Treatment Options in Multiple Chemical Sensitivity

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Treatment Options in Multiple Chemical Sensitivity


by Gerald H. Ross, MD, CCFP, DIBEM, FAAEM

Environmental Health Center
-
Dallas, Dallas, TX

Source
: This article was originally published in 1992 in
Toxicology and Industrial
Health
,
8
(4), 87
-
94. It is par
t of the Proceedings of the Multiple Chemical Sensitivity
Workshop, Washington, D.C., of the Association of Occupations and Environmental
Clinics (AOEC), with support from the Agency for Toxic Sensitivities and Disease
Registry (ATSDR).

Correspondence
: Ad
dress all correspondence to Dr. Gerald H. Ross, Environmental
Health Center
-
Dallas, 8345 Walnut Hill Lane, Suite 205, Dallas, TX 75231.

Introduction

Multiple chemical sensitivities (MCS), a condition that probably has been
present for hundreds of years in

various manifestations, is gaining
increasing recognition in medicine (Hileman, 1991). At the same time, the
prevalence of classical allergy like asthma and hay fever is growing, and
paralleling this is an increase of symptoms that some patients exhibit f
rom
exposure to commonly
-
encountered chemical substances. Simply defined,

MCS

is a significant intolerance to low
-
dose components in the patient’s
personal environment, which most other people tolerate quite well.

Because of the complex nature of this con
dition, it is important to keep in
mind the concept of total load or the total environment. This involves the
complex interplay of genetic endowment, nutritional status, emotional
stress, and exposure to foods, chemicals, microbes, inhalants, and even
elec
tromagnetic fields. How health is expressed is obviously a function of
the cumulative effect of these factors on the patient.

Treatment options for MCS center around education, avoidance of
allergens (including those in air, food, water), environmental cl
ean
-
up
procedures, rotational diets, enhancement of nutritional status,
immunotherapy, immune stimulation, detoxification where appropriate,
and addressing the patient’s social and emotional health. In addition, he
emerging awareness remains that electroma
gnetic fields may play a
significant role in certain situations (Fitzgerald, 1990). It is vital to
establish a relationship whereby patients feel that physicians take their
complaints (though perhaps myriad and long standing) seriously and in an
atmosphere

of mutual respect and trust. Within such a context, patients
will more readily accept education about things they potentially can do to
help themselves.



Treatment


Surely the basis of treatment for any allergic or sensitivity problem is to
avoid the se
nsitizing agent. This can be done whether the primary problem
is in air, food, water, or physical surroundings, and it may even apply to
electromagnetic fields to a certain extent.



Avoidance


Because MCS patients frequently have wide varieties of allerg
ies or
sensitivities, they usually benefit from programs that minimize their
contact with potentially sensitizing substances. Glass
-
bottled spring water
is frequently helpful because it is much purer and does not contain the
chlorine, fluorine, and other c
ontaminants usually found in domestic
drinking water supplies. Unfortunately, water bottled in plastic containers
may pick up the phthalate, solvents, or plasticizers used to manufacture
the plastic itself (Kailin and Brooks, 1963); for this reason the aut
hor
recommends water bottled in glass.

One of the largest and best
-
recognized sources of contact we have with
chemical contaminants is our food supply (Davies, 1986), which
frequently contains pesticides and other chemical residues potentially
harmful to
everyone’s health, and especially to persons with chemical
sensitivity. Consequently, MCS patients often do much better clinically by
consuming organically grown, less chemically contaminated food
products.

Because of the massive incidence of indoor air p
ollution, which is often
100 times that of outdoor air (Nero, 1988; NRC, 1981), air
-
filtration
devices that remove both particulate and chemical substances from
breathable indoor air usually benefit MCS patients considerably. In
addition, steps to minimize

indoor pollution by removing carpeting and
combustion products from the home (such as natural gas, heating oil, or
wood
-
burning stoves) usually bring about substantial improvements as
well (Barron, 1990; Drerup et al., 1990).

Indoor air pollution is gene
rally lower in homes that have hardwood or tile
floors, with natural wood rather than fiber board, plywood, or other
pressed
-
wood products that contain substantial amounts of glues, solvents,
and other chemicals (including formaldehyde). The latter will of
fgas and
contaminate indoor environments for months or even years (Levin, 1989).
Similarly, synthetic fabrics and other materials made from petroleum will
slowly offgas volatile organic compounds (VOCs) and other chemical
substances used in their manufactu
re, thus adding to the total load of
indoor pollution. These latter substances frequently trigger symptoms and
health deterioration in patients with MCS. An intelligent program of
minimizing this kind of exposure usually has substantial therapeutic
benefit

for these patients.



Nutrition


Shandra (1980), a widely recognized international nutrition expert, has
called undernutrition the most frequent cause of immunodeficiency.
Because human enzymatic, metabolic, and detoxification pathways are
largely depend
ant on adequate vitamins, minerals, and other essential co
-
factors, the nutritional status of patients with MCS is of obvious
importance and concern (Jacoby, 1980). A survey of more than 330
patients at the Environmental Health Center
-
Dallas showed widespr
ead
vitamin deficiencies (including a B
6

deficiency in almost 58% of these
patients) even in the presence of oral supplementation (Ross et al., 1990).
A rotational diet is one way to minimize exposure to food substances to
which the patient may be sensitiv
e, and the diet can be readily designed by
competent personnel within the context of nutritional adequacy (Radcliffe,
1987). A rotational diet does not repeat the same food or beverage item
within the rotational cycle, and such diets can be constructed in
several
ways. To illustrate a 4
-
day, monorotational diet (one food per meal): On
Day 1, the patient might consume eggs for breakfast and would not again
consume any egg products until the morning of Day 5, thereby minimizing
contact with potentially sensit
izing foods. A rotational diet is relatively
simple to institute, even before the foods to which the patient is actually
sensitive are known. Such a diet minimizes over
-
exposure to any foods,
and when properly constructed, can provide good nutritional adeq
uacy and
wide variety.

Patients with MCS are known to have a higher likelihood of nutritional
imbalances (Ross et al., 1989), especially magnesium deficiency (Rea et
al., 1987a). Because many patients with MCS seem to be nutrient deficient
despite oral su
pplementation, intravenous infusions of certain vitamins
and minerals (especially vitamin C and the B vitamins, magnesium, and
trace minerals) can have excellent therapeutic benefits. The exact
mechanism of benefit is not known but may be through enhancing

both
immune function and detoxication pathways.

The Nova Scotia Environmental Medicine Clinic is currently engaged in a
collaborative pilot study with the government of Nova Scotia in Canada
on intravenous infusion of nutrients, including magnesium, for
patients
with chronic fatigue syndrome. In the author’s experience, these patients
also frequently have intracellular magnesium deficits.



Candida Sensitivity
.

One aspect of the total
-
load or the total
-
environment
concept might include the possibility of

Candida sensitivity
or overgrowth (Kroker, 1987). Although this issue is
controversial, many of the author’s patients with MCS have
substantial elevations of antibodies against Candida and
may have had recurring vaginal or oral yeast infections. An
antica
ndida program involving dietary modification,
nutritional support, the replenishment of healthy gut flora,
and possibly an antifungal medication may prove very
beneficial. Moreover, present knowledge about the
potential adverse effects of Candida on suscep
tible
individuals appears far from complete. It seems reasonable
to keep an open mind on this topic because the author has
seen many patients who benefitted from such an approach,
within a context of evaluating and lowering the total load.

Testing

Intrader
mal and Sublingual Testing
. A vital question remains: How does
one evaluate and confirm chemical sensitivity? As in all medicine, initial
reliance is primarily on history. Two main types of confirmatory testing,
involving intradermal and inhalation challen
ge, are currently available.
Most patients with a history of MCS have widespread sensitivities to
chemicals, foods, and, to a lesser extent, inhalants (Rea and Ross, 1989).
The testing antigens used for intradermal food testing at the
Environmental Health
Center
-
Dallas are prepared from organically grown
products, with no preservatives in the vaccines. This is in distinction to
most testing antigens on the commercial market, which have either phenol
or glycerine as stabilizers. Many patients with MCS cannot

tolerate
antigens that contain these substances for either testing or treatment. A
variety of well
-
known, skin
-
testing techniques are available, including
scratch or prick testing. Serial
-
dilution, end
-
point titration (SDET) and
provocation
-
neutralization

also give reliable data for use in a treatment
program (King and King, 1990).

With provocation
-
neutralization, potential treatment vaccines may be
drawn up for foods, chemicals, inhalants, microbial substances (like mixed
respiratory vaccine and fluogen)
, and individual bacteria produced from
autogenous vaccines; the latter are particularly helpful in patients with
chronic rhinitis or sinusitis.

Sensitivity to a variety of chemicals may also be tested directly in the
same way. Subsequent immunotherapy tr
eatment with very low
-
dose,
subcutaneous or sublingual vaccines can proceed in conjunction with
avoidance of the offending agent (Scadding and Brostoff, 1986). Testing
and treatment are also possible with neutralizing doses to
neurotransmitters, like serot
onin, dopamine, methacholine and others,
which can produce substantial improvement in the patient’s
symptomatology. Intradermal testing involves not only evaluating the skin
whealing response but also assessing symptoms and signs that may be
produced from
the testing itself. Sublingual testing, which relies almost
exclusively on symptoms or signs, can nevertheless be a valuable testing
technique.

Inhalation
. One of the most scientifically rigorous evaluations of chemical
sensitivity is specific challenge w
ith low
-
dose chemical exposures. These
take place inside in an enclosed glass and anodized
-
aluminum booth,
under controlled circumstances (Rea et al., 1990). When done properly,
these can help determine whether the patient is sensitive to a variety of
chem
ical substances. Appropriate dilutions of chemicals are vaporized in
the booth to achieve concentrations that are below odor thresholds and that
approximate levels found in everyday settings (Rea et al., 1990). These
tests are performed on a double
-
blind b
asis, using placebos of water or
saline. The booth is evacuated and washed after each challenge to prevent
any potential contamination. The absence of intake pipes or tubes that
direct gas into the booth also prevents potential contamination and
subsequent

invalidation of subsequent tests at a later date. Chemical
testing performed in such a booth must be done with the patients in the
deadapted state for reliable results (Rea et al., 1990).

The ideal location for this type of low dow
-
dose, chemical challen
ge is a
hospital
-
based, environmental control unit (ECU) (Sprague, 1987) in
which the patient is housed in a very clean environment for several days
before testing begins. The principles of total load and deadaption must be
understood and followed with low
-
dose, inhaled, challenge testing,
because incidental outpatient exposures to perfume, traffic exhaust,
cigarette smoke, or other substances may trigger delayed responses that
will cause inconsistent results.

Transfer Factor
. Another potential treatment f
or patients with MCS is
immune stimulation, especially in view of the frequent occurrence of
immunosuppression with this illness (Levin and Byers, 1987). The use of
transfer factor may prove very helpful in these cases (Youdim et al.,
1991). Transfer facto
r is an extract of white blood cells with known
immune
-
stimulating properties. It is especially helpful in cases of
leukopenia or in reduced leukocyte
-
killing capacity, which may contribute
to recurring infections.

Pupilography
. An additional method being

developed to evaluate patients
with MCS is the assessment of autonomic nervous function by
pupilography (Shirakawa et al., 1992). Hamamatsu Photonics in Japan, in
cooperation with the Department of Ophthalmology at Kitasato
University, has developed a sop
histicated optical device called the
binocular iriscorder, that scans the eye surface in the infrared spectrum
and measures the pupilographic response to a specific light stimulus by
very precise, computerized measurements. These are then compared with
a s
tandard reference range.

The change in pupil size, velocity of contraction and dilation, recovery
time, and other parameters are measured in milliseconds following the
light stimulus. These measurements are usually quite stable in each
individual, with a
slight diurnal variation. Patients with MCS have
frequent deviations from baseline and exhibit considerable instability of
autonomic function, usually in a sympatholytic pattern (Shirakawa et al.,
1992). Many patients, whom the author has tested in blind,
intradermal
challenges with agents to which the patient is known to be sensitive, show
distorted autonomic stability. Further research with this computerized
analysis is pending.

Posturography
. Another technique for evaluating patients with MCS is
posturo
graphy testing, which essentially evaluates the neurologic
integration of the nervous input from the eyes, ears, and peripheral
nervous system by computerized methodology. Frequently, the author
finds disorders of balance in patients with chemical sensitiv
ity, and
especially patients with histories of significant chemical exposures. When
these patients undergo detoxification programs to enhance metabolism and
the elimination of toxic chemical substances from their bodies,
substantially improved measurements

of these specific, neurologic balance
function usually result.



Adipose and Nerve Tissue

Toxic chemical substances may be stored for long periods in adipose and
nerve tissue; many xenobiotics are direct neurotoxins (Seba et al., 1987).
Indeed, DDT
-
type
compounds and many others are often found in adipose
tissue at much higher levels than would be found in blood under steady
-
state conditions. Certain individuals appear to have an impaired ability to
detoxify effectively some of these exogenous substances.

The chemicals
may then build up over long periods following repeated exposures,
especially in industrial settings (Seba et al., 1987). Levels of potentially
toxic chemical substances at 10
-
40 times the population average, or even
greater, are not unusual
in MCS patients. With such toxic loads, it is
perhaps not surprising that patients are unwell with various neurologic and
other symptoms.

Detoxification
. One method that is gaining considerable interest for
reducing this total toxic load is a detoxificati
on program using an
integrated regimen of graduated exercise; nutrient replacement; and sauna
-
chamber, heat depuration therapy (Schnare et al., 1982). The heat chamber
at the Environmental Health Center
-
Dallas is built with ceramic tile on all
inside surfa
ces and untreated wooden benches; it uses relatively low
temperatures, in the range of 140


F. Patients first exercise and then spend
time in the sauna to induce profuse perspiration. Under these conditions,
stored xenobiotics appear to mobilize substantia
lly (Schnare et al., 1982)
and can then be metabolized, primarily through the liver and the gut, but
also through the breath, urine, and perspiration. The clearance rate of
stored xenobiotics from the body may be quite variable, and the author’s
experience

shows that styrene and chloroform come out most easily. 1,1,1
-
Trichloroethane is ubiquitous and seems to be the most difficult to clear
(Rea et al., 1987b). If, however, such a detoxification program proceeds
too quickly, the patient may worsen for a time
, usually in conjunction with
a rise in liver transaminases, which suggests a significant strain on hepatic
function. With caution, however, these xenobiotics can be substantially
reduced in MCS patients, usually with marked improvement in the
patient’s ov
erall chemical sensitivity and general health (Rea et al.,
1987b).



Amalgams

Another area of growing interest and potential treatment is the
controversial issue of amalgams and their adverse consequences on health.
The television program
60 Minutes

repor
ted on the hazards of
silver/mercury tooth fillings and raised many questions about the safety of
this heretofore well
-
accepted dental material. Although this subject is
controversial and consensus is lacking, sensitization to mercury is a real
phenomenon.

Removing amalgams is an option that certainly requires
investigation, especially for chemically sensitive patients.



Summary



The essential features of treatment for chemical sensitivity are the following:



(1) Enc
ouraging the provision of clean air, food, water, and surroundings.



(2) Identifying substances to which the patient is sensitive, with subsequent



(A) enhanced avoidance, or



(B)
specific immunotherapy to reduce the patient’s reactivity to those
substances.



(3) Assessing and enhancing the patient’s nutritional status to maximize the
body’s ability to detoxify and to



minimize the free
-
radical production and oxidative stress xenobiotics.



(4) Addressing concurrent problems such as infections, immunosuppression,
and other medical conditions in an



appropriate fashion.



(5) E
valuating the patient’s psychologic status and addressing any social and
emotional problems in a



compassionate manner.

The author believes that multiple chemical sensitivity is a real condition
with documented physiologic abnorm
alities. It is not a functional or
psychologic illness or a belief system of the patient. Second, this condition
is diagnosable and treatable by various means. These treatment options not
only make common sense but usually result in significant improvement

for
these unfortunate patients, who deserve the very best effort of their health
care providers.



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