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Multiple Chemical Sensitivity/Intolerance



Scents and Sensitivity

article by Brandy E Fisher

Fragrance is ubiquitous in nature and plays a major role in both helping animals and humans locate food and enticing them to reproduce. Throughout history, humans have drawn fragrances from the natural environment for a variety of purposes, including use in religious and burial rituals, in aphrodisiacs, and to cover foul odors. In the late 1800s, the first fragrance containing synthesized ingredients was introduced. Since then, people have used chemicals extensively to mimic scents from nature.

Consumers' fascination with scent has increased with the manufacture of a multitude of scented "personal" products including cosmetics, lotions, soaps, oils, and perfumes. There are more than 1,000 body fragrances (including colognes, perfumes, and toilet waters) on the market today, according to The Fragrance Foundation, a non-profit educational arm of the fragrance industry. Furthermore, scents are now added to a slew of commercial products ranging from cleaning products to tissues, from candles to diapers.

While many people enjoy wearing perfumes and using scented products, there is a growing outcry from some people who claim that exposure to certain fragrances, including perfumes and scented products, adversely impacts their health. They report symptoms such as headaches, dizziness, nausea, fatigue, shortness of breath, difficulty with concentration, and allergy-like symptoms. It has been shown that many asthmatic patients have adverse reactions to perfumes and other fragrances, and some researchers hypothesize that exposure to fragrance may actually cause asthma. People who suffer from multiple chemical sensitivity (MCS), a health condition in which exposure to one chemical is thought to lead to adverse reactions to other chemicals, claim that exposure to fragrance triggers various symptoms, often to the point that sufferers are incapacitated or must forgo many of their usual activities to avoid exposure.

As information continues to surface on the issue of indoor air pollution, it appears that fragrances may represent part of the problem. Some researchers believe that exposure to the types of chemicals found in many scented products may contribute to the development and exacerbation of sick building syndrome, a health condition allegedly caused by indoor air pollution. The chemicals in perfumes, colognes, and deodorants worn by employees add to the chemical mixtures in indoor air, as do fragrances in cleaning products. In addition, some building owners pump certain fragrances--believed to evoke an emotional response that results in increased work productivity--through office ventilation systems.

Claudia Miller, an associate professor of environmental and occupational medicine at the University of Texas Health Sciences Center in San Antonio, says that several studies indicate that 15-30% of the general population report some sensitivity to chemicals, including fragrances, and 4-6% report that chemical intolerance has a major impact on their quality of life. Of these people, more than 80% report that exposure to fragrances is bothersome. Miller, who has conducted extensive research on MCS and coauthored the book Chemical Exposures: Low Levels and High Stakes, adds that many Gulf War veterans report new chemical intolerances since the war, including sensitivity to fragrances.

Gerald McEwen, vice president of science at the Cosmetic, Toiletry, and Fragrance Association, a Washington, DC-based trade association for the personal care products industry, says that fragrance materials in most products are at very low concentrations, and that people who claim to be adversely affected by scented products may actually be reacting to other chemicals in the products or in their environments. He says that affected people are more likely to identify fragrances as the offending agents because they are readily noticeable. McEwen further suggests that reactions to fragrance could be psychological. "This could be a conditioned response just as easily as an organic response," he says.

This theory has many proponents, including Sally Satel, a lecturer in psychiatry in Yale University School of Medicine's department of psychiatry. In her article, published in the May 1997 issue of Psychiatric Times, Satel refers to MCS, sick building syndrome, and other chemical sensitivity illnesses as having "elements of paranoia and hypervigilance (directed toward the physical environment), somatization (as well as stress-induced psychosomatic symptoms), hypochondriasis, hysteria, and suggestibility."

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Avoiding Offending Chemicals

Avoiding the chemicals which trigger symptoms is a vital part of coping with and treating multiple chemical sensitivities (MCS). This reduces the burden on the body's overwhelmed detoxification pathways and tissues. Creating a home environment that will not trigger symptoms is the most important aspect of this. Many people find that if they tightly limit the amount of exposure to offending chemicals that they experience at home, they are able to tolerate more exposure without serious adverse effects when they are out and about. Obviously this allows them to lead more normal lives, which in turn brings about greater well being which is beneficial for their overall condition. It should be noted that the indoor environment is much more polluted than that outdoors due to extensive use of chemical cleaning agents, cosmetics, perfumes and tobacco to name the most common. Reducing intake of chemicals in foods and water and in the form of drugs is also important. Read the Entire Article.

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Battle allergies by making some changes in your home

Thursday, March 19, 2009
Susan Condon Love
Plain Dealer Columnist

It starts with an itchy, drippy nose, or maybe a wheeze.

Suddenly, memories of past misery, repressed by months of gray days, come rushing back. Could it be? Have we forgotten that the arrival of warmer weather and snowdrops pushing up through muddy gardens have a downside?

For those suffering from seasonal allergies, March through May is not a happy time. Tree pollen, floating in windows and swirling around yards, can cause sniffles, sneezing and scratchy eyes.

All the sneezing is a precursor to grass allergies that kick in May through July, and finally, ragweed misery that clogs noses in a multicounty swath in mid-August.

But misery is not limited to the outdoors.

Dust mites, pollen, animal dander and mold "are the big four" of household allergies, said Dr. Leigh Kerns, pediatric allergist and immunologist with Rainbow Babies & Children's Hospital.

Some 10 percent to 30 percent of adults and up to 40 percent of children nationwide suffer from allergies, according to Dr. Lily Pien, a Cleveland Clinic allergist and immunologist. That translates to 30 million to 60 million Americans suffering mightily from everyday and seemingly unavoidable allergies.

Both doctors agree: There are nonmedical steps homeowners can take to mitigate allergic reactions and maybe even prevent attacks.

Some are as simple as closing windows and avoiding outdoor activities during high-pollen-count days. Other preventive measures take a little more effort -- and maybe a minimal output of cash.

But when it comes to health issues, it's well worth the effort.

Caution: If you feel the need to research household allergens, never, EVER look up a picture of an actual dust mite. If you do, you will want to enclose yourself and your family in plastic and never venture out of this bubble world.

Dust mites are about .5 millimeters, creamy white and have eight hairy legs. They eat shed human skin and just love to live in pillows, mattresses, upholstery, bedding and carpet. Their average life span is 10 to 19 days, and a female can lay about 60 to 100 eggs in her last days of life.

There are no 100 percent cures for dust-mite problems or any other allergies. But a little prevention can make home life much easier for those with allergies.

If you follow all the tips and still have problems, take Pien's advice:

"Don't suffer," she said. "See your doctor, get a diagnosis and some advice. There are effective medications and immunotherapy to treat allergies."

Dust mites

Encase your pillow, mattress and box spring in impermeable covers. "Make sure it says something like 'Dust Mite Proof,' " Kerns said. (For an idea of cost and use, go to allergybuyers club.com/all-dust-mite- covers.html.)

Wash bedding once a week in hot (130 degrees) water.

Dust with a damp cloth so you don't stir up the sedentary things.

Get a vacuum with a HEPA filter.

Limit the number of stuffed animals in a bedroom. If you suspect a beloved plush toy may be infested, enclose it in a baggie and put it in a freezer for 24 to 48 hours. "The lack of air, not the lack of humidity, will kill [dust mites]," Kerns said.

Get enclosed bookshelves.

Pollen

Keep windows and doors shut.

On mornings and windy days, stay in. "Pollen is the worst in morning," Kerns said. "If you have to go for a walk, make it later in the day."

Use a damp cloth when dusting, preventing pollen that has settled on furniture and upholstery from flying back into the air.

Get HEPA stand-alone air filters. Check with Consumer Reports and your allergist for the best buys; don't rely on commercials or hype.

If you can, hire someone to do your cleaning. If that's financially impossible, wear a well-fitted mask so you aren't inhaling the pollen you stir up.

Animal dander

Avoidance is best. If you have a pet allergy, or someone in your family does, simply don't get a pet.

If you love Fluffy or Fido and don't want to get rid of your pet, follow all the rules that apply for pollen and dust-mite mitigation, especially ripping out all carpet, washing bedding, and using a damp cloth when dusting.

Some animals shed less than others. Research before buying a pet. Some dogs in particular are being sold as "designer" dogs that don't shed. They used to be called mutts. But hype aside, nonshedding or minimal shedding is good.

Keep all pets out of the bedroom.

Mold

Use a dehumidifier. Obviously, mold grows in damp situations. Get rid of dampness and mold will not grow.

Wash visible mold with a solution of 5 percent bleach to water.

Do not have carpeting in bathrooms.

Remove all plants from the house. "Soil can get mold," said Kerns.

Don't cut your own grass if you have a sensitivity to mold. Again, mold may be in the soil. "A lot of times, people think they are allergic to grass, when they are really reacting to the mold in the soil," said Kerns.

Pay attention to your bathmat and shower curtain. Put bleach in the tub (with the mat floating in it) and let it sit for a couple of hours. You might want to open the windows during this. Bleach down or replace shower liners frequently.

If there's mold behind your walls or invisible in your basement, you will more than likely know. "There's a smell," said Kerns. In that instance, bring in the professionals for an evaluation and mitigation.

Overall tips

Here are some general "anti-allergy" suggestions:

Remove all carpeting. Hardwood, laminates and tile floors are not amenable homes to pollen or dust mites. Tile floors are particularly good for mold-prone areas like bathrooms.

Replace upholstery with leather furniture.

Restrict the use of chemical cleaners. "For people who have irritant rhinitis or nonallergic rhinitis, strong odors from home cleaners can trigger nasal symptoms of congestion and drainage, mimicking some of the symptoms of nasal allergies," said Pien.

Avoid miniblinds, a haven for dust mites, pollen and pet dander.

To reach Susan Condon Love:
slove@plaind.com, 216-999-4784

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Considerations for the Diagnosis of Chemical Sensitivity

William J. Rea, Alfred R. Johnson, Gerald H. Ross, Joel R. Butler, Ervin J. Fenyves, Bertie Griffiths, John Laseter

INTRODUCTION

The study of the effects of the environment upon the individual is now feasible due to new technology developed in the construction of environmental units.1-3 Our observations reveal that individual or multiple organs may be involved. The brain is the target organ in only a subset of chemically sensitive patients, and its involvement should not be confused with psychosomatic disease.

Over the last 16 years, physicians and scientists at the Environmental Health Center in Dallas have had an opportunity to observe over 20,000 patients who had chemical sensitivity problems. These patients were studied under various degrees of environmental control. This experience is unique in the world and has resulted in numerous peer-reviewed scientific articles, chapters in books, and books on this subject.

Studies have resulted in over 32,000 challenge tests by inhalation, oral, or injection methods, of which 16,000 were double-blind. Blood chemical levels and fat biopsies for organic hydrocarbons number over 2,000, while the measurement of immune parameters are over 5,000 tests. Objective brain function tests have been accomplished in over 5,000 patients. Other objective tests, like computerized balance studies, depollutant enzyme levels, and autonomic nervous system changes as measured by the Iriscorder, number near 1,000.

We wish to share our findings with the participants of the National Academy of Sciences Committee for the study of chemical sensitivity.

DEFINITION AND PRINCIPLES

Chemical sensitivity is defined as an adverse reaction to ambient doses of toxic chemicals in our air, food, and water at levels which are generally accepted as subtoxic. Manifestation of adverse reactions depend on (1) the tissue or organ involved; (2) the chemical and pharmacologic nature of the toxin; (3) the individual susceptibility of the exposed person (genetic make-up, nutritional state, and total load at the time of exposure); (4) the length of time of the exposure; (5) the amount and variety of other body stressors (total load) and synergism at the time of reaction; and (6) the derangement of metabolism that may occur from the initial insults.

To demonstrate cause-and-effect proof of environmental influence on an individual=s health, one must understand several important principles and facts. These principles involve those of total body load (burden), adaptation (masking, acute toxicological tolerance), bipolarity, and biochemical individuality. Each principle will be discussed separately.

Total Body Load (Burden)

This is the patient=s total pollutant load of whatever source (usually from air, food, and water or surroundings).1,2,4 The body must cope with this total burden; usually, it must be utilized, expelled, or compartmentalized. Total body load includes (1) physical factors (e.g., hot, cold, weather changes, positive ions,5 electromagnetic phenomena,6 radon), (2) toxic chemicals (e.g., inorganics: Pb, Cd, Hg, Al, Br, etc.; organics: pesticides, formaldehyde, phenols, car exhausts, etc.),7-21 (3) biological (bacteria, virus, parasites, molds,22 food),23,24 (4) psychological or emotional factors also significantly affect the patient, confirmed by recent work in psychoneuroimmunology, linking the psyche and the neuroendocrine and immune systems.25-28 Failure to reduce the total body load prior to pollutant challenge will frequently yield inaccurate results. Accordingly, we believe it is essential to conduct investigative procedures in controlled environmental circumstances with the total load reduced.

Adaptation (Masking, Acute Toxicological Tolerance)

Induced by the internal or external environment, this is a change in the homeostasis (steady state) of body function with adjustment to a new Aset point.@29-32 Adaptation is an acute survival mechanism in which the individual Agets used to@ a constant toxic exposure in order to survive, at the same time suffering a long-term decrease in efficient functioning and perhaps longevity. Selye was among the first to describe this compensatory mechanism.33 Because of adaptation or tolerance, the patient=s total body load may increase undetected because the perception of a cause-and effect relationship is lost. With no apparent correlated symptoms, repeated exposures may continue to damage his immune and enzyme detoxification systems.34-35 The eventual result of continued toxic exposure over a period of days, weeks, months to years is end-organ failure. Withdrawal or avoidance of an offending substance for at least four days will aid in reducing the total body load, after which a controlled re-exposure challenge will reproduce cause-and-effect reactions. In these deadapted individuals, there is high reproducibility of these evoked reactions permitting the physician to acquire sound scientific information.

Bipolarity

After an exposure, the body initially develops a bipolar response of a stimulatory phase, followed by a depressive phase,1,29,37 usually with induction of immune and enzyme detoxification systems.38 If the incitant is strong enough, or if substantial size or duration of exposure occurs, the induced enzyme and immune detoxification systems are depleted or depressed by overstimulation and overutilization. An individual may also initially experience a stimulatory reaction in the brain, perceiving the inciting substance not as being harmful, but as actually producing an energizing Ahigh.@ Therefore, he continues to acquire more exposures. After a period of time, however, be it minutes, months, or years, his body=s defenses are adversely overstimulated, and he develops disabling depression-exhaustion symptoms.31 This stimulation and depression-exhaustion pattern has been observed with many pollutant exposures, including ozone.12,30 When studying the effects of pollutants upon adapted individuals, the stimulatory phase is often missed or misinterpreted as being normal, thus giving faulty data. Studies in the controlled environment, involving 16,000 challenges in 2,000 deadapted patients, has proven this bipolarity phenomenon repeatedly.

Biochemical Individuality

Another principle necessary to understand environmental aspects of health and disease, and especially chemical sensitivity, is that of biochemical individuality. Biochemical individuality of response is the individual=s uniqueness.39 This uniqueness of response depends on the differing quantities of carbohydrates, fats, proteins, enzymes, vitamins, minerals, immune and enzyme detoxification parameters with which an individual is equipped to handle pollutant insults. These variations determine an individual=s ability to process the noxious substances he encounters. They further contribute to the intensity of his reaction to toxic exposures and to his susceptibility to chemical sensitivity. Thus, a group of individuals may be exposed to the same pollutant. One person may develop arthritis, one sinusitis, one diarrhea, one cystitis, one asthma, and one may remain apparently unaffected.

We have differing quantities and interactions of carbohydrates, fats, proteins, enzymes, vitamins, minerals, and immune parameters with which to respond to environmental factors. One simple example is the noted relationship between low serum magnesium levels and the HLA B35 genotype.40 This biochemical individuality allows us to either clear the body of noxious substances, or to collect them and contribute to the body burden. Biochemical individuality is dependent on at least three factors: genetic endowment, the state of the fetus=s nutritional health and toxic body burden during pregnancy, and the individual=s present toxic body burden and nutritional state at the time of exposure.

Some individuals, for example, are born with significantly lower quantities of specific enzymes (it may be 75%, 50%, or even 25% of the norms). Their response to environmental stimuli if often considerably weaker than those born with 100% of the normal detoxifying enzymes and immune parameters. Examples are the babies with phenylketonuria or the individuals with transferase deficiency, who do well until exposed to their environmental triggers, and then damage sets in. There are over 2,000 genetically-transmitted metabolic errors, suggesting that most of the population will have at least one abnormality.41 Toxic volatile organic chemicals have been shown by Laseter to bioconcentrate in the fetus, increasing the acquired burden in some babies.42

It is well-known that some individuals acquire their toxic load at work or around their homes.42 This changes with different seasons and weather conditions thus giving variable effects and responses over time. Extreme care must be taken in evaluation of each patient, who may exhibit unique clinical responses due to his specific biochemical individuality. As an example, it is well-known that not all patients will exhibit every reported symptom associated with systemic lupus erythematosus (SLE). Similarly, each patient exposed to the same environmental pollutant will react with his or her unique complex of symptoms. Because this vital fact is misunderstood, many studies are flawed when the wrong signs and symptoms are assessed for that individual.

SPREADING PHENOMENA

Spreading is secondary response to pollutants that can involve new incitants or new target organs. Spreading that involves new incitants occurs when the body has developed increased sensitivity to increasing numbers of biological inhalants, toxic chemicals, and foods at increasingly smaller doses. At this time, overload becomes so taxing that a minute toxic exposure of any substance may be sufficient to trigger a response or autonomous triggering may occur. For example, a person initially may be damaged by a pesticide and then eventually have his disease process triggered by exposure to a myriad of toxic chemicals and foods, such as phenol, formaldehyde, perfume, beef, lettuce, etc.

Spreading may occur for many reasons. It may be due to a failure of the detoxification mechanismsCoxidation, reduction, degradation and conjugationCbrought about by toxic overloading, or it may occur because of depletion of the enzyme or coenzyme=s nutrient fuels, such as zinc, magnesium, all B vitamins, amino acid, or fatty acid. This depletion may account for an increasing inability to detoxify and respond appropriately. The blood brain barrier or peripheral cellular membranes of the skin, lung, nasal mucosa, gastrointestinal or genitourinary systems may be damaged allowing previously excluded toxic and nontoxic substances to penetrate to areas that increase the risk of harm. Immune or pharmacological releasing mechanisms may become so damaged that they are triggered by many substances toxic, then non-toxic (such as food) in addition to the specific one to which they were intended to respond. It is well substantiated that antigen recognition sites may be disturbed or destroyed by pollutant overload. Hormone deregulation (feedback mechanisms) may occur allowing for still greater sensitivity.

In contrast to patients who experience increased sensitivity to multiple triggering agents, some chemically sensitive patients may have one isolated organ involved in their disease process for years, only to have dysfunction spread to other organs as their resistance mechanisms break down. This kind of spreading from one to another or multiple end organs enables the progression of hypersensitivity and the eventual onset of fixed-named disease.

SWITCH PHENOMENON

The switch phenomenon is the changing of one end-organ response to another. This usually occurs acutely, but may occur over a much longer period of time. This phenomenon was first described by Savage in the 1700s. He observed that when mental patients were at their worst, they usually had a remission of their asthma or sinusitis. When they were better mentally and they were seen in the outpatient clinic, they had a much higher incidence of sinus and asthma problems. Randolph and most other environmentally oriented physicians have also observed this phenomenon. At the EHC-Dallas, we have observed similar occurrences in our patients and, in fact, take cognizance of this phenomenon when evaluating therapy outcome.

In observing thousands of controlled challenges in the environmental unit, we have seen the target organ responses of many of our patients switch to several different ones during a long (e.g., 24-hour) reaction. Often we have seen, for example, transient brain dysfunction followed by arthralgia, followed by diarrhea, followed by arrhythmia.

Therapy can appear to have been effective, even when a pollutant has not been totally eliminated. In this case, a new set of symptoms may begin indicating that a pollutant response has simply switched to another end organ. This phenomenon occurs frequently when symptom-suppressing medication therapy or inadequate environmental manipulation is used. For example, a patient may have his sinusitis cleared by medication (e.g., cortisone), but later, since the causes has not been eliminated, he may develop arthralgia and eventually arthritis, or his colitis may have cleared only later to have cystitis develop.

This life-long progression of disease does not have to occur if the switch phenomenon is recognized during initial evaluation. To prevent it, individuals and physicians need simply to be cognizant of seemingly unrelated events. For example, statements are often made to the effect that a child will outgrow a problem when, in reality, one symptom complex dissipates only to be replaced by a new set of symptoms. For example, a child may have recurrent ear infections. Eventually, these may stop, but bed wetting may ensue. Over time the bed wetting may cease, but the child may then develop asthma. These changes in health may appear to be totally unrelated; in this instance, however, they are switch phenomena. The situation of an adult who sprays pesticides in his home, and then visits a neurologist with complaints of headaches and a rheumatologist with symptoms of arthritis is similar. Both the physician and the patient frequently fail to recognize the relevancy of these seemingly disparate symptoms as being part of a larger pattern needing further investigation.

POLLUTION FACTS

In order to accomplish concise studies of the chemical sensitivity phenomena, one must understand some facts about environmental pollutants.

Modern technology=s rapidly accelerating rate of growth has produced a wide variety of chemical products, that contribute to the total chemical environment. Recent studies show that nearly 50% of the global atmospheric pollutants are generated by man (either isolated from natural products or synthesized), and the ubiquitous nature of the toxic chemical agents is widely appreciated.8,13,14 It has been estimated that more than 2,000 new chemical compounds are introduced annually and that over 60,000 different organic chemicals are used commercially today.

The widespread presence of hazardous chemicals has rendered critical the environmental sensitivity problems described by Randolph almost 40 years ago.43 While celebrated instances of gross contamination have long been the object of professional attention, only recently have literally thousands of synthetic chemical products, heretofore believed innocuous, been incriminated as agents of homeostatic dysfunction.11,14

Current data affirm the view that standard methods for the determination of chemical incitants may no longer be effective.1,7,8,36 With the finding that sensitivities can occur from subthreshold and picomolar quantities of chemicals has come the discovery that standard procedures, such as skin prick or scratch tests, often fail to demonstrate positive reactions which are otherwise verifiable.

Recent literature confirms the harmful effects of chemical incitants, like formaldehyde,44,45 phenol,45,46 some pesticides,7 chlorine,47 and petroleum alcohol.48 Commonly encountered chemicals like glycine,9,49 DDT, toluene and turpentine,50-52 and drugs such as hydralazine have been found to induce advanced-staged disease process.53

A number of familiar metals have also been incriminated, among them nickel, cobalt, chromium,54 aluminum,55 mercury,56 and platinum.57 Other common environmental chemical incitants include xylene,58 various acrylates,59 and acrylated prepolymers,60 benzyl peroxide, carbon tetrachloride,61 sulfates,62 dithiocarbamates,63 and diisocyanates.64

WATER POLLUTION

Water has an important role in delivering contaminant minerals, toxic organic and inorganic chemicals, particulate matter, and radiation to the human organism. In developed nations, the incidence of many chronic diseases, particularly cardiovascular disease, is associated with water characteristics, like purity and mineral content.13 Hardness, or the lack thereof, is involved in heart disease, hypertension, and stroke.13 Among the theorized protective agents found in hard water are calcium, magnesium, vanadium, lithium, chromium, and manganese.13 Certainly, once cardiovascular pathology is induced, waters with high sodium content may be harmful. Other adverse agents include the metals cadmium, lead, copper, and zinc, which tend to be found in higher concentrations in soft water. Nitrates in water (usually from fertilizer) pose immediate threats to children under three months of age due to production of methemoglobin,65 and sulfur can also cause reactions in susceptible patients.

City water, much of it secondhand, often contains from 100 to 10,000 times as many synthetic compounds as natural spring water.66 This, coupled with the rapid growth in the use of synthetic chemicals, has focused concern on the chemical quality of drinking water.13 Although microbes are important, attention is now being drawn to the microchemical contaminants. Advances in analytic chemistry have been able to reveal chemical contaminants in the parts-per-billion or parts-per-trillion range. It is a serious mistake to assume that extensive contamination of drinking water with Alow@ levels of synthetic pollutants is Anormal.@ These chemicals are widespread, and we should not be lulled into assuming these contaminants are innocuous. Examination of our ground water has revealed many hundreds of toxic chemicals in these ranges.67,68

Many examples of water contamination exist and have been documented, including Times Beach, Missouri, with winter floods flushing dioxin-contaminated oil used twenty years ago, Niagara=s Love Canal area, Waterbury, Connecticut, and Middleboro, Kentucky.69

In many cases, deadly materials have been accumulating for years in dumps and landfills. In the United States, some 80,000 pits and toxic waste lagoons hold chemicals ranging from carbon tetrachloride to discarded mustard-gas bombs.68 Slowly escaping from their burial sites, these leftovers directly contaminate our ground water. Polluted ground water exists at 347 of the nation=s 418 worst chemical dumps, and probably is occurring in the rest.68 Laseter7 and others70 have shown that a virtual organic chemistry laboratory exists in most drinking water.

In the early 1980s, California, New York, New Jersey, Arizona, Nova Scotia, and Pennsylvania condemned dozens of public water supply wells due to trichloroethylene or tetrachloroethylene pollution.71 Leaking fuel tanks contaminated nine Kansas public water supplies in 1981.71 Officials in New Mexico identified 25 cities where hydrocarbons and solvents contaminated the ground water.71 Analysis of New Orleans= drinking water alone revealed the presence of 13 halogenated hydrocarbons.

Sources of water pollution fall into three major categories: (1) municipal sewage; (2) agricultural wastes; and (3) industrial wastes. Approximately 55% of the water treated in municipal plants is from homes, while another 45% is from industry. Agricultural wastes include those from livestock and toxic chemicals (pesticides, herbicides, fertilizers), and farm runoff collects in rivers, lakes, and ground water. Industrial wastes, however, contain some of our more toxic substances. Over one-half of the total volume of industrial wastes come from paper mills, organic chemical manufacturing plants, petroleum companies, and steel manufacturing. The major pollutants are chemical byproducts, oil, grease, radioactive waste, and heat. Other sources of contamination are drinking water disinfectants and byproducts;68 it should be remembered that chlorine, interacting with organic material, produces toxic trihalomethanes and other organochlorines. Alternatives to treating water with chlorine include ozone, chloramines, ultra-violent irradiation, iodination, or home reverse-osmosis, and charcoal filtration.68

Chloride, added at many sewage treatment plants, can also react with organic matter in the water to form chlorinated hydrocarbons, many of which are also known to cause cancer. Copper sulfate, aluminum sulfate, and fluorine are other major contaminants which may add to the total body burden.68

Over a thousand different toxic chemicals have been found in public water supplies including pesticides, herbicides, industrial solvents, and polychlorinated biphenyls, just to name a few.

Inorganic pollutants include arsenic, cadmium, chromium, copper, manganese, mercury, silver, and selenium.13 The use of inorganic arsenic insecticides has led to high arsenic levels in some water supplies.13 Barium (>1 mg/L) has toxic effects on the heart, blood vessels, and nerves,68 while cadmium at levels > 0.01 mg/L has adverse arterial effects. At levels > 1 mg/L or 1 ppm, the following metals found as water contaminants have produced severe chronic toxicity: antimony,72 beryllium,73 cobalt,73 gold,73 iodoine,73 lithium,73 mercury,74 and vanadium.73 In Minamata, Japan, between 1953 and 1960, various plastic companies dumped methyl mercury chloride into the water, producing 50 to 85 ppm of mercury in nearby fish. After ingesting these mercury-contaminated fish, 406 people died. The adverse toxicological effects on developing children continue to be measured.75

A recently completed study found that skin absorption contributed from 29 to 91% of the total body dose of pollutants (from water), with an average of about 64%.76 This is even more important when one looks at the large number of volatile organic compounds found in our drinking and bath water.

Radiation occurs in some waters in the form of radon, a naturally occurring radio nuclide that seeps from rocks and may be concentrated in airtight homes, especially the basements. At this stage, more information is needed to assess fully its effects. It probably, however, can increase the total body load.

In 1965, a serious drinking-water problem was seen in 40% of patients hospitalized for a program of comprehensive environmental control.1,77,78 Today, it is up to 80%. We have found that patients susceptible to water contaminants virtually always exhibit multiple sensitivities, with advanced and severe environmental reactions, especially to airborne chemicals.1 Interestingly, water sensitivity in children was found to increase on a circadian and seasonal basis.79 Increased severity was seen during June and July or in September and October, when grass, pollen, and mold counts were also high.79 Some ECU patients had difficulty with waters containing high levels of sodium, others with calcium, and still others with high bicarbonate waters. A few individuals tolerated distilled water, even though it may contain some hydrocarbon residuals. Hundreds of outpatients have shown symptoms in reaction to both chlorinated and nonchlorinated waters, including numerous spring, charcoal-filtered, and distilled waters. If these water-induced symptoms remain undiscovered, food and chemical testing may be distorted. It is vital to test and find safe water before proceeding with other testing in these severely sensitive individuals.

CHEMICAL CONTAMINATION IN FOODS

The contamination of our urban food supplies is the result of widespread use of food additives, preservatives, and dyes in growth, manufacturing, and processing. Virtually all commercially grown and prepared foods have pesticides and herbicides in them.9,79

The literature abounds with reports of chemical sensitivities to many additives.80,81 Contaminant reactions complicate the study of food sensitivity, forcing one to define more clearly the nature of the incitant, not only as it is encountered in foods, but in the air and water as well. Bell has reported urticarial reactions and immunological changes to exposures to a number of food additives.82 Condemi83 and Bell both suggest that food dyes may trigger reactions in sensitive individuals, including conditions commonly thought to be psychogenic or certain forms of hyperactivity.28,84-89 Lindemayer has associated urticarial reactions with several additives such as p-hydroxy benzoic acid propyl ester, benzoic acid, sodium benzoate, ponceau rouge, and indigo carmine.90 Monroe=s data indicate a causal role played by tartrazine azo dyes and salicylates in the provocation of vascular alterations.36 Other additives, including sodium nitrite and sodium glutamate, have been found to trigger migraine phenomena in susceptible patients.91

Sulfur dioxide16 and sodium salicylate can provoke asthmatic reactions,92 while aspirin-like food contaminants and dyes may trigger urticaria, angioedema, bronchoconstriction, and purpura.93 An even wider variety of symptoms, including severe gastro-intestinal disorders, has been associated with sensitivities to aniline, commonly found in rapeseed oil.94

In our experience, natural toxic components of foods, such as alkaloids, phenols, lectins, etc. must also be accounted for when studying the secondary food sensitivity that occurs from pollutant overload in the chemically sensitive individual. Therefore, three factors must be considered when evaluating the total food load. These are manmade pollutant contamination, natural toxic effects of foods, and food sensitivity. Failure to consider all three in the chemically sensitive patient may color or negate otherwise a clearly defined case of chemical sensitivity.

CHEMICAL INCITANTS IN THE HOME ENVIRONMENT

Indoor air pollution in the home environment has produced a multitude of sensitivities to chemicals.8,95 Time and space limitations allow only a cursory review of the numerous commercial hygienic products which can be noxious for chemically susceptible individuals. Among these are a wide variety of cosmetics,96,97 particularly those containing glycerin, propylene glycol, or butylene glycol,98 perfumes,99 and hair products such as dyes,100,101 creams,102 sprays,103 and shampoo.104 Moreover, sensitivities have been demonstrated to occur in association with lip salve,105 fingernail preparations,106 soaps,107 sanitary napkins, mouthwash,109 antiperspirants,110 contact lenses,111 contact lens solutions,112 and suntan lotions.113

Reports of sensitivities to chemicals in textiles, including synthetic acrylic fibers,114 polyester spin finishes,115 the epoxy resins, and synthetic clothing are widespread.116 Products such as fabric spray starch may also be considered toxic for the chemically sensitive individual117 for whom even the metallic buttons on blue jeans may trigger reactions to nickel.118 Formaldehyde44 on synthetics or tetrachloroethylene, from dry-cleaned clothing can also produce problems.

Household cleaning products, particularly those containing formaldehyde, phenols, and chlorine are hazardous for many patients. Several laundry products and detergents may be identified as household incitants,119 as well as a number of products used to clean and polish furniture.119

The very construction of many homes may prove dangerous for the chemically sensitive patient. Data suggests that chemicals contained in wood preservatives (e.g., pentachlorphenols) are environmental incitants capable of triggering a variety of symptoms.121-123 Others report problems with reactions to formaldehyde-containing pressboard, carpets, plywood, and petrochemical contaminants.124

Current data confirm earlier findings regarding the hazards of pesticides125 such as 2,4,DNP and fungicides.126 Moreover, research increasingly suggests the possibility of sensitivities to apparently innocuous items such as rubber bands,127 coins,128 epoxy,129 and countless paper products.130,131 Pesticides, along with oil, gas, or coal, are major offenders for sensitive individuals.

Research shows house plants132,133 and common insects134 can now be viewed as environmental incitants or causes of homeostatic dysfunction. In addition, sensitivities to cold and heat36 and to contaminants in household water supplies have been associated with symptoms ranging from urticaria to severe respiratory distress.

Natural gas heat and stoves and routine insecticiding or termite proofing of homes can be prime offenders in chemical sensitivity. One must consider these potential source of contaminants when developing studies on chemical sensitivity. In our experience, failure to evaluate building and home environments before challenge testing will often make challenge studies invalid for the diagnosis of chemical sensitivity.

MECHANISMS

The mechanisms involved in chemical sensitivity are becoming clearer, one of which has pollutant injury occurring to the lungs or liver, with resultant free radical generation.135 Disturbances then occur at the cellular, subcellular and molecular levelsCproducing injury either immunologically or nonimmunologically through enzyme detoxification systems. Vascular or autonomic nervous system dysfunction will then occur with one or a myriad of end-organ responses.

IMMUNOLOGICAL

Type I hypersensitivity is usually mediated through the IgE mechanism on the vessel wall. Classic examples are angioedema urticaria and anaphylaxis due to sensitivity to pollen, dust, mold, or food136 or some chemicals such as toluene diisocyanate. Of the patients with immunological involvement with chemical sensitivity seen at the EHC-Dallas, 10% seem to fall within this category.

Type II cytotoxic damage may occur with direct injury to the cell. A clinical example of this is seen in patients exposed to mercury.137 A group in Minimata, Japan, developed neurological disease from eating fish exposed to toxic methyl mercury chloride. Mercurial pesticides fall into this category. Of the patients with immunological involvement seen at the EHC-Dallas, 20% seem to fall into this Type II category.

Type III shows immune complexes of complement and gamma globulin damaging the vessel wall. A clinical example of this is lupus vasculitis. Numerous chemicals, including procainamide and chlorothaizide, are known to trigger the autoantibody reaction of lupus-like reactions. Many other toxic chemicals can also trigger the autoimmune response.138 Other chemicals, such as vinyl chloride, will produce microaneurysms of small digital arterioles, probably due to this mechanism.51,139

Type IV (cell-mediated) immunity occurs with triggering of the T-lymphocyte. Numerous chemicals such as phenol, pesticides, organohalides, and some metals will also alter immune responses, triggering lymphokines and producing the Type IV reactions.138 Clinical examples are polyarteritis nodosa, hypersensitivity angiitis, Henoch-Schonlein purpura, and Wegener=s granulomatosis.1,139 A recent study done at the EHC-Dallas on 104 proven chemically sensitive individuals (70 vascular, 27 asthmatic, and 7 rheumatoid), comparing them with 60 normal controls, showed that those manifesting a chemical sensitivity through their vascular tree had suppression of the suppressor T-cells (>4 SD).47 Clearly the larger portion of our patients with immunological involvement fall into the Type III and IV categories.

NONIMMUNE ENZYME DETOXIFICATION

Nonimmune triggering of the cell and vessel wall may occur. Complement may be triggered directly by molds, foods, or toxic chemicals,139 and mediators like kinins, postaglandins, etc. may also be directly triggered. These reactions then cause vascular spasm, with resultant hypoxia and release of lysozymes, which further produces more spasm, hypoxia, etc. Eventually end-organ failure will occur.

Triggering of the enzyme detoxification, mostly in the system=s liver and respiratory mucosa, plays an important role in clearing of pollutants. It occurs, however, to a lesser extent in all systems. Foreign compound biotransformations have considerable variability, depending on genetic factors, age, sex, nutrition, health status, and the size of the dose.

The metabolism of foreign compounds usually occurs in the microsomal fraction (smooth endoplasmic reticulum) of liver cells. A few biotransformations are nonmicrosomal (redox reactions involving alcohols, aldehydes, and ketones). There are basically microsomal (redox reactions involving alcohols, aldehydes, and ketones). There are basically four biotransformation categoriesCoxidation, reduction, degradation, and conjugation.

The first three biotransformation pathways for xenobiotics are the same pathways that the body uses to process food and nutrients. If these enzyme systems are over-utilized by competing foreign pollutants, inadequate handling of food proteins can result, with the subsequent induction of food sensitivities. However, because these detoxification pathways are dependant on nutrient and mineral cofactors, these systems are inducible by appropriate oral or systemic supplementation. Such supplementation serves as an important factor in stabilizing and treating patients with chemical sensitivity. The fourth category of biotransformation , that of conjugation, is almost exclusively for handling foreign compounds. Conjugation appears to be uniquely utilized for the catabolism of foreign compounds, using amino acids and their derivatives with peptide bonds and carbohydrates and their derivatives with glucide bonds. Simpler compounds like sulfate and acetate are also involved in conjugation with linkage of ester bonds. Activated conjugated compounds plus specific enzymes are often detoxified by coupling with co-enzymes. For example, co-enzyme A with acetate and other short-chain fatty acids adenosine or phosphoadenosine phosphate are detoxified with a methyl group from sulfate methionine or the ethyl group from ethionine. Uridine and phosphate with glucose and glucuronic acids are similar.140,141

There are generally five major categories of foreign-compound conjugative processes.140 These are (1) acetylation through co-enzyme A, for detoxifying aromatic amines and sulfur amides; (2) peptide conjugation with glycine and aromatic carboxylic acids to hippuric acid; (3) sulfonation with glutathione (containing cysteine) or PAPS, and microsomal enzyme conjugation for multi-ring systems such as naphthalene, anthracene, and pheno-anthracene, which eventually results in benign mercaptic acids or alternatively benign sulfate esters; (4) alkylations by methionine of amines, phenols, thiols, noradrenalin, histamine, serotonin, pyridine, pyrogallol, ethylmucaptin sulfites, selenites and tellurites; (5) Glucuronation. Glucuronides detoxify pesticides, alcohols, phenols, enols, carboxylic acid, amino hydroxamines, carbamides, sulfonamide, and thiol.140,141 All of these process are dependent upon nutrient fuels to keep these processes running efficiently. Toxic chemicals disturb the supply of the nutrient fuels by (1) producing poor quality food, (2) reducing intake, (3) reducing normal absorption, (4) setting up competitive absorption in the gut with nutrients, (5) imbalancing intestinal flora, (6) disturbing transport mechanisms, (7) disturbing proper decomposition and metabolism, (8) causing renal leaks, and (9) directly damaging nutrients. If nutrient inadequacy occurs, normal metabolism is overloaded and disturbed, resulting in selective changes in the pools of nutrients such as vitamins, minerals, amino acids, enzymes, lipids, and carbohydrates. Once this occurs, there is a vicious cycle of dysmetabolism, often with production or worsening of chemical sensitivity. These detoxification and metabolic defects are often measurable and have been accomplished in over 2,000 chemically sensitive patients.

DIAGNOSIS

The diagnosis of chemical sensitivity can now be made with a combination of the following: history, physical examination, immune tests (including IgE, IgG, complements, T&B lymphocyte subsets, blood levels of pesticides, organic compounds, heavy metals [intracellular]), and occasionally objective brain function tests. Antipollutant enzymes, such as superoxide dismutase, glutathione, peroxidase, and catalase have been found to be suppressed in the chemically sensitive patient. Vitamin deficiencies, mineral deficiencies, and excess amino acid deficiency and disturbed lipid and carbohydrate metabolism have been observed.

Challenge tests are the cornerstone of confirmatory diagnosis. These may be accomplished through oral, inhaled, or intradermal challenges. Care should be taken to rule out inhalant problems with pollen, dust, and molds. Food sensitivity occurs in approximately 80% of the people with chemical sensitivity and must be evaluated. When diagnosing chemical sensitivity, one must investigate water contaminant sensitivities, as 90% of people with chemical sensitivity have water contaminant reactions.4 This can be checked by placing the patient on chemically less contaminated, charcoal-filtered, distilled, or glass-bottled spring water for four days, with subsequent rechallenge of the patient=s regular drinking water. This procedure will often elicit a reaction to the water pollutants in the sensitive individual.

Patients frequently know where and when the onset of their problems occurred, e.g., sudden exposure to pesticides, working around printing machines and factory machines, etc. They usually develop increased odor perception to gasoline, perfumes, new paints, car exhausts, gas stoves, fabrics, clothing or carpeting stores, chlorine and chlorox, and cigarette smoke. Not only will they find these smells offensive, but also they may have marked reactions to them. Other symptoms can range from the almost universally seen fatigue to classic end-organ failures. Physical findings frequently are vascular in nature, with edema, petechiae, spontaneous bruising, purpura, or peripheral arterial spasm. Frequently , there is flushing, adult-onset acne, and a yellowness of the skin without jaundice. Chronic, recurring nonspecific inflammation is usually a significant sign, e.g., colitis, cystitis, vasculitis, etc. Laboratory findings are often nonspecific, e.g., sedimentation rates may increase or liver profile may be mildly off. Fifteen percent of environmentally sensitive patients have positive C-reactive proteins. Twenty-five percent show abnormal serum complement parameters. Fifty percent of the chemically sensitive patients have depressed T cells. Twenty-five percent have impaired blastogenesis, and 25% have impaired delayed hypersensitivity, as evidenced by cell-mediated immunity skin tests. Of the patients with T-cell abnormalities, the depletion of the suppressor cells is seen by over four standard deviations from the control group of normals.141 In 10% of these patients, IgE or IgG is elevated. Patients with recurring infections have impaired phagocytosis and killing capacity. Very accurate blood measurements are now available for the chlorinated pesticides as well. The following were found in over 200 chemically sensitive patients:

Pesticide in Blood

% Distribution in 200 Patients

DDT and DDE

62.0

Hexachlorobenzene

57.5

Heptachlor Epoxide

54.0

b-BHC

34.0

Endosulfan I

34.0

Dieldrin

24.0

g-Chlordane

20.0

Heptachlor

12.5

g-BHC (Lindane)

9.0

Endrin

5.5

d-BHC

4.0

a-BHE

3.5

Mirex

2.0

Endosulfan II

1.5

Organophosphate levels are only positive within 24 hours after exposure and are not much help. Lab tests for pentachlorphenols and organic solvents like hexane and pentane are also now available, as are herbicide levels. General volatile organic hydrocarbons are found in a large portion of chemically sensitive patients. Their presence indicates either recent exposure or a failure in the enzyme detoxification system. Those found in over 500 chemically sensitive patients include benzene, toluene, trimethylbenzene, xylene, styrene, ethyl benzene, chloroform dichloromethane, 1,1,1-trichloroethane, trichloroethylene, tetrachloroethylene, dichlorobenzene. Metals including lead, mercury, cadmium, and aluminum are sometimes found in the intracellular contents of some chemically sensitive patients. These again are found in 10% of the patients.

Fat biopsies have been preferred on many patients with over 100 different compounds studied. Often there is more in the fat than blood in some cases such as organochlorine insecticides and more in the blood than fat such as seen with such substances as 2-methyl pentane and 3-methyl pentane.

Skin biopsies of bruising and petechiae reveal perivascular lymphocyte infiltrates around the vessel wall in chemically sensitive patients.

Challenge tests can be done by the sublingual or intradermal route. The efficiency of these tests is now well established as numerous studies (several double-blind) have now been done.4,24,47,142-145 These need to be done since 80% of the chemically sensitive are food sensitive. Blind intradermal challenge for chemicals can now be done with terpenes, petroleum derived ethanol, glycerine, formaldehyde, phenol, perfume, and newsprint, whereby production of symptoms will help establish the patient=s chemical sensitivity.

Over 200,000 intradermal challenges of chemicals have been done under environmentally controlled conditions at the EHC-Dallas. These are clearly reliable, especially as they meet the positive criteria of sign and symptom reproduction, wheal growth, and negative placebo response.

Inhalation challenge is another method for the diagnosis of chemical sensitivity, done under varying degrees of environmentally controlled conditions. For best results, one uses an anodized aluminum and glass booth to do ambient dose challenge of any toxic chemical in a hospitalized, environmentally controlled setting. Some studies done in our center, under strictly controlled conditions in an environmental unit, showed significant findings (4 SD) of the chemical reactors over the controls when using <0.20 ppm formaldehyde, <0.0025 ppm phenol, < 0.33 ppm chlorine, <0.50 ppm petroleum derived ethanol, <0.034 ppm of the pesticide, 2,4,DNP, along with three placebos. These tests have been used in over 3,000 patients with over 99% accuracy. Similar studies can be done in the office setting, although controls are much more difficult and one finds many more placebo reactions. This is because environmentally controlled conditions are generally much more difficult to achieve and patients are often studied in the masked or adapted state, wherein symptoms may not be perceived. With the inhaled challenges, one can measure and plot blood levels, immune parameters, metabolic changes as well as sign and symptom scores.

Vitamin and intracellular mineral levels are needed to completely evaluate the chemically sensitive individual. In our Center, analysis of over 300 chemically sensitive patients showed the following vitamin deficiencies: B6C64%; B2C30%; B1C29%; folic acidC27%; vitamin DC24%; B3C19%; vitamin CC6%; B12C3%; Out of 190 chemically sensitive patients with mineral deficiencies, 88% had chromium deficiency, 12% selenium, 8% zinc, 40% magnesium, and 35% sulfur. Many had mineral excess in their blood cells.

TREATMENT

The cornerstone of treatment for chemical sensitivity is avoidance.146 This will decrease total body burden, allowing recovery of the overtaxed detoxification systems. Chemically less contaminated water (including spring, distilled, and charcoal filtered) may be used, but only in glass or steel containers. Water will leach a variety of contaminants from the walls of synthetic plastic containers. A rotary diet of chemically less contaminated food should also be used to reduce load and keep the patient in the unmasked state. As many household incitants as possible, including petroleum-derived heat, insecticides, synthetic carpets and mattresses, and formaldehyde-containing substances, such as pressboard and plywood, should be removed. Toxic exposures can be monitored by the general volatile organic hydrocarbon blood tests. Some job changes may be needed, while occasionally the most severely affected patents have to leave badly polluted areas. Techniques should be developed for follow-up and monitoring of these modalities.

Injection therapy for inhalants, foods, and some chemicals will also help this problem.24,144,145,147-150 Low-dose sublingual therapy in patients with allergic rhinitis was effective.151 These treatments can be done daily, but usually every four to seven days. In our opinion, a properly balanced rotary diet is essential in treating the patient with food sensitivity, whether or not it may be induced by chemical overload. Vitamin and mineral supplementation is often necessary to replace the deficiencies that occur from the direct toxic damage, exhausted enzymatic detoxification pathways, and from the direct competition absorption. In rare cases, nutritional replacement with intravenous hyperalimentation is needed for severely debilitated patients. Techniques should be developed for monitoring and evaluating the outcome.

CONCLUSION

The philosophy and techniques of environmental medicine developed over the last 25 years offers a means to scientifically investigate and treat patients affect by pollutants. This approach gives the physician valuable, accurate information, in the pursuit of optimum health for these environmentally-sensitive patients.
REFERENCES

1. Randolph, T.G. Human Ecology and Susceptibility to the Chemical Environment. Springfield, IL: Charles C. Thomas, 1962 (sixth printing 1978). 2. Dickey, L.D., ed. Clinical Ecology. Springfield, IL: Charles C. Thomas, 1976. . Bell, I.R. Clinical Ecology. Bolina, CA: Common Knowledge Press, 1982. 4. Rea, W.J., and M.J. Mitchell. Chemical sensitivity and the environment. Immun Allerg Prac Sept/Oct:21-31, 1982. 5. Wordan, J.I. The effect of air in concentrations and polarity on the CO2 capacity of mammalium plasma. Fed Proc 13:557, 1954. Choy, R.V.S., J.A. Monro, and C.W. Smith. Electrical Sensitivities in Allergy Patients. Clin Ecol IV(3):93-102. 7. Laseter, J.L., I.R. DeLeon, W.J. Rea, and J.R. Butler. Chlorinated hydrocarbon pesticides in environmentally sensitive patients. Clin Ecol 2(1):3-12, 1983.8. National Research Council. Indoor Pollutants. Washington, D.C.: Natl. Academy Press, 1981. 9. Gilpin, A. Air Pollution, 2nd ed. St. Lucia, Queensland: University of Queensland Press, 1978. 10. Wark, K., and C. Warner. Air Pollution: Its Origin and Control. New York: Harper & Row, 1961. 11. Adelman, R.C. Loss of adaptive mechanisms during aging. Fed. Proc. 38:1968-1971, 1979. 12. Stokinger, H.E. Ozone toxicology: A review of research and industrial experience, 1954-1962. Arch Environm Health 110:719, 1965. 13. The National Research Council. Water hardness and health. In Drinking Water and Health. New York: National Academy of Science, 1977, 439-447. 14. Winslow, S.G. The Effects of Environmental Chemicals on the Immune System: Selected Bibliography with Abstracts. Oak Ridge, TN: Toxicology Information Response Center, Oak Ridge National Laboratory, 1981. 15. Calabrese, E.J. Pollutants and high risk groups. The Biological Basis of Increased Human Susceptibility to Environmental and Occupational Pollutants. New York: Wiley Interscience, 1977. 16. Freedman, B.J. Sulphur dioxide in foods and beverages: Its use as a preservative and its effect on asthma. Br J Dis Chest 74(2):128-134, 1980. 17. Davidson, M., and M. Fienleib. Disulfide poisoning: A review. Am Heart H 83:100, 1972. 18. Innami, S., H. Tojo, S. Utsuja, A. Nakamura, and S. Nagazama. PCB Toxicity and Nutrition I. PCB Toxicity and Vitamin A. Jap J Nutr 32:58-666, 1974. 19. Villeneune, D.C., D.L. Grant, W.E.J. Phillipos, M.L. Clark, and D.J. Clegg. Effects of PCB administration on microsomal enzyme activity in pregnant rabbits. Bull Environm Contam Toxico l 6:120, 1971. 20. Rea, W.J., A.R. Johnson, R.E. Smiley, B. Maynard, and O. Dawkins-Brown. Magnesium deficiency in patients with chemical sensitivity. Clinical Ecology 4(1):17-20, 1986. 21. Pan, Y, A.R. Johnson, and W.J. Rea. Aliphatic Hydrocarbon Solvents in Chemically Sensitive Patients. Clin Ecol 5(3):126-131, 1987-88. 22. Olson, K.R., et al. Amanita phalloides-type mushroom poisoning. West. J. Med. 37:282, 1982. 23. Brostoff, Johnathan, and Stephen Challacombe. Food Allergy and Intolerance. London: Bailliere Tindall/W.B. Saunders, 1987.  24. Rapp, O.J. Double-blind confirmation and treatment of milk sensitivity. Med J Aust 1:571-572, 1978. 25. Rea, W.J., Y. Pan, et al. Toxic Volatile Organic Hydrocarbons in Chemically Sensitive Patients. Clin Ecol 5(2):70-74, 1987. 26. Hill, Johanna. Peptides and Their Receptors as the Bochemicals of Emotion. Proceedings of the American Acad. Envir. Med. Annual Mtg., Nashville, TN, Oct. 29, 1987. 27. Ader, Robert. Behavioral Influences of Immunity. Proceedings of Amer. Acad. Envir. Med. Annual Mtg. Nashville, TN, Oct. 29, 1987. 28. King, D.S. Can allergic exposure provoke psychological symptoms? A double-blind test. Biol Psychiat. 16:3-10, 1981. 29. Randolph, T.G. Specific Adaptation. Ann Allergy 40:333-45, 1978. 30. Mustafa, M.G., and D. F. Tierney. Biochemical and metabolic changes in the lung with oxygen, ozone, and nitrogen dioxide toxicity. Am Rev Resp Dis 118(6):??, 1978.31. Stokinger, H.E., and D.L. Coffin. Biological effects of air pollutants. In Air Pollution. Ed. A.C. Stern. New York: American Press, 1968. 32. Rinkel, H.J., T.G. Randolph, and M. Zeller. Food Allergy. Norwak, CT: New England Foundation of Allergic an Environmental Disease, rpt of 1951 text. 33. Selye, H. The general adaptation syndrome and the diseases of adaptation. J. Allergy 17:23, 1946. 4. Jollow, D.J., et al. 1977. Biological Reactive Intermediates: Formation, Toxicity, and Innetivation. New York. 35. Wand, A.M., et al. 1976. Immunological mechanisms in the pathogenesis of vinyl chloride disease. Brit Med J 1(6015):936-938. 36. Rea, W.J., D.W. Peters, R.E. Smiley, et al. Recurrent environmentally triggered thrombophlebitis. Ann Allergy 47:338-344, 1981.  37. Savage, G.H. Insanity and Allied Neuroses. Philadelphia: Lea and Febiger, 1884. 38. Rowe, A.H. Allergic toxemia and migraine due to food allergy. Calif West Med. 33:785-792, 1930. 39. Williams, R.J. Biochemical Individuality. New York: Wiley, 1963. 40. Noordhout, B., et al. Latent tetany, magnesium, and HLA tissue antigens. Magnesium-Bulletin 3 (offizielles organ Gesellshaft fur magnesium forssehung) 9:3, 1987. 41. Standbury, J.B., et al. The Metabolic Basis of Inherited Disease, 5th printing. New York: McGraw-Hill Book Co., 1983. 50. McMillian, R. Environmentally-induced thrombocytopenic purpura. JAMA 242(22):2434-5, Nov. 30, 1979.

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Scented Products: Overlooked source of indoor air pollution

Though fragrance is generally considered pleasant, the numbers of complaints related adverse effects of fragrance have increased. Fragrance is frequently cited as triggering and exacerbating health conditions such as asthma, allergies, and migraine headaches. Chemicals used in fragrance are volatile compounds that can irritate the respiratory system.

The fragrance and flavors industry has increased more than tenfold since the early 1950s. The industry experienced its fastest growth and doubled in size form 1980 to1989. This growth has resulted in exposure to virtually every segment of the population, both through use and second-hand exposures. In spite of widespread exposure, there has been little focus on the impact of scented products on indoor air quality and health.

Information was gathered by looking at both types and specific chemicals used in fragrance, assessing available use data, and reviewing scientific, medical, industry, and regulatory literature. There is high potential for exposure to several hundred chemicals used in fragrance due to their high volume use and/or high use in consumer products. These materials are volatile organic compounds and can contribute to indoor air pollution. Presence of synthetic musk compounds in blood, adipose tissue, and human breast milk indicates significant exposure to these materials. Studies suggest that synthetic musk compounds cross the placental barrier. Concerns have been raised over potential impact on reproductive health, the developing fetus, and nursing infants.

One of the major areas of concern is impact on respiratory health. Fragrance is one of the most frequently cited triggers for asthma. An EPA-sponsored literature review by the Institute of Medicine identified fragrance, along with environmental tobacco smoke and formaldehyde as chemical triggers for asthma. The increase in use of fragrance has paralleled the increase in asthma rates. Hispanics and African-Americans are more heavily impacted by asthma. These same population groups are also more likely to use fragrance. These and other factors support further investigations into the impact of fragrance on indoor air quality and on health. READ ENTIRE PAPER

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Multiple Chemical Sensitivities

Cyndi Norwitz

Multiple Chemical Sensitivities (MCS) is a syndrome with the major presenting symptom of marked reactions to a variety of toxins in concentrations that most healthy people can tolerate. MCS overlaps substantially with Chronic Fatigue Syndrome (presenting symptom is fatigue) and Fibromyalgia (presenting symptom is pain) to the point that many consider them to be variants of the same disease. Gulf War Syndrome is also most likely MCS or something very similar.

The sensitivities of MCS are similar to allergies but, for most, do not qualify as allergies in the strict sense of a process leading to a specific set of bodily responses within approximately 20 minutes. The resulting symptoms include those of traditional allergies, such as headaches, migraines, nausea, anaphylactic shock, asthma, rashes and other skin eruptions, as well as more unusual symptoms such as acute abdominal pain, fatigue, insomnia, neurological signs, brain fog (a cloudy feeling in the head connected to loss of memory, cognitive functioning, alertness, and mental sharpness), body aches and pains, and, rarely, heart attacks.

Toxins that trigger MCS attacks can come from a variety of sources. Many people with MCS react to traditional allergens such as foods, dust, air pollution, pollen, animal dander, and molds, but the most common toxins that cause reactions are chemical substances found in everyday life. Perfumes, air fresheners, cigarette smoke, dry-erase markers, many household cleaning products, fabric softeners and dryer sheets, scented detergents and other products, new carpeting, solvents, fresh tar, and pesticides are among the most common reactants but do not make a complete list.

Although there are congenital cases, most people with MCS acquire it as an adult. The body loses the ability to process toxic substances. Many people with MCS end up so sensitive to some chemicals that they can react to amounts so small that a healthy person might not even know it is there. This is especially true in people whose bodies are overloaded with past chemical exposures (toxins that never break down and exit the body).

Anyone can acquire MCS; most sufferers had normal healthy lives before becoming ill. The most common way of acquiring MCS is chemical injury. One very large chemical exposure or many smaller exposures over time can lead to the body losing its ability to detox. Exposure to pesticides is a frequent route to MCS. Once the body's ability to process toxins is damaged, the person will react to chemicals he or she never had trouble with before, including chemicals not involved in the original injury.

Chemical injury is not the only way to impair the detox processes. Some other routes to MCS include viruses, severe emotional or physical trauma (especially in childhood), liver damage, or disorders of metabolism. Some people with MCS also have porphyria, a genetic disorder of the enzyme pathways that may not manifest itself until triggered by a chemical exposure.

Treatment

The most important treatment for MCS is complete avoidance of toxins that cause the person to react. Unlike with some allergies, there is no way to medicate the reaction and allow the person full exposure to the substance. It is also important to avoid chemicals that may be further injuring the body even though the person is not obviously reacting to them.

Cleaning up the Local Environment: A Basic Checklist of the Most Common Reactants

  • Completely avoid all traces of all pesticides

  • Stop smoking and avoid breathing cigarette smoke

  • Stop using "diet" products, or anything containing aspartame (Nutrasweet)

  • Reduce processed foods; avoid additives; eat organic when possible

  • Identify food allergies and avoid those substances

  • Stop using perfume, cologne, scented versions of deodorant and aftershave

  • Avoid scented shampoo and soap

  • Get rid of all air fresheners, stickup/plug-in/sprays, and deodorizers

  • Switch cleaning and laundry products to nontoxic, fragrance-free versions

  • Remove all dryer sheets and fabric softener from the house

  • Stay away from new carpet, fresh paint, solvents, and new construction

  • Don't use dry-erase markers

  • Avoid OTC and prescription medicines that are not medically necessary

  • Watch carefully for reactions, and avoid anything that makes one ill, even if the reason for the reaction seems to make no sense

Most people with MCS who get better do so through avoidance and careful, controlled detox of existing toxins in the body. Some detox can be done on one's own but it's best to start off with medical supervision. Some examples of detox methods are sauna, vitamin C, bentonite clay, charcoal, and special diets.

Some people with MCS can safely use medicines to alleviate symptoms but most people with MCS are also hypersensitive to drugs. Some people find lasting relief through mainstream treatments such as allergy shots. Others go outside of Western Medicine and successfully use Chinese Medicine (acupuncture and herbs). Chiropractic care, homeopathy, and massage can also be useful.

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The Quick Environmental Exposure and Sensitivity Inventory (QEESIŠ)

A screening questionnaire for multiple chemical intolerances (MCI). The instrument has four scales: Symptom Severity, Chemical Intolerances, Other Intolerances, and Life Impact. Each scale contains 10 items, scored from 0 = “not a problem” to 10 = “severe or disabling problem.” A 10-item

Masking Index gauges ongoing exposures that may affect individuals’ awareness of their intolerances as well as the intensity of their responses to environmental exposures. Potential uses for the QEESIŠ include:

1. Research—to characterize and compare study populations, and to select subjects and controls.

2. Clinical evaluations—to obtain a profile of patients’ self-reported symptoms and intolerances. The QEESIŠ can be

administered at intervals to follow symptoms over time or to document responses to treatment or exposure avoidance.

3. Workplace or community investigations—to identify and assist those who may be more chemically susceptible or who

report new intolerances. Affected individuals should have the option of discussing results with investigators or their

personal physicians. Click here to print Questionnaire

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Study Says Carbon Filters Ineffective for Multiple Chemical Sensitivities

For many with allergies and multiple chemical sensitivities (MCS), a mask is the only way to go into stores and other public places where volatile organic compounds (VOC’s) such as perfume, detergents, cleaning products, formaldehyde, scented products, and pesticides, among others, are abundant. Since reactions may include respirator problems, seizures, headache, fatigue, confusion, and other unpleasant debilitating symptoms, it is important to assure adequate protection when unavoidable exposures are encountered. Frequently, those with allergies and MCS resort to cloth masks. But is a simple carbon mask effective? Or, must one upgrade to a respirator or other form of protection?

A scientific study by Millqvist and Lowhagen found that breathing through a carbon filter does not protect people from perfume exposures that trigger symptoms. The study, Placebo-controlled Challenges with Perfume in Patients with Asthma-like Symptoms, examined nine patients with respiratory symptoms after nonspecific irritating stimuli. The patients did not have any IgE-mediated (histamine) allergy or bronchial obstruction, therefore represented a population similar to multiple chemical sensitivity (MCS) sufferers.

Millqvist and Lowhagen used provocation with perfume or a placebo with or without a carbon filter mask. The purpose was to determine if breathing through a filter with active carbon would prevent symptoms. A nasal clamp was used to prevent smelling of the perfume while patients breathed through the mouth.

The researchers found that the patients' earlier symptoms were verified by the perfume provocation. More importantly, breathing through the carbon filter had no protective effect! “The symptoms are not transmitted via the olfactory nerve, since the patients could not smell the perfume, but they may have been induced by a trigeminal reflex via the respiratory tract or by the eyes” (Millqvist & Lowhagen, 1996).

Those with MCS already know that carbon filtered masks only provide nuisance level protection. For full respiratory protection, one must upgrade to a half-mask respirator. If the eyes are a factor in reactions, a full-mask respirator is in order. The respirator should have both a particulate filter and a VOC filter. An example is a 3M 6000 series mask with a 6006 or 6003 VOC cartridge and an N-95 particulate filter that fits on top of the VOC cartridge.

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Multiple Chemical Sensitivity: A Hidden Disability

(Note: This is my tenth post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)There is a hidden disability among us, and nurses must become aware of its existence and champion the cause of so many individuals who suffer in relative silence and medical neglect.

That hidden disability is Multiple Chemical Sensitivity (MCS). This article will introduce MCS, its symptoms and proposed etiology, and provide resources for nurses who wish to become more conversant with the vicissitudes of this very modern illness. As a nurse living with MCS, I see it as my mission to bring this condition to the awareness of nurses and other medical professionals, thus increasing knowledge, understanding, compassion, and available treatment options for the many sufferers of this much misunderstood and unacknowledged condition.

Multiple Chemical Sensitivity is a chronic health condition afflicting many people throughout the world. Individuals with MCS report a variety of symptoms when exposed to varying levels of chemical or fragrance exposure, including but not limited to headache/migraine, shortness of breath, confusion, irritability, dermal erythema/rash, mood changes, anxiety, throat irritation, dysphagia, bronchospasm, asthma exacerbation, and burning eyes. Standard diagnostic tests generally do not elicit confirmation of chemical sensitivity, and MCS has yet to be officially acknowledged by the American Medical Association as a physiological illness, relegating this very real condition with very real physical symptoms to the realm of psychosomatic disorders. Encouragingly, The Americans with Disabilities Act, Social Security Administration, Department of Housing and Urban Development, and the Environmental Protection Agency all recognize MCS as a legitimate disability in need of full accommodation (Kendall, Katherine. "Accessible Health Care and Chemical Sensitivity", Environmental Health Coalition of Western Massachusetts, 2006, PO Box 187, Northampton, MA, 01061.)

Since World War II, thousands of unregulated chemicals have been introduced into our environment. Through the mediums of household conveniences, modern packaging, air fresheners, cleaning agents, and a multitude of hair and personal care products, many chemicals which are known carcinogens (and often banned in other Western countries) are applied daily to the skin of unknowing individuals, aerosolized into the air we breathe, or even transmitted through breast milk or across the placenta to our children's growing bodies. An astronomical number of chemicals with known neurotoxic effects are used to produce a plethora of personal care products, and due to lack of regulation to protect proprietary trade secrets, citizens' health is regularly compromised.

A growing body of literature is continuing to document the physiological effects of chemicals on multiple human organ systems. A 2006 study by the University of Colorado and and Baylor College of Medicine in Houston clearly drew conclusions linking chemicals in commercially available air fresheners to the formation of cancerous cells. Another study by Anderson Laboratories in Vermont showed a direct correlation between exposure to commercial perfumes and acute neurotoxicity and air flow reduction in mice. Additionally, a German study found a potential genetic link vis-a-vis sensitivity to chemicals in the form of L-Glutathione, a endogenous hepatic chemical important for the detoxification of exogenous chemicals and irritants.

While some workplaces have begun to initiate "fragrance-free" policies to protect workers and clients alike, even the real estate industry is beginning to notice the economic impact that chemical exposure can have on prospective home buyers. The Investor Environmental Health Network also recognizes the economic risk posed by chemical contaminants in products and homes, with reports of shareholders withdrawing support for investments in companies whose products contain ingredients known to be harmful to human health, as well as those ingredients which have never been tested for human toxicity. An informative video on their website details the issue.

In 2006, Bill Moyers aired a PBS special highlighting the deleterious effects of chemicals on human physiology, exposing the nefarious and cynical lack of government and regulatory oversight of the chemical industry in the interest of trade secrets. His investigative journalism uncovered scientific proof that children---especially children still in utero---are exposed to enormous concentrations of neurotoxins during critical periods of neurological development. During the course of his investigation, Mr. Moyers' hair was tested for the presence of various heavy metals and neurotoxins, and the results were staggering, with dozens of toxic chemicals present in his bloodstream. Recent scientific findings have led to ongoing research to discover if the "epidemic" of ADD, ADHD and even Autism may be linked to the explosion of unregulated chemicals saturating our environment since World War II. Moyers points out that political contributions by the chemical industry to both major political parties over the decades have bought a great deal of freedom from oversight for the purveyors of such substances, and the only party injured by that sweetheart deal has been the blissfully ignorant American people.

In terms of attention from healthcare professionals, this writer has been most heartened by an article in the American Journal of Nursing (Cooper, Carolyn. "Multiple Chemical Sensitivity in the Clinical Setting", AJN, March 2007, Volume 107, Number 3, pp. 40-47). The author, Carolyn Cooper, presents a thoughtful and relatively comprehensive article, outlining the potential etiology of MCS, general symptomatology, demographics, as well as the controversy surrounding the struggle for recognition of MCS as a physiological condition. To her credit, Ms. Cooper uses a case study, complete with photographs and a patient's true identity, to illustrate the special considerations and accomodations necessary for a hospitalized patient with MCS. I was both impressed and gratified that Ms. Cooper took her patient's needs at face value, working closely with his wife to manage his care without exacerbating his condition, providing optimal care for a patient at his most vulnerable, and taking the time to educate her colleagues as part of the process. Ms. Cooper then provides a thoughtful and step-by-step list of instructions and recommendations for accomodating patients' dietary and environmental needs while hospitalized. This is truly a must-read for every nurse.

Due to the prevalence of respiratory diseases such as COPD, asthma, and environmental allergies, all healthcare facilities should consider enacting strict fragrance-free policies for both visitors and staff. Individuals with MCS are often socially isolated due to the risk of chemical exposure in both public and private spaces. Sadly, individuals with MCS often feel at great risk when entering a healthcare facility, even for the most basic of preventive healthcare. With potential sensitivities to ammonia, bleach, latex, chemical cleaning products, fragranced soaps and hand sanitizers, colognes worn by staff and other visitors, as well as the ubiquitous second-hand cigarette smoke lingering around the entrances to public buildings, a visit to a healthcare facility can be an exercise in anxiety and damage control for the person with MCS. We all know that a hospital stay for a non-chemically sensitive individual can be stressful and far from restful. With MCS on board, a hospital stay can indeed feel potentially lethal to the patient with MCS.

When considering the controversy over the medical validity of MCS, please recall the uphill battles for recognition waged vis-a-vis Fibromyalgia/Myofascial Pain Syndrome, Restless Legs Syndrome, and Chronic Fatigue Syndrome. Many diseases begin their careers as second-class illnesses discarded on the psychosomatic scrap heap. I would venture a guess that even Borderline Personality Disorder and Post-Traumatic Stress Disorder saw their share of nay-sayers back in the day. While rigorous scientific validation is indeed useful when a new disease is barking at the door of the AMA, it appears that politics, economic interests and entrenched ways of thinking can often stand in the way of progress. The insurance lobby certainly has a vested (financial) interest in keeping MCS out of the ICD-9 code-book, and those chemical companies must be plenty worried as investors withdraw funding from their products due to fear of litigation and reprisal for deleterious health effects. Politics and healthcare make strange bedfellows, but one must not forget that managed care and the insurance lobby also have economic interests at heart, and I would not be surprised if some of those economic interests could be traced to decision makers high within the echelons of the venerable AMA. What a tangled web we weave.

As nurses, beyond the politics, the insurance tangles, and the economic vicissitudes of healthcare, we are faced with patients who entrust us with their lives and well-being. When a patient enters your unit and informs you that he or she has Multiple Chemical Sensitivity, what are you to do? How will you approach other staff members? How will you even begin to accommodate your patient and assuage his or her concerns? With all of the normal stressors of your workload, how will you make the time to accommodate such specific needs? The answer is education and information, and when that patient walks through your door, that education will be a steep learning curve indeed for the ill-prepared. Listening to your patient and taking his or her concerns at face value is a good place to start. The article mentioned above in the American Journal of Nursing is another valuable resource. MCS-America offers resources and links, as does MCS Resources and Referrals. Governmental websites---like OSHA and The Interagency Workgroup on Multiple Chemical Sensitivity---offer some additional guidance.

As professionals who want to provide the best care possible for every patient, it behooves us to prepare in advance for as many eventualities as we can. As latex allergies have come to the fore, awareness has increased as facilities begin to provide staff education (and proper accommodations) for patients and staff with such sensitivities.

If your facility has indeed addressed latex allergies (which this writer hopes they have), perhaps the administration will be open to discussions regarding MCS if the request is framed in light of the exponential explosion of latex sensitivity (and perhaps peanut allergies) across the population. Making a link between latex allergies (which worsen with continued exposure) and MCS (which also worsens with each exposure) will help administrators and managers understand and integrate the importance of the issue. As peanut and latex allergies have gained acceptance, recognition, and action throughout the country, those suffering such sensitivities have felt increasingly emboldened to demand accommodation and safety. It cannot be denied that unregulated and dangerous chemicals permeate our environment, homes, schools, and hospitals. Shouldn't those sensitive to, and made ill by, such products also be given our attention and support?

Nurses are not just caregivers. We are advocates. We do not just treat patient's symptoms. Nurses look at the whole person, sometimes called a "biopsychosocial" approach to care. Apropos of this fact, this writer contends that nurses must take up the cause of vulnerable populations within the healthcare setting. When we think of vulnerable populations, what generally comes to mind are the homeless, the uninsured, the underinsured, children, the elderly. Moving beyond that more narrow definition of vulnerability, we must also embrace the "silently vulnerable", those whose disability is less apparent, and perhaps, as is the case with MCS, resolutely rejected by the medical establishment.

Chemicals and chemical sensitivity are not going away, no matter how the AMA, the insurance industry, and the chemical industry hope that they will simply fade into the background. The MCS community is lobbying hard to win recognition and validity. This writer calls on nurses everywhere to take up the gauntlet of MCS and bring it to the attention of your coworkers and administrators. Our voice can be heard loud and clear. Let's be the megaphone for a condition whose time has come.

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How toxic is your bathroom?

Be warned: your daily beauty regime could be taking years off your life.

Pat Thomas reports on the chemical timebomb in your cosmetics cabinet
Published: 24 October 2005

Earlier this year, the US Food and Drug Administration (FDA) did something amazing. It issued an unprecedented warning to the cosmetics industry that it was time to inform consumers that most personal care products have not been safety tested.

Where the US goes, the UK inevitably follows. If the FDA starts the ball rolling by flexing its muscles, it is possible that in the not too distant future 99 per cent of personal care products could be required to carry a caution on the label: "Warning: The safety of this product has not been determined."

What concerns scientists at the FDA and at environmental health organisations throughout the world is the "cocktail effect" - the daily mixing of many different types of toxins in and on the body - and how this might damage health over the longer term.

On average, we each use nine personal care products a day containing 126 different ingredients. Such "safety" testing as exists looks for reactions, such as skin redness, rashes or stinging, but does not investigate potential long-term problems for either humans or the environment. Yet the chemicals that go into products such as shampoos and hand creams are not trace contaminants. They are the basic ingredients.

Absorbed into the body, they can be stored in fatty tissue or organs such as the liver, kidney, reproductive organs and brain. Cosmetics companies complain of unfounded hysteria, but scientists are finding industrial plasticisers such as phthalates in urine, preservatives known as parabens in breast-tumour tissue, and antibacterials such as Triclosan and fragrance chemicals like the hormone-disrupting musk xylene in human breast milk. Medical research is proving that fragrances can trigger asthma; that the
detergents in shampoos can damage eye tissue; and that hair-dye chemicals can cause bladder cancer and lymphoma. An even greater number of substances in personal care products are suspected to present potential risks to human health from this known effect on animals.

If these problems had been linked to pharmaceutical drugs, the products would have been taken off the market. At the very least, money would have been spent on safety studies. But because the cosmetics industry is largely self-governing, and because we all want to believe in the often hollow promises of better skin and whiter teeth, products containing potentially harmful substances remain in use and on sale.

Think it can't be that bad?
Consider what goes into some of the UK's most popular toiletries.

OLAY REGENERIST

What they claim: Instantly improves the appearance of fine lines and wrinkles.

But watch out: To work, the product needs to be well absorbed, so Regenerist contains penetration enhancers like disodium EDTA. But these also drive toxins deeper into the skin. Watch out for hormone disrupters such as ethylparaben, methylparaben and propylparaben and potential carcinogens such as polyacrylamide, triethanolamine (which can form cancer-causing nitrosamines), and the artificial colours CI 16035, CI 19140 and PTFE (Teflon). Regenerist contains the sunscreens butyl
methoxydibenzoylmethane (B-MDM) and ethylhexyl salicylate; not enough for an SPF rating, but potentially enough to irritate skin.

CLAIROL HERBAL ESSENCES SHAMPOO DRY/DAMAGED HAIR

What they claim: A totally organic experience.

But watch out: It looks and smells appealing because it is coloured using four potentially cancer-causing dyes (CI 17200, CI 15510, CI 42053, CI 60730) and perfumed with synthetic fragrances that are known neurotoxins and skin irritants. Among its detergents, sodium lauryl sulphate can irritate skin and permanently damage eye tissue, and sodium laureth sulphate and cocamide MEA can be contaminated with 1,4-dioxane, a hormone disrupter associated with breast cancer. Cocamidopropyl betaine, another detergent, is a penetration enhancer, as is the solvent propyelel glycol and the preservative tetrasodium EDTA; all allow other chemicals to pene-trate more deeply into skin and bloodstream.

JOHNSON'S BABY SOFTWASH

What they claim: Best for baby, best for you.

But watch out: Children's skin is thinner and more absorbent than adults', so is a less effective barrier to chemical toxins. The rates of eczema and allergies among children are on the rise and the early introduction of toiletries on to sensitive skin may be a factor. When soap does the job, why expose your child to skin and eye irritants such as sorbitan laurate, cocamidopropyl betaine and acrylates/C10-30 alkyl acrylate crosspolymer, or PEG-150 distearate, PEG-80, PEG-14M and sodium laureth sulphate that can be contaminated with the carcinogens 1,4 dioxane and ethylene oxide, or hormone disrupters such as parabens? In addition, there's nothing here that naturally moisturises the skin - only synthetic polymers (plastic-like substances) like polyquaternium-7 and polypropylene terephthalate that coat it, merely giving the impression of smoothness.

CALVIN KLEIN'S ETERNITY

What they claim: What the world needs now is love.

But watch out: Perfumes are made from the same neurotoxic solvents found in glues and adhesives and volatile chemicals common in garages and factories, albeit in much smaller concentrations. Eternity contains a staggering 41 ingredients, about 80 per cent of which have never been tested for safety in humans. The rest are known neurotoxins, allergens, irritants and/or hormone disrupters. Still think perfume is sexy?

LYNX DRY

What they claim: Spray more, get more.

But watch out: Lynx Dry contains three types of neurotoxins: solvents such as PPG-14 butyl ether; the propellants butane, isobutane and propane; and synthetic fragrance chemicals. It contains a preservative BHT (butylated hydroxytoluene), which has been linked with cancer, and PEG-8 distearate, which can be contaminated with the hormone-disrupting carcinogens ethylene oxide and 1,4-dioxane as well as polycyclic aromatic compounds such as benzene and benz(a)pyrene. Aluminium zirconium tetrachlorohydrex GLY and aluminium chlorohydrate work by clogging pores, but long exposure to aluminium-containing deodorants raises the risk of diseases such as Alzheimer's.

COLGATE TOTAL

What they claim: 12-hour fresh breath and antibacterial protection.

But watch out: Conventional toothpastes often contain irritating detergents like sodium lauryl sulphate, which can cause sore gums and mouth ulcers, and abrasives like hydrated silica, which can erode tooth enamel. Total contains a glue-like substance, PVM/MA copolymer, that sticks the active ingredients to teeth. Saccharin, a known carcinogen in animals, is also found. The colouring CI 42090 (banned in Austria, Belgium, France, Germany, Norway, Switzerland and Sweden) causes cancer in animals. Total contains Triclosan, an antibacterial agent that can in certain circumstances combine with chlorine in tap water to produce chloroform gas, which is easily absorbed into the skin or inhaled and can cause depression, liver problems and cancer.

GILLETTE MACH 3 SHAVING GEL

What they claim: The best a man can get.

But watch out: Helped by a global advertising campaign featuring David Beckham, Gillette shaving products have carved their way into the male psyche. If he thought about the ingredients, would the "epitome of the well groomed man" be so keen to promote the product? Mach 3 gel contains skin irritants such as triethanolamine, palmitic acid glyceryl oleate, three potential carcinogens (polytetrafluoroethylene (Teflon), BHT, CI 42090) and three central nervous system toxins or pollutants (isopentane, parfum and isobutane).

CLAIROL NICE 'N EASY

What they claim: Natural-looking colour with complete grey coverage.

But watch out: All hair dye sold in the EU containing phenylenediamines, resorcinol and/or 1-naphthol must carry a warning: "Can cause an allergic reaction. Do not use to colour eyelashes or eyebrows." Other hair dye ingredients - including coal tar dyes, 4-chloro-m-phenylenediamine, 2,4-toluenediamine, 2-nitro-p-phenylenediamine and 4-amino-2-nitrophenol - have proven carcinogenic in at least one animal species. In humans, intensive longer-term use of permanent hair dye is associated with breast, ovarian and bladder cancer, non-Hodgkin's lymphoma, multiple meyeloma and rheumatoid arthritis.

RADOX BUBBLE BATH

What they claim: Soothes emotions, cleanses the body.

But watch out: Soaking in hot water increases skin permeability and helps vaporise chemicals in products, making them more easily inhaled. Radox Relax contains potential skin irritants (sodium laureth sulphate, cocamidopropyl betaine) potential carcinogens such as the preservative combo methylchloro-isothiazolinone and methylisothiazolinone and synthetic dyes, and hormone-disrupting ethylhexyl methoxycinnamate. It contains perfume ingredients that are capable of irritating (coumarin, benzyl
salicylate, limonene) and disrupting the central nervous system (butylphenyl methylpropional, alpha-isomethyl ionone, linalool).

NIVEA BODY

What they claim: Feel the essential care.

But watch out: Along with semi-synthetic fatty acids and waxes, Nivea Body contains denatured alcohol and glycerine, which can dry skin with repeated use. It also contains several estrogenic preservatives (methylparaben, butylparaben, ethylparaben, isobutylparaben, propylparaben), contact allergens (phenoxy-ethanol, linalool, citronellol, hydroxyisohexyl 3-cyclohexene carcoxaldehyde) and a potential carcinogen (limonene). Film-formers like dimethicone keep undesirable ingredients next to the skin longer. About one-third of the listed ingredients are fragrances that are known irritants and sensitisers of human skin; chemicals that, with repeated exposure, can trigger allergic reactions.

CLEARASIL 3-IN-1 DEEP CLEANING WASH

What they claim: Clinically proven to help fight spots.

But watch out: A mix of strong detergents and surfactants (sodium lauryl sulfate, cetyl betaine, distearyl-dimonium chloride and steareth-21), chemical exfoliants (salicylic acid) and solvents (glycerin, alcohol, menthol) that are capable of removing the skin's natural oils, and synthetic skin conditioners for repairing some of the damage inflicted by the other ingredients. It contains two potential carcinogens (BHT and disodium EDTA) and fragrance ingredients among the most commonly reported contact allergens in the EU (behenyl alcohol, limonene benzyl salicylate, linalool and hexyl cinnamal). These so consistently lead to skin problems that they must now be listed separately on labels within the EU.

LISTERINE TEETH AND GUM DEFENCE

What they claim: Kills the germs that cause plaque and bad breath.

But watch out: This mouthwash is 21.6 per cent alcohol. Alcohol dries and changes the pH of the mouth and throat and long-term use of alcohol-containing mouthwashes increases the risk of mouth and throat cancers. Listerine also contains a mild detergent, poloxamer 407, that is soluble in liquids at low temperatures but turns to a gel at higher temperatures (ie, body temperature). That makes it a film-former, "glueing" other ingredients on to the surfaces of the mouth for longer. Fluoride in
quantity is poisonous if swallowed, and the sweetener saccharin causes bladder cancer in animals. Finally, synthetic colours, aromas and flavours are made from volatile solvents that can alter the basic flora of the mouth and may cause dermatitis.

Pat Thomas is health editor of The Ecologist. Her series 'Behind the Label'
appears in the magazine every month (www.theecologist.org)


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Accommodation and Compliance Series: Employees with Fragrance Sensitivity
By Tracie DeFreitas Saab, M.S.

Introduction

JAN’s Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee’s individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar.

Information about Fragrance Sensitivity

What is fragrance sensitivity?

Fragrance sensitivity may be an actual allergy or a simple irritation. It can be difficult to diagnose which is occurring. In addition, fragrances are composed of many different chemicals. This can make it difficult to identify if the sensitivity is to one particular chemical or to a combination of chemicals (Allergy Health Online, 2007).

Typical reactions to fragrances include breathing problems, asthma, and contact dermatitis (an itchy and inflamed skin rash). Once a person has developed fragrance irritation it is likely that the sensitivity will grow over time and with repeated exposure. Certain chemicals may be sensitizers at high levels of exposure and can result in sensitivity to the chemical at much lower levels after initial exposure (Allergy Health Online, 2007).

What are the symptoms of fragrance sensitivity?

Fragrances can enter the body through inhalation, ingestion, or absorption. The first indicator of a fragrance irritation or allergy is usually a skin rash after the use of a perfume, cream, or lotion. Reactions can also take other forms, including: hives; nausea; dizziness; headache; itchy skin, eyes, and nose; runny nose; wheezing; coughing; eczema; difficulty breathing; sore throat; asthma attacks or asthma–like symptoms; and strange tastes in the mouth. The severity of symptoms varies from one individual to another. Symptoms can show up over a wide time range from a few minutes to seven to ten days (Allergy Health Online, 2007).

How is fragrance sensitivity prevented and treated?

The best way to prevent fragrance sensitivity is to avoid the offending substance. Discussing the fragrance sensitivity with people at work and at home will help to limit exposure to other people’s fragrances. Careful examination of product labels is also important. A product labeled “unscented” does not mean it is fragrance free, merely that it has no perceptible scent. A fragrance may have been added to the product to mask scent. While such a trace amount of fragrance is unlikely to cause irritation, it may trigger allergic reactions in people with fragrance allergies (Allergy Health Online, 2007).

Fragrances added to products to mask scent do not have to be labeled as ingredients. A label that is marked “perfume free” or “fragrance free” is more likely to contain no fragrances. Sensitive people may wish to consult a dermatologist for recommendations on fragrance free skin products or an allergist for recommendations on avoiding a variety of scented products (Allergy Health Online, 2007).

Fragrance Sensitivity and the Americans with Disabilities Act

Is fragrance sensitivity a disability under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with fragrance sensitivity will have a disability under the ADA and some will not.

A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment (EEOC, 1992). For more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.

Is an employer required to implement a fragrance policy as an accommodation?

JAN discusses the implementation of a fragrance policy as an option to consider when addressing possible accommodations. An employer could choose to make a request that employees voluntarily refrain from wearing fragrances or the employer could go as far as creating a policy that requires employees to refrain. An employer has the right to decide how far is reasonable when implementing accommodations. Employers who have concerns about the legalities of implementing a fragrance policy as an accommodation should consult an appropriate legal professional.

Accommodating Employees with Fragrance Sensitivity

Note: People with fragrance sensitivity may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with fragrance sensitivity will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.

Questions to Consider:

1. What limitations is the employee with fragrance sensitivity experiencing?

2. How do these limitations affect the employee and the employee’s job performance?

3. What specific job tasks are problematic as a result of these limitations?

4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?

5. Has the employee with fragrance sensitivity been consulted regarding possible accommodations?

6. Once accommodations are in place, would it be useful to meet with the employee with fragrance sensitivity to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

7. Do supervisory personnel and employees need training regarding fragrance sensitivity?

Accommodation Ideas:

  • Maintain good indoor air quality

  • Discontinue the use of fragranced products

  • Modify workstation location

  • Modify the work schedule

  • Provide an air purification system

  • Modify communication methods

  • Modify or create a fragrance-free workplace policy

For information about improving indoor air quality, see "An Office Building Occupant's Guide to Indoor Air Quality" at http://www.epa.gov/iaq/pubs/occupgd.html.

Sample Policy Language:

The following are examples of fragrance-free workplace policy statements.

Anonymous City Law Enforcement Agency Policy: "To reasonably accommodate bureau employees who have written memoranda documenting chemical sensitivity to perfume, employees will wear no perfume or cologne during business hours when they are scheduled to be within the bureau during their shift. This policy will not affect those bureau employees who are in an off-site training class, on city business, or out of the office for an entire shift."

Anonymous Employer: "(Name of employer) strives to ensure the comfort and safety of staff and visitors by encouraging a smoke free and fragrance free environment."

Anonymous State Community Development Agency, Employee Administrative Bulletin: "Given that chemically sensitive individuals may react to different products with widely varying degrees of severity, it is very difficult to ensure a consistently comfortable and accommodating work environment under every conceivable set of circumstances. Even so, it is the general consensus of the Labor/Management Committee and the desire of the (company name) to minimize to the extent possible the barriers and difficulties experienced in the workplace by both employees and clients subject to chemical/fragrance sensitivities. The (company name) requests that all offices and spaces used by the staff and their visitors remain free of chemical-based scented products."

Anonymous Employer, Staff Memo from Executive Director: "I ask that we refrain from applying spray colognes, hairsprays, and or air fresheners in the office, as the use of such products may trigger allergic reactions and create health problems."

Anonymous Employer, Administrative Manual Policy, Subject: Employee Appearance: "Cologne, perfume, aftershave lotions, scented lotions, or body washes are not to be worn in the Medical Center."

State Protection and Advocacy Agency: "This is a fragrance free office. Thank you for not wearing any of the following: cologne, after shave lotion, perfume, perfumed hand lotion, fragranced hair products, and/or similar products. Our chemically-sensitive co-workers and clients thank you."

Anonymous Employer: "This is a fragrance free office. Please help us to accommodate our co-workers and clients who are chemically sensitive to fragrances and other scented products. Thank you for not wearing perfume, aftershave, scented hand lotion, fragranced hair products, and or similar products."

Anonymous Employer, Memo to All Staff: "You may have noticed the signs up on the front door and on the library doors stating that this is a fragrance-free office. Please cooperate with this request because there are several of us on staff and visitors to our office who are chemically sensitive to varying degrees. Our bodies have a hard time when we come into contact with a variety of chemicals and each episode takes its toll on our bodies. Please use only unscented products during work hours. This does not include deodorant or bath soap at this time."

U.S. Access Board: "Under this policy, the Board requests that all participants refrain from wearing perfume, cologne, and other fragrances, and use unscented personal care products in order to promote a fragrance-free environment. This request is included in notices and on displayed signage for the Board's meetings, hearings, and other public events. In addition, the Board will work with the operators of meeting sites to prevent the use of deodorizers and cleaning products immediately before the event in and around meeting locations."

The Access Board is an independent Federal agency devoted to accessibility for people with disabilities. The Board has adopted a policy to promote access for individuals who are sensitive to fragrances at http://www.access-board.gov/about/policies/fragrance.htm

Products:

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

Allergy Health Online. (2007). Fragrance irritation & allergies. Retrieved September 5, 2008, from http://allergy.healthcentersonline.com/cosmeticschemicalsmetals/fragrancesensitivity.cfm

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act.  Retrieved September 5, 2008, from http://www.jan.wvu.edu/links/ADAtam1.html

National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. (2007). FAQ for the General Public. Retrieved September 4, 2008, from http://www.niaaa.nih.gov/FAQs/General-English/


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