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Iris Bell researched brain-wave patterns in people with MCS. He showed, in several studies using [[Electroencephalography|Electroencephalograms (EEG)]], that people with MCS often had certain abnormal brain wave patterns.<ref name=":4" /><ref>Schwartz GE, Bell IR, Dikman Z''V,'' et al. EEG responses to low-level chemicals in normals and cacosmics. ''Toxicol Ind Health'' 1994; 10(4-5): 633-43.</ref> For example, he found that women with MCS were more likely to have greater resting [[Alpha wave|alpha waves]] than controls, which he said suggested the possibility of central nervous system hypo-activation.<ref>Bell IR, Schwartz GE, Hardin EE, Baldwin CM, Kline JP. Differential resting quantitative electroencephalographic alpha patterns in women with environmental chemical intolerance, depressives, and normals. ''Biol Psychiatry'' 1998; 43(5): 376-88.</ref>
Iris Bell researched brain-wave patterns in people with MCS. He showed, in several studies using [[Electroencephalography|Electroencephalograms (EEG)]], that people with MCS often had certain abnormal brain wave patterns.<ref name=":4" /><ref>Schwartz GE, Bell IR, Dikman Z''V,'' et al. EEG responses to low-level chemicals in normals and cacosmics. ''Toxicol Ind Health'' 1994; 10(4-5): 633-43.</ref> For example, he found that women with MCS were more likely to have greater resting [[Alpha wave|alpha waves]] than controls, which he said suggested the possibility of central nervous system hypo-activation.<ref>Bell IR, Schwartz GE, Hardin EE, Baldwin CM, Kline JP. Differential resting quantitative electroencephalographic alpha patterns in women with environmental chemical intolerance, depressives, and normals. ''Biol Psychiatry'' 1998; 43(5): 376-88.</ref>


Multiple neuro-imaging studies have shown that people with MCS often have other neurological abnormalities, including abnormal [[Cerebral perfusion pressure|cerebral perfusion]] patterns, especially in the [[Autonomic nervous system|autonomic nervous system areas]].<ref name=":4" /><ref>Callender TJ, Morrow L, Subramanian K. Evaluation of chronic neurological sequelae after acute pesticide exposure using SPECT brain scans. ''Toxicol Environ Health'' 1994; 41(3): 275-84.</ref><ref>Callender TJ, Morrow L, Subramanian K, Duhon D, Ristov M. Three dimensional brain metabolic imaging in patients with toxic encephalopathy. ''Environ Res'' 1993; 60''(''2): 295-319.</ref><ref>Heuser G, Mena I, Alamos F. NeuroSPECT findings in patients exposed to neurotoxic chemicals. ''Toxicol Ind Health'' 1994; 10(4-5): 561-71.</ref><ref>Hillert L, Musabasic V, Berglund H, Ciumas C, Savic I. Odor processing in multiple chemical sensitivity''. Hum Brain Mapp'' 2006; 28(3): 172-82.</ref><ref>Ross GH, Rea WI, Johnson AR, Hickey DC, Simon TR. Neurotoxicity in single photon emission computed tomography brain scans of patients reporting chemical sensitivities. ''Toxicol Ind Health'' 1999; 15(3-4): 415-20.</ref> These abnormalities have been documented both in studies using [[Positron emission tomography|PET (Positron Emission Tomography)]] and [[Single-photon emission computed tomography|SPECT (Single Photon Emission Computed Tomography)]] scans.<ref name=":4" /><ref>Alessandrini M, Micarelli A, Chiaravalloti A, et al. Involvement of Subcortical Brain Structures During Olfactory Stimulation in Multiple Chemical Sensitivity. ''Brain Topogr 2''016; 29''(''2): 243-52.</ref><ref>Chiaravalloti A, Pagani M, Micarelli A, et al. Cortical activity during olfactory stimulation in multiple chemical sensitivity: a (18)F-FDG PET/CT study''. Eur J Nucl Med Mol Imaging'' 2015; 42(5): 733-40</ref>
Multiple neuro-imaging studies have shown that people with MCS often have other neurological abnormalities, including abnormal [[Cerebral perfusion pressure|cerebral perfusion]] patterns, especially in the [[Autonomic nervous system|autonomic nervous system areas]].<ref name=":4" /><ref>Callender TJ, Morrow L, Subramanian K. Evaluation of chronic neurological sequelae after acute pesticide exposure using SPECT brain scans. ''Toxicol Environ Health'' 1994; 41(3): 275-84.</ref><ref>Callender TJ, Morrow L, Subramanian K, Duhon D, Ristov M. Three dimensional brain metabolic imaging in patients with toxic encephalopathy. ''Environ Res'' 1993; 60''(''2): 295-319.</ref><ref>Heuser G, Mena I, Alamos F. NeuroSPECT findings in patients exposed to neurotoxic chemicals. ''Toxicol Ind Health'' 1994; 10(4-5): 561-71.</ref><ref>Hillert L, Musabasic V, Berglund H, Ciumas C, Savic I. Odor processing in multiple chemical sensitivity''. Hum Brain Mapp'' 2006; 28(3): 172-82.</ref><ref>Ross GH, Rea WI, Johnson AR, Hickey DC, Simon TR. Neurotoxicity in single photon emission computed tomography brain scans of patients reporting chemical sensitivities. ''Toxicol Ind Health'' 1999; 15(3-4): 415-20.</ref> These abnormalities have been documented both in studies using [[Positron emission tomography|PET (Positron Emission Tomography)]] and [[Single-photon emission computed tomography|SPECT (Single Photon Emission Computed Tomography)]] scans.<ref name=":4" /><ref>Alessandrini M, Micarelli A, Chiaravalloti A, et al. Involvement of Subcortical Brain Structures During Olfactory Stimulation in Multiple Chemical Sensitivity. ''Brain Topogr 2''016; 29''(''2): 243-52.</ref><ref>Chiaravalloti A, Pagani M, Micarelli A, et al. Cortical activity during olfactory stimulation in multiple chemical sensitivity: a (18)F-FDG PET/CT study''. Eur J Nucl Med Mol Imaging'' 2015; 42(5): 733-40</ref>

As well as documented neurological abnormalities, neuroplasticity is thought by some researchers to be a key mechanism in MCS. In 2018, an official representative of the Royal Australasian College of Physicians said in an Australian parliamentary inquiry into environmental illness: “It could be a multiple chemical sensitivity phenomenon. It could be an irritable bowel phenomenon. It could be fibromyalgia...The common unifying features in all of these conditions is related to what we do know is happening, which is neuroplasticity in the nervous system. We know that, regardless of the initiating trigger—whether it was an overwhelming infection of a mould related organism or some other viral infection—it sets up, within the biological system called the nervous system, neuroplastic changes. They can be, and have been, documented by the evidence based research. We can document that there are changes in the nervous system, and that change in the nervous system results in a change in the sensitivity and responsiveness of the human being.”<ref name=":3" />


===Immunological===
===Immunological===

Revision as of 00:55, 24 November 2019

Multiple Chemical Sensitivity (MCS), also known as Idiopathic Environmental Intolerances (IEI) and Environmental Sensitivities/Multiple Chemical Sensitivities (ES/MCS), was defined in a 2017 scientific review as "a complex syndrome that manifests as a result of exposure to a low level of various common contaminants."[1]

A 2019 review described the condition as an "acquired disorder, characterized by recurrent symptoms, affecting multiple organs and systems, which arise in response to a demonstrable exposure to chemicals, even at low doses, much lower than those that would cause a reaction in the general population."[2]

Chemicals that are common triggers for MCS symptoms include pesticides, petrochemicals, formaldehyde and perfumed products.[3] Natural irritants like mold and woodfire smoke are also common incitants.[4]

The etiology, diagnosis, and treatment of MCS are still debated among researchers.[1]

MCS is not recognized as a separate, discrete disease by the World Health Organization, American Medical Association, or by several other professional medical organizations.

Signs and symptoms

In 1999, an International Consensus on MCS was published in The Archives of Environmental Health.[5] The Consensus was the conclusion of a ten-year study by an international multidisciplinary team of 89 clinicians and researchers, with different points of view about MCS.[6] What they agreed was that the clinical characteristics of MCS should be defined as follows: “[1] a chronic condition, [2] with symptoms that recur reproducibly, [3] in response to low levels of exposure, [4] to multiple and unrelated chemicals, and [5] improve or resolve when incitants are removed, [6] MCS involves symptoms in different organs.”[5][6]

The symptoms of MCS affect multiple organs and body systems,[3][5][7][8] range from mild to disabling[3][8][9] and decrease quality of life.[7][10][9][1][11][12][13][14][15][16][17]

Common symptoms of MCS include headache, migraine, neurocognitive deficits, dizziness, fatigue, cardiac arrhythmia, tachycardia, hypotension, hypertension, gastrointestinal problems, nausea, vomiting, muscle and joint pain, skin rashes, visual disturbances, seizures[10] asthma and anaphylaxis.[3][8][9][10][18][19][20]

A 2017 review of MCS studies said: “MCS is a syndrome that progresses to increasingly serious stages, with the gradual onset of multiple pathologies”.[1]

Causes

There is a lack of agreement among MCS researchers on the cause or causes of the condition.[9]

In 2017, a Canadian government Task Force on Environmental Health said that there had been very little rigorous peer-reviewed research into MCS and almost a complete lack of funding for such research in North America.[21] "Most recently," it said, "some peer-reviewed clinical research has emerged from centres in Italy, Denmark and Japan suggesting that there are fundamental neurobiologic, metabolic, and genetic susceptibility factors that underlie ES/MCS."[21]

One of the most thorough academic reviews of MCS research to be undertaken was published in Italy in May 2019.[22] It said that the predominant hypotheses for the causes of MCS were: biochemical, neuro-physiological, related to the limbic system, immunological, respiratory, vascular, and psychological.[23]

Some researchers say a consensus that the causes are multifactorial has been reached.[24]

In 2018, when speaking at an Australian federal parliamentary inquiry into environmental illness, Dr Graeme Edwards, a representative of the the Royal Australasian College of Physicians, said that there was "relatively good consensus" that causation was multifactorial. "There is no single causative factor," he said. "It is a combination of factors...unless you have all the pieces of the puzzle lining up, you actually don't get the disease. And because we are talking about multi-dimensional triggers, any one individual, at any one point in time, may not have exposure to all of those triggers to get a pathological result. And therein lies the complexity.”[24]

Toxicological

Professor Martin L. Pall proposed that MCS had a toxicological and biochemical cause and that "seven individual chemicals or chemical classes—organophosphorus/carbamate, organochloride and pyrethroid pesticides, organic solvents, carbon monoxide, hydrogen sulphide and mercury/mercurial compounds—could initiate MCS through their ability to increase N-methyl-D-aspartate (NMDA) receptor activity.”[4][25] 

Pall hypothesized that overactivity of the NMDA receptors, coupled with stress-related increases in nitric oxide and the oxidative product peroxynitrite (known as the NO/ONOO cycle) caused MCS symptoms and worsened the condition.[26][27]

He suggested that hypersensitivity occurred because of limbic kindling, or neural sensitization, and/or neurogenic inflammation processes, both of which were driven by the above processes.[25]

A 2019 scientific review said that while further research was required to confirm Pall's theory, that his hypothesis "had found broad consensus in the scientific community” and was compatible with previous hypotheses,[23] including Dr. Iris Bell's theory of neuronal sensitization[28][29] and William Meggs’ theory of neurogenic inflammation.[30] The review said Pall's theory may also explain the comorbidity MCS had with other pathologies related to the same mechanism, including Fibromyalgia (FM) and Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) and that it might explain why MCS symptoms tend to reduce after exposure to inhibitors and/or antagonists of NMDA receptors.[23] It could also be one of the reasons that Gulf War veterans, who were exposed to organophosphate pesticides, are more likely to have MCS than the general population.[31][26]

In addition, Dr. William J. Rea and other researchers[32][33][34] concluded that mold and mycotoxin exposures (like pesticide exposures) could trigger the onset of the condition.[4]

Neurological

Many common symptoms of MCS are neurological[1][7][3] (for example, "dizziness, seizures, head pain, fainting, loss of coordination"[10]). And neurogenic inflammation and sensitization are widely thought to be mechanisms involved in causing, perpetuating and worsening MCS.[3][28][29][30]

William Meggs said that neurogenic inflammation was a well-defined pathophysiological process, in which chemical irritants triggered nerve fibers to release inflammatory mediators, which led to disease. In a 2017 review, he said that with MCS, an initiating chemical exposure (commonly a respiratory irritant or pesticide) was usually identified in association with the onset of the disease.[30]

Iris Bell researched brain-wave patterns in people with MCS. He showed, in several studies using Electroencephalograms (EEG), that people with MCS often had certain abnormal brain wave patterns.[23][35] For example, he found that women with MCS were more likely to have greater resting alpha waves than controls, which he said suggested the possibility of central nervous system hypo-activation.[36]

Multiple neuro-imaging studies have shown that people with MCS often have other neurological abnormalities, including abnormal cerebral perfusion patterns, especially in the autonomic nervous system areas.[23][37][38][39][40][41] These abnormalities have been documented both in studies using PET (Positron Emission Tomography) and SPECT (Single Photon Emission Computed Tomography) scans.[23][42][43]

As well as documented neurological abnormalities, neuroplasticity is thought by some researchers to be a key mechanism in MCS. In 2018, an official representative of the Royal Australasian College of Physicians said in an Australian parliamentary inquiry into environmental illness: “It could be a multiple chemical sensitivity phenomenon. It could be an irritable bowel phenomenon. It could be fibromyalgia...The common unifying features in all of these conditions is related to what we do know is happening, which is neuroplasticity in the nervous system. We know that, regardless of the initiating trigger—whether it was an overwhelming infection of a mould related organism or some other viral infection—it sets up, within the biological system called the nervous system, neuroplastic changes. They can be, and have been, documented by the evidence based research. We can document that there are changes in the nervous system, and that change in the nervous system results in a change in the sensitivity and responsiveness of the human being.”[24]

Immunological

Immune system dysfunction following sensitization by a chemical exposure is one proposed hypothesis for the cause of MCS.[18] An August 2019 consensus paper by clinicians treating Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), "a multisystem disease involving neurological, immunological, autonomic, and energy metabolism impairments," said that chemical sensitivities were commonly reported by patients diagnosed with ME/CFS and that MCS was a commonly comorbid diagnosis of ME/CFS.[44]

Psychological

Several mechanisms for a psychological etiology have been proposed, including theories based on misdiagnoses of an underlying mental illness, stress, or classical conditioning.[citation needed] Many people with MCS also meet the criteria for major depressive disorder or anxiety disorder.[45][non-primary source needed] Other proposed explanations include somatic symptom disorder,[46][non-primary source needed] panic disorder,[47][non-primary source needed] migraine[citation needed], chronic fatigue syndrome[citation needed], or fibromyalgia[citation needed], where symptoms such as brain fog and headaches can be triggered by chemicals or inhalants. Through behavioral conditioning, it has been proposed that people with MCS may develop real, but unintentionally psychologically produced, symptoms, such as anticipatory nausea, when they encounter certain odors or other perceived triggers.[48][46][non-primary source needed] It has also been proposed in one study that individuals may have a tendency to "catastrophically misinterpret benign physical symptoms"[49][46][non-primary source needed] or simply have a disturbingly acute sense of smell.[medical citation needed] The personality trait absorption, in which individuals are predisposed to becoming deeply immersed in sensory experiences, may be stronger in individuals reporting symptoms of MCS.[50][46][non-primary source needed] In the 1990s, behaviors exhibited by MCS sufferers were hypothesized by some to reflect broader sociological fears about industrial pollution and broader societal trends of technophobia and chemophobia.[51][52][46]

Genetic differences in metabolism

Genetic differences relating to toxicant metabolism pathways, such as polymorphisms and differences in expression in CYP2D6, NAT2, GSTM1, and PON1 and PON2, have been proposed as a cause for differences in susceptibility to MCS.[53][54][non-primary source needed]

Diagnosis

International Classification of Diseases

The International Statistical Classification of Diseases and Related Health Problems (ICD), maintained by the World Health Organization, does not recognize multiple chemical sensitivity or environmental sensitivity as a valid diagnosis.[55] The American Medical Association does not recognize MCS as an organic disease because of the lack of scientific evidence supporting a cause-and-effect relationship between very low level exposure and the symptoms of MCS. The American Academy of Allergy, Asthma, and Immunology, the California Medical Association, the American College of Physicians, and the International Society of Regulatory Toxicology and Pharmacology also do not recognize MCS.[51][56][57] The US Occupational Safety and Health Administration (OSHA) indicates that MCS is highly controversial and that there is insufficient scientific evidence to explain the relationship between the suggested causes of MCS and its symptoms. OSHA recommends evaluation by a physician knowledgeable of the symptoms presented.[58]

Other

In response to a WHO call for papers at the 5th Paris Appeal Congress of Environmental Idiopathic Intolerance conference that took place in Belgium on 18 May 2015, a report that was generally supportive quoted a number of international practitioners.[59] This was provisionally accepted by the Spanish health ministry, and later found proven by a judge in the case of a plumber in the Province of Castellón.[60]

MCS is a diagnosis of exclusion, and the first step in diagnosing a potential MCS sufferer is to identify and treat all other conditions which are present and which often explain the reported symptoms. For example, depression, allergy, thyroid disorders, orthostatic syndromes, lupus, hypercalcemia, and anxiety need to be carefully evaluated and, if present, properly treated. The "gold standard" procedure for identifying a person who has MCS is to test response to the random introduction of chemicals the patient has self-identified as relevant. This may be done in a carefully designed challenge booth to eliminate the possibility of contaminants in the room. Chemicals and controls, sometimes called prompts, are introduced in a random method, usually scent-masked. The test subject does not know when a prompt is being given. Objective and subjective responses are measured. Objective measures, such as the galvanic skin response,[61] indicate psychological arousal, such as fear, anxiety, or anger. Subjective responses include patient self-reports. A diagnosis of MCS can only be justified when the subject cannot consciously distinguish between chemicals and controls, and when responses are consistently present with exposure to chemicals and consistently absent when prompted by a control.

Treatment

At this time, there is no clinically proven cure for MCS.[9][62] There is also no scientific consensus on supportive therapies for MCS, "but the literature agrees on the need for patients with MCS to avoid the specific substances that trigger reactions for them and also on the avoidance of xenobiotics in general, to prevent further sensitization."[1][8][9][62][63]

There is also consensus that a multidisciplinary approach is required for adequately managing the health of someone with MCS.[1][7][62] And some studies suggest a special focus on correcting any nutritional deficiences may be beneficial.[7][62][64]

There is also evidence that some patients with MCS have poor tissue oxygenation when exposed to triggers,[65] likely because of oxidative stress[66][67] or because neural inflammation has reduced blood flow.[65][68] Breathing medical oxygen is a suggested remedy for these patients, following accidental chemical exposures.[65]

The 2019 consensus and clinical guidelines on MCS said that patients with MCS "must be guaranteed, according to their individual needs and level of disability" medical Oxygen and the necessary equipment to use it (that is, tubing and mask from non-triggering materials).[69]

Epidemiology

Prevalence rates for MCS vary according to the diagnostic criteria used.[2][70] What is clear is that the condition is reported across industrialised countries and it affects women more than men.[1][71][72][73][74][75][76]

The most extensive epidemiological study into MCS in the United States was in 2005.[2][77] It found that the national prevalence rate for MCS diagnosed by a doctor was 2.5% and self-reported MCS was 11.2%.[2][78][79]

In 2018, the same researchers reported that the prevalence rate of diagnosed MCS had increased by more than 300% and self-reported chemical sensitivity by more than 200% in the previous decade.[2][80] They found that 12.8% of those surveyed reported medically diagnosed MCS and 25.9% reported having chemical sensitivities.[2][81]

A 2014 study by the Canadian Ministry of Health estimated, based on its survey, that 0.9% of Canadian males and 3.3% of Canadian females had a diagnosis of MCS by a health professional.[82][83]

While a 2018 study at the University of Melbourne found that 6.5% of Australian adults reported having a medical diagnosis of MCS and that 18.9 per cent reported having adverse reactions to multiple chemicals.[2][84][85][86] The study also found that for 55.4 per cent of those with MCS, the symptoms triggered by chemical exposures could be disabling.[85][10]

These findings demonstrate that in the above countries, MCS is not a rare disease.

Gulf War syndrome

Several clinical and epidemiological studies conducted in the United States and in the United Kingdom have investigated the occurrence of MCS in military personnel deployed to the Persian Gulf during the 1990s. Some of the health complaints and symptoms reported by veterans of the Gulf War attributed to Gulf War syndrome are similar to those reported for MCS, including headache, fatigue, muscle stiffness, joint pain, inability to concentrate, sleep problems, and gastrointestinal issues.[87]

A population-based, cross-sectional epidemiological study involving American veterans of the Gulf War, non-Gulf War veterans, and non-deployed reservists enlisted both during Gulf War era and outside the Gulf War era concluded the prevalence of MCS-type symptoms in Gulf War veterans was somewhat higher than in non-Gulf War veterans.[88] After adjusting for potentially confounding factors (age, sex, and military training), there was a robust association between individuals with MCS-type symptoms and psychiatric treatment (either therapy or medication) before deployment and, therefore, before any possible deployment-connected chemical exposures.[88]

The odds of reporting MCS or chronic multiple-symptom illness was 3.5 times greater for Gulf War veterans than non-Gulf veterans.[89]

Gulf War veterans have an increased rate of multiple-symptom conditions compared to military personnel deployed to other conflicts, and although it is unexplained, Gulf War syndrome is not considered distinct from other medically unexplained syndromes observed in civilian populations, including MCS.[90]

History

MCS was first proposed as a distinct disease by Theron G. Randolph in 1950. In 1965, Randolph founded the Society for Clinical Ecology as an organization to promote his ideas about symptoms reported by his patients. As a consequence, clinical ecology emerged as a non-recognized medical specialty.[91] In 1984, the Society for Clinical Ecology changed its name to American Academy of Environmental Medicine (AAEM). In the 1990s, an association was noted with chronic fatigue syndrome, fibromyalgia, and Gulf War syndrome.[92]

In 1994, the AMA, American Lung Association, US EPA and US Consumer Product Safety Commission published a booklet on indoor air pollution that discusses MCS, among other issues. The booklet further states that a pathogenesis of MCS has not been definitively proven, and that symptoms that have been self-diagnosed by a patient as related to MCS could actually be related to allergies or have a psychological basis, and recommends that physicians should counsel patients seeking relief from their symptoms that they may benefit from consultation with specialists in these fields.[93]

In 1995, an Interagency Workgroup on Multiple Chemical Sensitivity was formed under the supervision of the Environmental Health Policy Committee within the United States Department of Health and Human Services to examine the body of research that had been conducted on MCS to that date. The work group included representatives from the Centers for Disease Control and Prevention, United States Environmental Protection Agency, United States Department of Energy, Agency for Toxic Substances and Disease Registry, and the National Institutes of Health. The Predecisional Draft document generated by the workgroup in 1998 recommended additional research in the basic epidemiology of MCS, the performance of case-comparison and challenge studies, and the development of a case definition for MCS. However, the workgroup also concluded that it was unlikely that MCS would receive extensive financial resources from federal agencies because of budgetary constraints and the allocation of funds to other, extensively overlapping syndromes with unknown cause, such as chronic fatigue syndrome, fibromyalgia, and Gulf War syndrome. The Environmental Health Policy Committee is currently inactive, and the workgroup document has not been finalized.[94]

In 1997, U.S. Social Security Administration Commissioner John Callahan issued a court memorandum officially recognizing MCS "as a medically determinable impairment" on an agency-wide basis.[95] That is, without making any statement about the cause of MCS or the role of chemicals in MCS, the Social Security administration agrees that some MCS patients are too disabled to be meaningfully employed.[96]

A 1997 U.S. court decision held that MCS "is untested, speculative, and far from generally accepted in the medical or toxicological community," and thus cannot be used as the basis for disability claims.[97] Furthermore, accommodations sought for MCS are sometimes denied as being unreasonable as a matter of law.[98]

In 2007, the Australian Human Rights and Equal Opportunity Commission referenced chemical sensitivities, in a publication about access guidelines. It said “a growing number of people report being affected by sensitivity to chemicals used in the building, maintenance and operation of premises. This can mean that premises are effectively inaccessible to people with chemical sensitivity.”[99]

In 2014, a task force into Environmental Health was established in Canada by the Ministry of Health and Long-Term Care to take an evidence-based approach to investigating ES/MCS and chronic fatigue syndrome and fibromyalgia.[100][9] In 2017, the task force issued its first report[9] which recommended that the Minister of Health make a statement "reinforcing the serious debilitating nature of these conditions," "dispelling the misperception that they are psychological,"[101] and that hospitals and long-term care homes be made safe for people with these conditions, complying "as quickly as possible, with relevant accessibility and accommodation legislation."[102] The basis for these recommendations, the report said, was that “there is [was] lack of understanding and recognition about these conditions,”[103] and that sufferers faced "significant stigma and discrimination within the health care system” and “overwhelming barriers accessing high quality, appropriate patient-centred care”. It concluded that they "were more likely to have unmet health needs” than the rest of the population.[103]

In February 2018, the Journal of Occupational and Environmental Medicine published "Multiple Chemical Sensitivity: Review of the State of the Art in Epidemiology, Diagnosis, and Future Perspectives" covering 17 years of literature internationally on the topic.[1]

Safe (1995), a cult film by director Todd Haynes, is an iconic depiction of MCS.

Voted best film of the nineties by The Village Voice Film Poll[104], and described by critics as ”the scariest film of the year”[104], “a mesmerizing horror movie”[105] and “a work of feminist counter-cinema,”[106] Safe depicts MCS as a profoundly destabilising and alienating condition.

Protagonist Carol White, played by Julianne Moore, is a homemaker who suddenly develops a range of symptoms following the renovation of her home, in an affluent suburb of polluted Los Angeles. As Carol’s symptoms worsen, the chemicals that are triggering them seem ubiquitous. Her husband is skeptical; her community indifferent and unsupportive. She realises there is no place for her in society. So, like a refugee, she leaves her home, possessions and world behind. Without her husband, she moves to an eerie desert community for people with environmental illness.

“She is so excruciatingly alone”, Moore said of her character at the end of the film.[107] While Haynes said Carol’s isolation was both the answer and the problem for her.[104]

Twenty years after the film’s release, Haynes said its themes—disease and immunity in a post-industrial landscape and how recovery is a burden often put on victims of disease—were even more relevant than they were when he made the film.[107]

See also

References

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  83. ^ Canadian Community Health Survey (CCHS) 2014, Ministry of Health and Long-Term Care Share File, Statistics Canada.
  84. ^ Pigatto PD, Guzzi G. Prevalence and Risk Factors for MCS in Australia. Preventive Medicine Reports 2019.
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  92. ^ Donnay Albert H (1999). "On the Recognition of Multiple Chemical Sensitivity in Medical Literature and Government Policy". International Journal of Toxicology. 18 (6): 383–392. doi:10.1080/109158199225099.
  93. ^ Indoor Air Pollution: An Introduction for Health Professionals. Co-sponsored by: The American Lung Association (ALA), The Environmental Protection Agency (EPA), The Consumer Product Safety Commission (CPSC), and The American Medical Association (AMA). 1994. Retrieved 2008-06-30. [D]efinition of the phenomenon is elusive and its pathogenesis as a distinct entity is not confirmed....The current consensus is that in cases of claimed or suspected MCS, complaints should not be dismissed as psychogenic, and a thorough workup is essential. Primary care givers should determine that the individual does not have an underlying physiological problem and should consider the value of consultation with allergists and other specialists.
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  95. ^ October 31, 1997, R-164, Creamer v. Callahan
  96. ^ "DI 24515.064 Evaluation Of Specific Issues — Environmental Illness". Social Security Administration. Retrieved 8 May 2010. Therefore, in evaluating claims based on environmental illness, all of the claimant's symptoms, signs, and laboratory findings must be considered to determine if there is a medically determinable impairment and the impact of any impairment on the claimant's ability to work. This evaluation should be made on an individual case-by-case basis to determine if the impairment prevents substantial gainful activity.
  97. ^ Frank v. New York, 972 F. Supp. 130 (N.D.N.Y. 1997)
  98. ^ Andrew K. Kelley, "COMMENT: Sensitivity Training: Multiple Chemical Sensitivity and the ADA," 25 B.C. Envtl. Aff. L. Rev. 485; see, for example, Whillock v. Delta Air Lines, 926 F.Supp. 1555 (N.D.Ga. 1995) http://lawdigitalcommons.bc.edu/ealr/vol25/iss2/5/
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  100. ^ Hu, Howard, Banes Cornelia (2018) “Recent insights into 3 underrecognized conditions: Myalgic encephalomyelitis–chronic fatigue syndrome, fibromyalgia, and environmental sensitivities–multiple chemical sensitivity” Canada Family Physician. 2018 Jun; 64(6): 413–415.; PMID: 29898928; PMCID: PMC5999262
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