations. Among the causes of LUTS we should also think of MCS.

INTRODUCCIÓN Y OBJETIVOS: La sensibilidad química múltiple (SQM) es una enfermedad debida a una respuesta sistémica desproporcionada a los agentes químicos presentes en el medio ambiente. Sus manifestaciones urinarias son raras y poco conocidas. Presentamos un caso que cursó con síntomas recurrentes del tracto urinario inferior (STUI) y revisamos estos síntomas en publicaciones españolas y extranjeras.CASO CLÍNICO: Mujer de 30 años remitida para estudio de síntomas recurrentes del tracto urinario inferior de 17 años de evolución, desencadenados por alimentos, perfumes, productos de limpieza, cosméticos y lejía. Repetidas pruebas analíticas, radiológicas y funcionales fueron normales. Sospechamos que podía padecer SQM, aconsejando estudio en Medicina Preventiva. La paciente consultó en un Centro de Medicina Ambiental, diagnosticándole SQM grado III-IV/IV.CONCLUSIONES: Éste es el primer caso de SQM diagnosticado a partir de manifestaciones clínicas del tracto urinario inferior. Entre las causas de STUI deberíamos pensar también en la SQM.

Síndrome de sensibilidad química múltiple y gestación: cómo actuar / Management of multiple chemical sensitivity syndrome in pregnancy

El síndrome de sensibilidad química múltiple es un trastorno crónico poco conocido que ocasiona múltiples síntomas en diversos aparatos y sistemas del organismo tras la exposición a agentes químicos a muy bajas concentraciones consideradas no perjudiciales para la población. Se trata de un proceso de instauración solapada y progresiva que afecta de forma mayoritaria a mujeres de mediana edad. En 1987 Cullen propone el término de SQM, no siendo hasta 1999 cuando se llega a un consenso para su diagnóstico basado en los criterios de Nethercott, los cuales son publicados por Bartha. En España se reconoce la enfermedad en el año 2014 incluyéndose en el CIE-9-MC con el código 995, dentro del acápite de alergias no especificadas. Una actualización posterior en el año 2016 del CIE-10-MC la clasifica con el código T78.40. Su etiopatogenia a día de hoy es desconocida, por lo que la OMS no la ha reconocido como enfermedad, pero se cree que podrían participar factores genéticos, alergénicos, químicos y anatómicos. Se trata de una enfermedad neurológica, con factores de predisposición claros, que empeora al hacer sobreesfuerzos físicos o ante estresores psicológicos mínimos, así como por exposición a factores químicos y ambientales. Su diagnóstico es fundamentalmente clínico y a día de hoy no tiene un tratamiento específico. Exponemos el caso de una gestante afecta de esta patología, así como las medidas llevadas a cabo de forma multidisciplinar en el manejo del parto y puerperio inmediato

Multiple Chemical Sensitivity Syndrome is a poorly understood chronic disorder that causes multiple symptoms in various body systems and organs following exposure to chemicals at very low concentrations that are not considered to be harmful to the population. It is an overlapping and progressive process that mostly affects middle-aged women. In 1987 Cullen proposed the term MCS, but it was not until 1999 that a consensus was reached for its diagnosis based on Nethercott's criteria, which were published by Bartha. In Spain, the disease was recognized in 2014 and was included in the ICD-9-MC with the code 995, under the heading of Unspecified Allergies. A later update in 2016 of the ICD-10-MC classifies it as code T78.40. Its aetiopathogenesis is currently unknown, thus it has not been recognised by the WHO as a disease, but it is believed that genetic, allergenic, chemical, and anatomical factors may be involved. It is a neurological disease, with clear predisposing factors, which is made worse by physical overexertion or minimal psychological stress, as well as by exposure to chemical and environmental factors. Its diagnosis is fundamentally clinical, and it currently does not have a specific treatment. The case is presented of a pregnant woman affected by this disorder, who was cared for by a multidisciplinary team in the management of the childbirth and immediate puerperium

Multiple Chemical Sensitivity Syndrome: A Principal Component Analysis of Symptoms.

Multiple Chemical Sensitivity (MCS) is a chronic and/or recurrent condition with somatic, cognitive, and affective symptoms following a contact with chemical agents whose concentrations do not correlate with toxicity in the general population. Its prevalence is not well defined; it mainly affects women between 40 and 50 years, without variations in ethnicity, education and economic status. We aimed to assess the core symptoms of this illness in a sample of Italian patients. Two physicians investigated different symptoms with a checklist compilation in 129 patients with MCS (117 women). We conducted a categorical Principal Component Analysis (CATPCA) with Varimax rotation on the checklist dataset. A typical triad was documented: hyperosmia, asthenia, and dyspnoea were the most common symptoms. Patients also frequently showed cough and headache. The CATPCA showed seven main factors: 1, neurocognitive symptoms; 2, physical (objective) symptoms; 3, gastrointestinal symptoms; 4, dermatological symptoms; 5, anxiety-depressive symptoms; 6, respiratory symptoms; 7, hyperosmia and asthenia. Patients showed higher mean prevalence of factors 7 (89.9%), 6 (71.7%), and 1 (62.13%). In conclusion, MCS patients frequently manifest hyperosmia, asthenia, and dyspnoea, which are often concomitant with other respiratory and neurocognitive symptoms. Considering the clinical association that is often made with anxiety, more studies are necessary on the psychosomatic aspects of this syndrome. Further analytical epidemiological studies are needed to support the formulation of aetiological hypotheses of MCS.

Hypnosis as Sole Anesthesia for Dental Removal in a Patient with Multiple Chemical Sensitivity.

Despite a number of studies on hypnosis as analgesia and anesthesia in several medical conditions, case studies on patients with multiple chemical sensitivity (MCS) are still relatively few. This case study is about a female patient with MCS who underwent dental removal using hypnosis as the sole anesthesia. The paradigm in which we work is psychosocial genomics of clinical hypnosis. We used the mind-body transformations therapy, one of the clinical methods of the psychosocial genomics paradigm. In order to induce not only effective analgesia and anesthesia but also a condition of well-being, problem-solving, effective coping and self-empowerment in our patient, 3 different hypnotic protocols were used in a multidimensional approach. Although further research is needed, our work might open up new scenarios for the application of hypnosis as sole anesthesia in conditions such as MCS.

Electrohypersensitivity as a Newly Identified and Characterized Neurologic Pathological Disorder: How to Diagnose, Treat, and Prevent It.

Since 2009, we built up a database which presently includes more than 2000 electrohypersensitivity (EHS) and/or multiple chemical sensitivity (MCS) self-reported cases. This database shows that EHS is associated in 30% of the cases with MCS, and that MCS precedes the occurrence of EHS in 37% of these EHS/MCS-associated cases. EHS and MCS can be characterized clinically by a similar symptomatic picture, and biologically by low-grade inflammation and an autoimmune response involving autoantibodies against O-myelin. Moreover, 80% of the patients with EHS present with one, two, or three detectable oxidative stress biomarkers in their peripheral blood, meaning that overall these patients present with a true objective somatic disorder. Moreover, by using ultrasonic cerebral tomosphygmography and transcranial Doppler ultrasonography, we showed that cases have a defect in the middle cerebral artery hemodynamics, and we localized a tissue pulsometric index deficiency in the capsulo-thalamic area of the temporal lobes, suggesting the involvement of the limbic system and the thalamus. Altogether, these data strongly suggest that EHS is a neurologic pathological disorder which can be diagnosed, treated, and prevented. Because EHS is becoming a new insidious worldwide plague involving millions of people, we ask the World Health Organization (WHO) to include EHS as a neurologic disorder in the international classification of diseases.

Manejo anestésico de histerectomía más doble anexectomía por tumor borderline de ovario izquierdo en paciente con síndrome de sensibilidad química múltiple / Anesthetic management of hysterectomy and double adnexectomy for borderline left ovarian tumor in a patient with multiple chemical sensitivity syndrome

El síndrome de sensibilidad química múltiple (SQM), también conocido como intolerancia ambiental idiopática (IAI), entre otros, es un desorden complejo y mal definido que produce diversos síntomas en respuesta a diferentes estímulos. No hay estudios válidos que establezcan la patogénesis de este síndrome. El manejo anestésico de estos pacientes es un reto para los anestesiólogos, dado que no hay unas pautas de actuación establecidas. Se presenta un caso de cirugía exitosa en una paciente afecta de SQM realizándose una anestesia total intravenosa (TIVA) convencional a la que se añadió una premedicación exhaustiva y la aplicación del protocolo de alergia al látex

The multiple chemical sensitivity syndrome (MCS), also known as idiopathic environmental intolerance (IAI), among others, is a complex and poorly defi ned disorder that produces various symptoms in response to various stimuli. There is a lack of valid studies that establish the pathogenesis of this syndrome. The anesthetic management of these patients is a challenge for anesthesiologists, due to the fact that there are no established guidelines. We present a case of successful surgery in a patient that suffers from MCS by performing a conventional TIVA enhanced with a thorough premedication and the latex allergy protocol

Sensibilidad Química Múltiple: análisis de un caso registrado en un Hospital de referencia / Multiple Chemical Sensitivity: analysis of a case registered in a reference hospital

Introducción: La contaminación y la exposición a productos químicos han condicionado un aumento de la prevalencia de enfermedades crónicas no sólo explicables por la genética o susceptibilidad individual. La Sensibilidad Química Múltiple (SQM) es un ejemplo de estas afecciones. Se trata de un trastorno adquirido, crónico y caracterizado por la aparición de síntomas recurrentes como respuesta a la exposición a compuestos químicos en concentraciones que no se consideran tóxicas para la población general. Su etiología es incierta y multifactorial, su diagnóstico clínico y su abordaje multidisciplinar. En ocasiones está vinculada a la exposición ocupacional, aunque la diversidad de sustancias que pueden desencadenarla la convierten en impredecible. Objetivo: La finalidad de este trabajo es aportar una visión general sobre esta patología con el objetivo de analizar la situación derivada de dicha afección tras la revisión de un caso de SQM. Metodología: Revisión bibliográfica del SQM mediante la búsqueda de literatura científica durante el mes de septiembre de 2017 utilizando los términos Mesh «Multiple Chemical Sensitivity.» Se presenta un caso clínico con diagnóstico de SQM vinculado a exposición ocupacional y se analiza la situación derivada de esta afección. Resultados: Se describe el caso clínico de una trabajadora de 45 años de edad, técnico de laboratorio en un hospital de referencia que tras el diagnóstico de hiperreactividad bronquial probablemente relacionado con la exposición a determinados reactivos comienza un periodo de incapacidad temporal con adaptaciones, cambios de puesto de trabajo y múltiples valoraciones por distintos especialistas hasta llegar al diagnóstico de SQM. Se analiza el informe médico de valoración y el expediente administrativo derivado de esta afección poniendo de manifiesto la dificultad que entraña la valoración de este tipo de patologías. Conclusión: Las peculiaridades del SQM en cuanto etiología, diagnóstico y tratamiento obligan a individualizar cada caso. La subjetividad que rodea el SQM lo convierte en una afección muy difícil de valorar. Uno de los grandes desafíos en la actualidad es continuar investigando para facilitar el abordaje multidisciplinar que requiere esta dolencia

Introduction: Pollution and exposure to chemical products has conditioned an increase in the prevalence of chronic diseases not only explained by genetics or individual susceptibility. The Multiple Chemical Sensitivity (MCS) is an example of these conditions. It is an acquired, chronic disorder identified by recurrent symptoms in response to exposure to chemical compounds at concentrations that are not considered toxic for the general population. Its etiology is uncertain and multifactorial; its diagnosis is clinical and must be multidisciplinary approached. It is sometimes linked to occupational exposure, being unpredictable most of the times due to the diversity of the categories that may trigger it. Objective: The purpose of this work is to provide a general overview of this pathology with the aim of analize the situation derived from this condition reviewing a case of MCS. Methodology: Literature review of the MCS through the search of scientific literature in the month of September 2017 using the terms Mesh «Multiple Chemical Sensitivity». A clinical case with a MCS diagnosis linked to an occupational exposure is presented and the consequences of the condition are analyzed. Results: The clinical case of a 45-year-old female laboratory technician in a reference hospital is described. After the diagnosis of bronchial hyperreactivity, probably related to certain reagents exposure, she begins a period of temporary disability with adaptations, changes in workplace and several valuations by specialized doctors ending with the diagnosis of MCS. The analysis of the medical assessment report and administrative record highlights the difficulty to assess this type of pathologies. Conclusion: The peculiarities of MCS in terms of etiology, diagnosis and treatment make it necessary to individualize each single case. The subjectivity surrounding the SQM makes it a very difficult condition to assess. One of the great challenges nowadays is to continue researching to facilitate the multidisciplinary approach that this ailment requires

Anestesia con sevoflurano para cirugía de senos paranasales en un paciente con sensibilidad química múltiple / Sevoflurane anaesthesia for nasal surgery in a patient with multiple chemical sensitivity

El síndrome se sensibilidad química múltiple supone un conjunto de desórdenes complejos que incluyen, entre otros, una serie de trastornos psiquiátricos, síntomas de fatiga crónica y/o trastornos respiratorios. Los desencadenantes del cuadro serían alergenos inespecíficos o tóxicos que provocan una sensibilización neurofisiológica y la aparición de la sintomatología clínica. El tratamiento anestésico de estos pacientes supone siempre un reto para el anestesiólogo por la búsqueda y utilización de fármacos que no desencadenen o agraven los síntomas de dicha enfermedad. Así, el sevoflurano en estas circunstancias podría acercarse al «anestésico ideal». La realización de anestesia general con sevoflurano como agente anestésico único, junto con una serie de medidas ambientales, fueron la base para la realización exitosa de la cirugía en una paciente afecta de síndrome se sensibilidad química múltiple (AU)

Multiple chemical sensitivity syndrome is a group of complex disorders that include psychiatric disorders, chronic fatigue and/or respiratory problems. This syndrome could be triggered by specific allergens and toxins that cause neurophysiological sensitization and the appearance of the clinical symptomatology. Anaesthesia for these patients always poses a challenge for the anaesthetist, because they need to find and use drugs that do not trigger or aggravate the symptoms of the disease. Therefore, sevoflurane in these circumstances might be "the ideal anaesthetic". Performing general anaesthesia with sevoflurane as the sole anaesthetic agent, together with a series of environmental measures formed the basis for successful anaesthesia and surgery in our patient with a multiple chemical sensitivity syndrome (AU)

The association between multiple chemical sensitivity and mental illness: Evidence from a nationally representative sample of Canadians.

OBJECTIVE: The goal of the present study was to investigate the association between multiple chemical sensitivity (MCS) and major depressive disorder (MDD), generalized anxiety disorder (GAD), MDD and GAD comorbidity (MDD+GAD), severe distress, and positive mental wellbeing. METHODS: This cross-sectional investigation was carried out using the 2012 Canadian Community Health Survey - Mental Health Component. The study population consisted of 21,977 individuals aged 20 and older, from Canada's ten provinces. Odds ratios were computed using multinomial logistic regression to calculate estimates of the association between MCS and mental illness. All analyses were weighted to take into account the complex survey design. RESULTS: Individuals with MCS had 2.37 (1.55, 3.64) times greater odds of MDD, 3.09 (1.80, 5.30) times greater odds of MDD+GAD, and 2.60 (1.67, 4.07) times greater odds of severe distress. No association between MCS and GAD was observed. A sex difference was observed with males with MCS having lower odds of positive mental wellbeing, whereas no association was observed in females. CONCLUSIONS: The present study findings supported an association between MCS and mental illness. The causal mechanism supporting this association remains unclear.

Multiple chemical sensitivity: Genotypic characterization, nutritional status and quality of life in 52 patients. / Sensibilidad química múltiple: caracterización genotípica, estado nutricional y calidad de vida de 52 pacientes.

BACKGROUND AND OBJECTIVES: Multiple chemical sensitivity (MCS) is a chronic, multisystem syndrome of unknown etiology. The aim of the present study was to describe the nutritional status and quality of life of patients suffering from MCS, as well as to identify potential polymorphisms associated with this illness. PATIENTS AND METHODS: A cross-sectional, descriptive study was performed on patients with a diagnosis of MCS. Data on anthropometric and body composition variables, hand muscle strength and quality of life were collected. The selection of single nucleotide polymorphisms (SNPs) was based on genes previously associated with MCS and genes involved in inflammatory and oxidative stress pathways. RESULTS: A total of 52 patients (93.2% female), with a mean age of 50.9 (10.3) years were included in the study. Among them, based on their BMI, 48% had an inadequate nutritional status (17% were underweight and 32% were overweight or obese). Thirty percent of patients had a low muscle mass for their age, 84% had muscle strength below the tenth percentile, and 51.8% had a high fat mass percentage. Regarding quality of life, all median scores were lower than those of other illnesses assessed for every subscale assessed. Statistically significant differences between patient cases and controls were found with respect to rs1801133 (MTHFR), rs174546 (FADS1) and rs1801282 (PPARγ) polymorphisms. CONCLUSION: A high percentage of patients had a poor nutritional status, low muscle strength and decreased muscle mass. These facts exacerbate the already-lower quality of life of these patients. Specific genetic polymorphisms associated with the syndrome or its pathogenesis were not identified.

Differences in psychological and somatic symptom cluster score profiles between subjects with Idiopathic environmental intolerance, major depression and schizophrenia.

Idiopathic Environmental Intolerance (IEI) has been associated with psychogenic factors and an increased number of comorbid psychiatric disorders such as depression and anxiety disorder. The purpose of the current study was to examine a possible overlap of psychological and somatic symptoms between subjects with IEI and patients with major depression and schizophrenia as well as to specify characteristic differences. The different symptom clusters included symptoms of chemical intolerance, neurotoxicity and psychological distress as well as measurements of mental health such as anxiety, depression, somatoform symptoms, and schizophrenia-specific disturbances in cognitive domains. IEI patients reported higher overall levels in physical symptoms such as chemical intolerance, neurotoxicity and somatic symptoms not attributable to an organic cause. Schizophrenia patients showed higher overall levels in self-experienced disturbances in several schizophrenia-specific cognitive domains, whereas general psychological distress, anxiety and depression were rated highest by patients with major depression. Importantly, the groups markedly differed in the shapes of profiles of various symptom clusters. Our results provide evidence that IEI patients can be distinguished on the phenomenological level from patients with major depression or schizophrenia, and that distinct domains of psychological and somatic symptoms are particularly problematic in specific diagnostic groups.

A randomised, placebo-controlled trial of transcranial pulsed electromagnetic fields in patients with multiple chemical sensitivity.

OBJECTIVE: To evaluate the efficacy of transcranially applied pulsed electromagnetic fields (PEMF) on functional impairments and symptom severity in multiple chemical sensitivity (MCS) patients. METHODS: The study was conducted as a nationwide trial in Denmark using a randomised, parallel-group, double-blind and placebo-controlled design. Sample size was estimated at 40 participants. Eligibility criteria were age 18-75 years and fulfilment of the MCS case criteria. Participants received either PEMF or placebo PEMF (no stimulation) applied transcranially for 6 weeks. The primary outcome was the Life Impact Scale (LIS) of the Quick Environmental Exposure and Sensitivity Inventory (QEESI). Secondary outcomes were the Symptom Severity Scale (SSS) and the Chemical Intolerance Scale of QEESI. RESULTS: A total of 39 participants were randomised to PEMF or placebo treatment. No significant difference was observed on QEESI LIS between groups with a mean change score of -5.9 in the PEMF group compared with -1.5 in the placebo group (p=0.35, effect size=-0.31). However, a significant decrease was detected on QEESI SSS within and between groups with a mean change score of -11.3 in the PEMF group compared with -3.2 in the placebo group (p=0.03, effect size=-0.60). CONCLUSION: PEMF treatment of 6 weeks showed no effect on functional impairments in MCS. However, a significant decrease in symptom severity was observed.

Lack of contralateral suppression in transient-evoked otoacoustic emissions in multiple chemical sensitivity: a clinical correlation study.

Multiple chemical sensitivity (MCS) is a chronic disorder characterized by a variety of symptoms associated with the exposure to chemicals at a concentration below the toxic level. Previous studies have demonstrated peculiar responses in brain activity in these patients with respect to sensory stimuli while the association between chemical sensitivity and other environmental intolerances such as noise sensitivity has been questioned by researchers. In this study, a cohort of 18 MCS patients underwent transient-evoked otoacoustic emission (TEOAE) testing with and without contralateral suppression to evaluate the functionality of the medial olivocochlear (MOC) reflex involved in speech-in-noise sensitivity. Results were compared with an age- and gender-matched control group (n = 20) and correlation analysis with disease onset and quick environmental exposure sensitivity inventory (qEESI) symptom severity scale was performed. Subjects affected by MCS showed statistically significant impairment of MOC reflex, and the onset of the disease and several symptom subscales showed to be correlated to such reduction in some of the frequencies tested. These data suggest that alterations of MOC reflex could be part of the complex features of this disease although more studies are needed to further explore auditory perception disorders in environmental intolerances.

Sensibilidad química múltiple: evaluación clínica de la gravedad y perfil psicopatológico / Multiple chemical sensitivity: Clinical evaluation of the severity and psychopathological profile

Introducción y objetivo: La sensibilidad química múltiple (.SQM) es un trastorno multisistémico de etiología controvertida que afecta a algunos sujetos al exponerse a productos químicos a concentraciones no perjudiciales. El objetivo de este trabajo es describir las características epidemiológicas, clínicas y psicológicas de una muestra de pacientes con SQM, para un posterior tratamiento grupal específico. Pacientes y método: Estudio descriptivo de los pacientes diagnosticados de SQM en una unidad de toxicología, mediante la administración del cuestionario Quick Environmental Exposure and Sensitivity Inventory, junto con la entrevista estructurada SCID-II, la escala de ansiedad HAS y el test de personalidad tipo A, PCTA. Resultados: Se incluyeron 73 pacientes, con una edad media de 52,6 años (rango 33-77; DE 9,29), siendo 66 mujeres (90,4%). El 53% estaban clasificados como grado i-ii y ii. Sesenta y un pacientes (83%) presentaron algún tipo de comorbilidad, fundamentalmente dolor crónico, fibromialgia y fatiga crónica, con niveles de ansiedad mayores (puntuación media 19,2), predominio de rasgos de personalidad fóbico-evitativo y patrón de conducta tipo A (31,1%). Conclusiones: La SQM afecta principalmente a mujeres de mediana edad, con comorbilidades (dolor crónico, fibromialgia y fatiga crónica), elevada ansiedad y conductas de evitación. Este análisis previo debería ayudar a ofrecer un abordaje psicoterapéutico específico a estos pacientes (AU)

Introduction and objective: Multiple chemical sensitivity (MCS) is a multisystem disorder of controversial etiology, affecting some subjects when exposed to chemicals at no harmful concentrations. The objective of this paper is to describe the epidemiological, clinical and psychological features of a sample of patients with MCS for further specific group treatment. Patiens and method: Descriptive study of patients diagnosed with MCS in a toxicology unit. We administered the Quick Environmental Exposure and Sensitivity Inventory, the structured interview SCID-II, the anxiety scale HAS and the type A personality test, PCTA. Results: Seventy-three patients were included. The mean age was 52,6 years (range 33-77; SD 9.29). Sixty-six were females (90.4%). Fifty-three percent were classified as i-ii and ii grade. Sixty-one patients (83%) presented some type of comorbidity, mainly chronic pain, fibromyalgia and chronic fatigue. They exhibited higher levels of anxiety (average score of 19.2), prevalence of phobic-avoidant traits of personality and type A behavior in 31.1%. Conclusions: MCS affects middle-aged women with comorbidities (chronic pain, fibromyalgia and chronic fatigue) and high anxiety and avoidance behaviors. This preliminary analysis should help provide a specific therapeutic approach to these patients (AU)

Vestibular impairment in Multiple Chemical Sensitivity: Component analysis findings.

Multiple chemical sensitivity (MCS) is a common clinical diagnosis in western populations and its symptoms are thought to be mainly related to chemical compounds exposure. Although MCS subjects refer to complain from many central nervous system symptoms, including dizziness, no study to now deepened vestibular detriment nor to what extent such an impairment could worsen MCS. Thus, the purpose of present study was to objectively highlight those clinical/subclinical aspects of vestibular impairment that could be related to MCS symptoms cohorts. A principal component analysis within a wide battery of otoneurological test scores was employed in 18 right-handed MCS patients and 20 sex- and age-matched healthy individuals. A deranged dimensionality in near-optimal re-weighting within otoneurological variables was found in MCS as compared with healthy subjects. These data seem to support the idea that MCS physiopathological underpinnings could lead to a peripheral and higher vestibular decay that could be addressed as a further aspect to better follow MCS patients up along natural history of disease in clinical practice.

Clinical problems in patient with Ehlers-Danlos syndrome and Multiple Chemical Sensitivity undergoing total thyroidectomy.

Clinical practice sometimes brings to face with situations quite peculiar, potentially dangerous for the patient's life. In the great majority of cases, pathologies associated with each other (cardiovascular, respiratory, neurological), while in other cases we can treat rare diseases or syndromes. It's considered exceptional the simultaneous presence of "rare" pathologies in a single patient. This exceptionality has been a push to treat a patient as a "unique" asking for help to deeper studies of pharmacogenetics. Our case reports the management of a patient with Ehlers-Danlos syndrome (EDS) and Multiple Chemical Sensitivity (MCS), undergoing a total thyroidectomy. We found several problems, and we tried to find effective solutions for the management of the patient during the whole peri-operative process, from a clinical, pharmacological and also from a surgical point of view.

Odor-related Chronic Somatic Symptoms Are Associated with Self-Reported Asthma and Hay Fever: The Hordaland Health Study.

The aetiology behind odor-related chronic somatic symptoms (O-RCSS) is unknown, although both immunological and psychiatric causes have been suggested. The aim of this study was to investigate the occurrence of self-reported asthma and hay fever and psychiatric symptoms in individuals having O-RCSS compared to individuals with similar chronic somatic symptoms (CSS) which were not odors-related, and also compared to healthy controls. Data from the Hordaland Health Study were used. 13,799 individuals, 40-45 years, answered a questionnaire including 16 questions related to somatic symptoms. They also indicated if the symptoms were odor-related, and answered questions about asthma and hay fever. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale. 38 (0.6%) men and 106 (1.4%) women had O-RCSS, whereas 88 (1.5%) men and 192 (2.5%) women had CSS. Adjusted logistic regression analyses showed increased odds of self-reported asthma in those with O-RCSS compared to those with CSS (males: 3.81, 1.06-13.8, females: 2.60, 1.05-6.93) and compared to male and female controls (3.56, 1.89-6.68 and 4.81, 1.92-12.1 respectively). Increased odds of self-reported hay fever were in addition seen in females with O-RCSS. There were no differences in psychiatric symptoms between individuals with O-RCSS and CSS, although individuals in both groups showed increased odds compared to male and female controls. Increased occurrence of self-reported asthma was exclusively found among male and females with O-RCSS, compared to CSS and controls. Increased occurrence of psychiatric symptoms was seen both in individuals with O-RCSS and CSS.