The best current data suggest that certain psychologic factors predispose individuals to develop symptoms and to seek out someone who will provide a "physical" explanation of their symptoms. Many of these patients suffer from somatization disorder, an emotional problem characterized by persistent symptoms that cannot be fully explained by any known medical condition, yet are severe enough to require medical treatment or cause alterations in lifestyle. Some are paranoids who are prone to believe that their problems have outside causes. Others suffer from depression, panic disorder, agoraphobia, or other anxiety states that induce bodily reactions to stress. Many patients are relieved when a clinical ecologist offers what they think they need and encourages them to participate actively in their care. However, the treatment they receive may do them far more harm than good.
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One observer has commented that the variety of treatments they prescribe "seems limited only by outsiders their imagination and resourcefulness." The usual approach emphasizes avoidance of suspected substances and involves lifestyle changes that can range from minor to extensive. Generally, patients are instructed to modify their diet and to avoid such substances as scented shampoos, aftershave products, deodorants, cigarette smoke, automobile exhaust fumes, and clothing, furniture, and carpets that contain synthetic fibers. Extreme restrictions can involve wearing a charcoal-filter mask, using a portable oxygen device, staying at home for months, or avoiding physical contact with family members. Many patients are advised to take vitamins, minerals, and other dietary supplements. "Neutralization therapy based on the results of provocative tests, can involve administration of chemical extracts under the tongue or by injection. Mcs patients typically portray themselves as immunologic cripples in a hostile world of dangerous foods and chemicals. In many cases, their life becomes centered around their illness. Various companies cater to these beliefs by offering such items as "organic" foods; odor-free personal products; special clothing, household products, and building materials; and even specially outfitted travel trailers. A recent article. Reason described how one woman wore a protective mask while shopping and another woman hung her mail on a clothesline for weeks before reading it, to allow the "toxins" in the ink to dissipate. Case Studies, many experts have studied "MCS" patients and concluded that their basic problem is psychologic rather than physical.
Fragrances and other odorants could, however, be associated with symptoms as claimed by mcs symptomatics, because they are recognizable stimuli, but fragrance has not been demonstrated to be causal in the usual sense. A more recent study tested whether "MCS" patients could reliably distinguish between airborne solvents and placebo and whether there were significant differences in measurable biological and neuropsychological parameters between solvent and placebo exposures. During the study, 20 mcs patients and 17 controls underwent six sessions in a challenge chamber in which they were exposed to solvent fumes and clean air reviews in random order. Neither the patients nor the experimentors knew which exposures were which at the time they took place. No differences accuracy in identifying chemical exposure were found between the two groups. Nor was cognitive performance influenced by solvent exposure or different between the groups. Nor was there any difference between the groups in serum cortisol levels measured before and after exposures. The treatment clinical ecologists offer is as questionable as their diagnoses.
These patients believed that they were reactive or hypersensitive to low-level exposure to many chemicals. Some had previously been evaluated and managed by clinical ecologists and diagnosed with "MCS." During nonblinded tests, these patients consistently reported symptoms they had associated with exposure at work, at home, or elsewhere. The environmental chamber enabled the patients to encounter measured amounts of purified air, compressed gasses, and air containing specific chemical concentrations, without knowing which situation was which. None of the patients demonstrated a response pattern implicating the chemicals supposedly responsible for their symptoms. Eighteen reported no symptoms at least once when the suspect chemical was present. Fifteen reported symptoms at least once when the suspect chemical was absent. In other words, patients reacted to their feelings and beliefs about the test, rather than to the substance in question. In 1999, the American health foundation's Environmental health and Safety council paper reached a similar conclusion. After reviewing london the evidence for various alleged mechanisms though which odor-bearing chemicals might cause mcs symptoms, the council concluded: In no case was there persuasive evidence that any olfactory mechanism involving fragrance underlies either induction of a sensitized state or the triggering of mcs symptoms.
Environmental Illness: Myth and reality. He believes that although some people are very sensitive to various microorganisms, noxious chemicals, and common foods, there is no scientific evidence that an immunologic basis exists for generalized allergy to environmental substances. During the 1990s, like rea, staudenmayer and his colleague—the late john. (an allergist)—used an environmental chamber to test sensitivity to airborne chemicals. However, they rejected clinical ecology theories and practices. Using well-designed double-blind tests, they demonstrated that "universal reactors" may develop multiple symptoms in response to the testing process without being allergic to any of the individual substances administered. One of their reports describes how they used an environmental chamber to evaluate 20 patients with multiple symptoms attributed to chemical hypersensitivity.
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The provocation-neutralization test was conclusively debunked by a study performed in the early 1980s by researchers at the University of California. The tests took place in the offices of clinical ecologists who had been treating the patients. During three-hour sessions, the patients received three injections of suspected food extracts and nine of normal saline. Sixteen patients were tested once, and two were tested twice. In nonblinded tests, these patients had consistently reported symptoms when exposed to food extracts and no symptoms when given saline injections. Under double-blind conditions, however, they developed symptoms with 16 young of 60 food-extract injections (27) and 44 of the 180 (24) salt-water injections.
The symptoms elicited by both types of injections were identical and included itching of the nose, watery or burning eyes, plugged ears, a feeling of fullness in the ears, ringing ears, dry mouth, scratchy throat, an odd taste in the mouth, tiredness, headache, nausea, dizziness. The results clearly demonstrated that the patients' symptoms were placebo reactions. The study also tested the claim that "neutralizing" doses of offending allergens can relieve the patient's symptoms. All seven patients who were "treated" during the experiment had equivalent responses to extracts and saline. Psychologist Herman Staudenmayer,. D., of Denver, colorado, has treated "MCS" patients for more than 30 years and written a comprehensive textbook called.
However, allergists test and treat with substances that produce measurable allergic responses, whereas clinical ecologists base their judgments on subjective responses. Elimination and rotation diets may be used with the hope of identifying problematic foods. Single-food challenges may also be used. In severe cases, rea's patients may spend several weeks in an environmental care unit (ECU) intended to remove them from exposure to airborne pollutants and synthetic substances. After fasting for several days, these patients are given "organically grown" foods and gradually exposed to environmental substances to see which ones cause symptoms to recur. Many clinical ecologists use tests related to immune function or exposure to specific chemicals.
Samples of blood, urine, fat, and hair may be examined for various environmental chemicals. Other blood tests may assess immunoglobulins, other immune complexes, lymphocyte counts, and "antipollutant enzyme" levels. Some of these tests lack an accepted protocol and have not been standardized, and none has been demonstrated to have a consistent pattern of alteration in mcs patients. Some treatments are based on blood tests that can detect chemicals in concentrations of parts per billion. This enables levels too low to be clinically significant to be misinterpreted as evidence of unusual and harmful chemical exposure. If any "toxin" level is interpreted as abnormal, the patient will be advised that "detoxification" or "purification" can wash the undesirable chemicals from the body. The regimens may include exercise, sauna treatments, showers, massage, herbal wraps, megavitamin therapy (usually including several grams of niacin per day self-administered "desensitization" injections, and the use of water and air purifiers.
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The history-taking procedure may include a lengthy questionnaire that emphasizes dietary habits and exposure to environmental chemicals. The nature and purpose of the apple physical examination is unclear because no combination of physical findings can establish the diagnosis. Standard allergy test results are often normal. The test clinical ecologists consider most important is called provocation-neutralization. During this procedure, the patient is asked to report any symptoms that develop after various concentrations of suspected substances are administered under the tongue or injected into the skin. If symptoms occur, the test is considered positive and various concentrations are given until a dose is found that "neutralizes" essay the symptoms. A variety of other chemicals, hormones, food extracts, and other natural substances may be prescribed as "neutralizing" agents. "Neutralization" superficially resembles the desensitization process used by allergists.
In 1997, the academy's board of directors reviewed the evidence again and concluded that "a causal connection between environmental chemicals, foods, and/or drugs and the patient's symptoms is speculative and not based on the results of published scientific studies.". Dubious diagnosis and Treatment, ronald. D., who has reviewed the medical records of more than a hundred mcs patients, describes mcs as "a label given to people who do not feel well for will a variety of reasons and who share the common belief that chemical sensitivities are to blame. He further states: "It defies classification as a disease. It has no consistent characteristics, no uniform cause, no objective or measurable features. It exists because a patient believes it does and a doctor validates that belief.". The fact that mcs has not been meaningfully defined does not deter clinical ecologists from diagnosing it—typically in all or nearly all of their patients. Their diagnostic evaluation usually includes an "ecological oriented history a physical examination, and laboratory tests.
as infections and psychological stresses) would have the same effects as massive doses of single chemicals—which is not true. Like drugs, chemicals have specific effects whose development and severity depend on the amounts to which individuals are exposed. Most physicians who diagnose and treat mcs identify themselves as "clinical ecologists" or "specialists in environmental medicine." About 200 of them now belong to the American Academy of Environmental Medicine (aaem, which Randolph founded in 1965 as the society for Clinical Ecology, is composed mainly. Clinical ecologists also play a significant role in the American Academy of Otolaryngic Allergy (aaoa which Randolph helped found in 1941. Clinical ecology is not a recognized medical specialty. Environmental medicine and occupational medicine are components of the specialty of preventive medicine, but the theories and practices of clinical ecology are not. Critics of clinical ecology charge that: (a) mcs has never been clearly defined, (b) no scientifically plausible mechanism has been proposed for it, (c) no diagnostic tests have been substantiated 1, and (d) not a single case has been scientifically validated. The theories and practices of clinical ecology have been severely criticized by the American Medical Association 2, the American College of Physicians 3, the canadian Psychiatric Association, the International Society of Regulatory toxicology and Pharmacology 4, the American Academy of Allergy, asthma and Immunology.
His concern with foods then expanded to encompass a wide range of environmental chemicals. Over the ensuing years, the condition he postulated has been called allergic yardage toxemia, cerebral allergy, chemical sensitivity, ecologic illness, environmental illness (ei immune system dysregulation, multiple chemical sensitivity, total allergy syndrome, total environmental allergy, total immune disorder syndrome, toxic response syndrome, 20th century disease, universal. These labels are also intertwined with Gulf War syndrome, sick building syndrome, toxic carpet syndrome, and other politically controversial diagnoses. The complaints associated with these labels include depression, irritability, mood swings, inability to concentrate or think clearly, poor memory, fatigue, drowsiness, diarrhea, constipation, dizziness, mental exhaustion (also called "brain fog" or "brain fag lightheadedness, sneezing, runny or stuffy nose, wheezing, itching eyes and nose, skin. D., who says he has treated more than 20,000 environmentally ill patients, states that they "may manifest any symptom in the textbook of medicine.". Mcs proponents suggest that the immune system is like a barrel that continually fills with chemicals until it overflows and symptoms appear. Some also say that a single serious episode of infection, stress, or chemical exposure can trigger "immune system dysregulation." The alleged stressors include practically everything that modern humans encounter, such as urban air; diesel exhaust; tobacco smoke; fresh paint or tar; organic solvents and pesticides;.
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The expression "multiple chemical sensitivity" mcs is used to describe people with numerous troubling symptoms attributed to environmental factors. Many such people are seeking special accommodations, applying for disability benefits, and filing lawsuits claiming that exposure to common foods and chemicals has made them ill. Their efforts are supported by a small cadre of physicians who entry use questionable diagnostic and treatment methods. Critics charge that these approaches are bogus and that mcs is not a valid diagnosis. The concepts underlying mcs were developed by allergist Theron. (1906-1995 who asserted that patients had become ill from exposures to substances at doses far below the levels normally considered safe. In the 1940s, he declared that allergies cause fatigue, irritability, behavior problems, depression, confusion, and nervous tension in children. In the 1950s, randolph suggested that human failure to adapt to modern-day synthetic chemicals had resulted in a new form of sensitivity to these substances.