Multiple Chemical Sensitivity

Multiple Chemical Sensitivity
Sandra K. McDonald Colorado State University

An increased sensitivity to chemicals in the environment attributed to prior chemical exposure

Multiple Chemical Senstivity
Other names: Environmental illness (EI) Ecological illness Total allergy syndrome The 20th century disease (Hileman, 1991) Idiopathic environmental intolerances (IPCS, 1996)

Term most commonly applied to a condition that challenges patients, health-care providers & health & environmental agencies alike

In broad terms it means an unusually severe sensitivity or allergy-like reaction to many different kinds of pollutants including : Solvents VOC's (Volatile Organic Compounds) Perfumes fuels Smoke "chemicals" in general Multiple Chemical Sensitivity - also referred to as MCS - is also known as Chemical Injury, Chemical Sensitivity, Environmental Illness (E.I.), and Multiple Allergy. Multiple Chemical Sensitivity; in broad terms it means an unusually severe sensitivity or allergy-like reaction to many different kinds of pollutants including solvents, VOC's (Volatile Organic Compounds), perfumes, petrol, diesel, smoke, "chemicals" in general and often encompasses problems with regard to pollen, house dust mites, and pet fur & dander.

MCS – Do We Understand? The idiopathic or "not understood" nature of MCS means that doctors & others are often highly skeptical about the reality of – and nature of - the MCS condition Many features of MCS and it’s effects and the way it’s effects are described by the sufferer seem altogether unrealistic, impossible or implausible to a conventional & scientifically trained consultant or General Practitioner The idiopathic or "not understood" nature of MCS means that doctors & others are often highly sceptical about the reality of – and nature of - the MCS condition. Many features of Multiple Chemical Sensitivity and it’s effects and the way it’s effects are described by the sufferer seem altogether unrealistic, impossible or implausible to a conventional & scientifically trained consultant or GP. The population at large are often equally sceptical, because the described symptoms (say, headache, joint pains, etc. ) and the externally observable effects ( say, runny nose, watering eyes, etc ), are blamed by the Multiple Chemical Sensitivity sufferer on an invisible chemical or toxin that the average person cannot even detect, much less be affected by !

MCS First Report Theron Randolph, 1952
Physician trained in allergy & immunology Reported a number of patients reacted adversely to chemicals in their environment

MCS First Report Linked the adverse effects of this "petrochemical problem" to contact with chemicals found in commonly encountered substances i.e., cosmetics, auto fuels, exhaust fumes & food additives

MCS First Report Observed that many patients reacted to many industrial solvents found in small amounts in manufactured products such as construction materials, newspaper & other ink-related products, furniture & carpet

American Academy of Environmental Medicine
Randolph, 1965, founded Society for Human Ecology In response to this lack of acceptance within his specialty 1985, name changed to the American Academy of Environmental Medicine Environmental physicians

MCS Definitions Cullen’s (1987) definitions is widely used – four elements: syndrome is acquired after a documentable environmental exposure that may have caused objective evidence of health effects; symptoms are referable to multiple organ systems and vary predictably in response to environmental stimuli; symptoms occur in relation to measurable levels of chemicals, but the levels are below those known to harm health; and no objective evidence of organ damage can be found. Definitions Several definitions have been proposed for MCS.1 Cullen's10 definition is widely used. It includes four elements: (1) the syndrome is acquired after a documentable environmental exposure that may have caused objective evidence of health effects; (2) the symptoms are referable to multiple organ systems and vary predictably in response to environmental stimuli; (3) the symptoms occur in relation to measurable levels of chemicals, but the levels are below those known to harm health; and (4) no objective evidence of organ damage can be found. Cullen's definition has the practical advantage of describing a syndrome without specifying individual symptoms or mechanisms of disease. Other definitions have been proposed that describe specific symptoms or postulate disease mechanisms.1 These definitions are reflected in the other names that have been used for MCS and overlapping conditions, such as environmental illness, chemical AIDS, 20th century disease, total allergy syndrome, sick building syndrome, chemophobia, immune dysregulation and others.

MCS Definitions Cullen’s definition has the practical advantage of describing a syndrome without specifying individual symptoms or mechanisms of disease Definitions Several definitions have been proposed for MCS.1 Cullen's10 definition is widely used. It includes four elements: (1) the syndrome is acquired after a documentable environmental exposure that may have caused objective evidence of health effects; (2) the symptoms are referable to multiple organ systems and vary predictably in response to environmental stimuli; (3) the symptoms occur in relation to measurable levels of chemicals, but the levels are below those known to harm health; and (4) no objective evidence of organ damage can be found. Cullen's definition has the practical advantage of describing a syndrome without specifying individual symptoms or mechanisms of disease. Other definitions have been proposed that describe specific symptoms or postulate disease mechanisms.1 These definitions are reflected in the other names that have been used for MCS and overlapping conditions, such as environmental illness, chemical AIDS, 20th century disease, total allergy syndrome, sick building syndrome, chemophobia, immune dysregulation and others.

Wide variety of symptoms have been reported (Terr, 1986; Lax & Henneberger, 1995)

Symptoms of MCS Extreme fatigue Headache Gastrointestinal problems
Muscle & joint pain Depression Memory & concentration difficulties Anxiety Upper airway irritation Symptoms may change over time and differ from person to person.

Patients have associated their symptoms with many substances (Ziem, 1992; Lax & Henneberger, 1995)

Exposures linked to MCS
Perfumed ‘personal’ products Pesticides Petroleum products Plastics Wood preservatives Carpet & upholstery materials Construction materials Deodorizers Disinfectants Fabrics Newspapers Paint

Persons reported as suffering from MCS present with outcomes that range from minor discomfort to severe disability

Americans with Disability Act
In 1991, multiple chemical sensitivity was defined as a disability under the act Resulted in the demand for accommodation at work, at school and in housing for those with a diagnosis of MCS In some states, MCS is recognized under workers' compensation laws as a disability resulting in free health care for persons with symptoms related to the phenomenon, as well as payment for lost wages Because a major treatment recommendation is avoidance of chemical exposure, the worker may never return to active employment In 1991, multiple chemical sensitivity was defined as a disability under the Americans with Disability Act. This has resulted in the demand for accommodation at work, at school and in housing for those with a diagnosis of multiple chemical sensitivity. In some states, multiple chemical sensitivity is recognized under workers' compensation laws as a disability resulting in free health care for persons with symptoms related to the phenomenon, as well as payment for lost wages. Because a major treatment recommendation is avoidance of chemical exposure, the worker may never return to active employment.

OSHA’s View on MCS MCS is a highly controversial issue In theory, MCS is an adverse physical reaction to low levels of many common chemicals Chemical sensitivity is generally accepted as a reaction to chemicals but debate continues as to whether MCS is classifiable as an illness U.S. Department of Labor Occupational Safety & Health Administration Multiple Chemical Sensitivities (MCS) is a highly controversial issue. In theory, MCS is an adverse physical reaction to low levels of many common chemicals. Chemical sensitivity is generally accepted as a reaction to chemicals but debate continues as to whether MCS is classifiable as an illness. There are a number of synonyms for MCS, including 20th century disease, environmental illness, total allergy syndrome, idiopathic environmental illness, and chemical AIDS. Proposed theories to explain the cause of MCS include allergy, dysfunction of the immune system, neurobiological sensitization, and various psychological theories. There is insufficient scientific evidence to confirm a relationship between any of these possible causes and symptoms. Due to the lack of definite information an evaluation must be performed by a physician knowledgeable of the symptoms of this condition.

Proposed Mechanisms Theories of the etiology of MCS can be grouped into four broad categories: Physical Stress Misdiagnosis Illness belief Sparks 1994 Proposed Mechanisms Theories of the etiology of MCS can be grouped into four broad categories: physical, stress, misdiagnosis and illness belief.15

Physical Three basic physical mechanisms have been proposed to explain MCS: Allergy Direct toxic effects Neurobiologic sensitization Simon 1993 Physical Three basic physical mechanisms have been proposed to explain MCS: allergy, direct toxic effects and neurobiologic sensitization. Allergy. Followers of the clinical ecology movement believe chemical exposure causes the development of allergy to low levels of many chemicals, not just the initiating one. Supporters point to a spectrum of immune system tests that have been found to be abnormal in patients with MCS syndrome. However, there are many problems with these tests, such as wide natural variation in the test results, few reference standards to determine what statistically "normal" is and lack of reproducibility. Finally, careful studies comparing patients with MCS and control patients have found no differences on immunologic testing.16 Thus, it is not possible to rely on immunologic testing to demonstrate the etiology of MCS. Toxicologic Effects. Others propose a toxicologic effect of low-dose exposure--in effect, poisoning. However, objective evidence for such an effect is lacking.17 Patients with MCS experience symptoms at levels of chemical exposure far lower than those considered toxic. Neurobiologic Sensitization. The third proposed physical mechanism is that affected persons develop increasing neurologic sensitivity to the adverse effects of chemicals.18,19 Animal models for such neurologic changes include limbic kindling and time-dependent neurologic sensitization. In these models, animals repeatedly exposed to seizure-inducing chemicals or electrical stimulation have been found to develop lower thresholds for seizure induction than the thresholds observed before exposure. With other stimuli, animals have been found to have an amplification of the response to the stimulus over time.20 However, these events have been documented only with pharmacologic doses and only in animals, not in humans and not at the low doses purported to cause MCS.

Allergy Chemical ecology movement believes chemical exposure causes the development of allergy to low levels of many chemicals, not just the initiating one Supporters point to a spectrum of immune system tests that have been found to be abnormal in patients with MCS Physical Three basic physical mechanisms have been proposed to explain MCS: allergy, direct toxic effects and neurobiologic sensitization. Allergy. Followers of the clinical ecology movement believe chemical exposure causes the development of allergy to low levels of many chemicals, not just the initiating one. Supporters point to a spectrum of immune system tests that have been found to be abnormal in patients with MCS syndrome. However, there are many problems with these tests, such as wide natural variation in the test results, few reference standards to determine what statistically "normal" is and lack of reproducibility. Finally, careful studies comparing patients with MCS and control patients have found no differences on immunologic testing.16 Thus, it is not possible to rely on immunologic testing to demonstrate the etiology of MCS. Toxicologic Effects. Others propose a toxicologic effect of low-dose exposure--in effect, poisoning. However, objective evidence for such an effect is lacking.17 Patients with MCS experience symptoms at levels of chemical exposure far lower than those considered toxic. Neurobiologic Sensitization. The third proposed physical mechanism is that affected persons develop increasing neurologic sensitivity to the adverse effects of chemicals.18,19 Animal models for such neurologic changes include limbic kindling and time-dependent neurologic sensitization. In these models, animals repeatedly exposed to seizure-inducing chemicals or electrical stimulation have been found to develop lower thresholds for seizure induction than the thresholds observed before exposure. With other stimuli, animals have been found to have an amplification of the response to the stimulus over time.20 However, these events have been documented only with pharmacologic doses and only in animals, not in humans and not at the low doses purported to cause MCS.

Patients react to extremely tiny amounts of chemicals Only mechanism which is now known to cause reaction to tiny amounts is antibody formation (i.e., allergy) Some MCS patients react to chemicals which do not induce formation of antibodies

True allergies - where the underlying mechanisms of the problem are relatively well understood widely accepted MCS , is generally regarded as "idiopathic" - meaning that it has no known mechanism of causation & it's processes are not fully understood The problem here is made more difficult still, due to the variable nature of Multiple Chemical Sensitivity from one patient to the next & this often makes treatment with conventional medicine & practices ineffective or inappropriate; for most sufferers with Multiple Chemical Sensitivity, the avoidance of pollutants/toxicants is the key. Multiple chemical sensitivity unlike true allergies - where the underlying mechanisms of the problem are relatively well understood widely accepted, is generally regarded as "idiopathic" - meaning that it has no known mechanism of causation & it's processes are not fully understood. The problem here is made more difficult still, due to the variable nature of Multiple Chemical Sensitivity from one patient to the next & this often makes treatment with conventional medicine & practices ineffective or inappropriate; for most sufferers with Multiple Chemical Sensitivity, the avoidance of pollutants/toxicants is the key.

True Allergy An acquired reaction caused by an immune system response to one SPECIFIC excitant that has already been encountered at least once before In conventional science and in the present state of knowledge, this effect is “impossible” because an allergy is an acquired reaction caused by an immune system response to one SPECIFIC excitant that has already been encountered at least once before : a multilateral response to many and varied toxicants is inexplicable using conventional medicine. Yet many MCS sufferers do report the same effects and the same symptom picture following exposure to varied excitants – in short, they all "tell the same story".

Miniscule Dose of a Toxicant
Sensitization is a true allergic reaction to one chemical or irritant and is caused by involvement within the body of mast cells and IgE antibodies Once sensitized to a particular irritant, a subsequent exposure to even a tiny amount of the same irritant even parts per million – ppm – or parts per billion – ppb can cause an extreme allergic reaction one ppm = % How can a person really be affected by such a miniscule dose of a toxicant even if such a toxicant IS present? Surprisingly, perhaps, this is one aspect of Multiple Chemical Sensitivity that is very well understood in conventional medicine and it is called Sensitization. Sensitization is a true allergic reaction to one chemical or irritant and is caused by involvement within the body of mast cells and IgE antibodies. Once sensitized to a particular irritant, a subsequent exposure to even a tiny amount of the same irritant ( even parts per million – ppm – or parts per billion – ppb) can cause an extreme allergic reaction. Note: one ppm = %.

Toxicological Effects
Others propose a toxicological effect of low-dose exposure -- poisoning Objective evidence for such an effect is lacking Patients with MCS experience symptoms at levels of chemical exposure far lower than those considered toxic Physical Three basic physical mechanisms have been proposed to explain MCS: allergy, direct toxic effects and neurobiologic sensitization. Allergy. Followers of the clinical ecology movement believe chemical exposure causes the development of allergy to low levels of many chemicals, not just the initiating one. Supporters point to a spectrum of immune system tests that have been found to be abnormal in patients with MCS syndrome. However, there are many problems with these tests, such as wide natural variation in the test results, few reference standards to determine what statistically "normal" is and lack of reproducibility. Finally, careful studies comparing patients with MCS and control patients have found no differences on immunologic testing.16 Thus, it is not possible to rely on immunologic testing to demonstrate the etiology of MCS. Toxicologic Effects. Others propose a toxicologic effect of low-dose exposure--in effect, poisoning. However, objective evidence for such an effect is lacking.17 Patients with MCS experience symptoms at levels of chemical exposure far lower than those considered toxic. Neurobiologic Sensitization. The third proposed physical mechanism is that affected persons develop increasing neurologic sensitivity to the adverse effects of chemicals.18,19 Animal models for such neurologic changes include limbic kindling and time-dependent neurologic sensitization. In these models, animals repeatedly exposed to seizure-inducing chemicals or electrical stimulation have been found to develop lower thresholds for seizure induction than the thresholds observed before exposure. With other stimuli, animals have been found to have an amplification of the response to the stimulus over time.20 However, these events have been documented only with pharmacologic doses and only in animals, not in humans and not at the low doses purported to cause MCS.

Miller et al. (1997) Theory of "toxicant-induced loss of tolerance" (TILT) Acute or chronic chemical exposures might cause certain susceptible persons to lose their tolerance for previously tolerated chemicals, drugs & foods Subsequently, even minute quantities of these & other substances may trigger symptoms

Neurobiological Sensitization
Affected persons develop increasing neurologic sensitivity to the adverse effects of chemicals Animal models for such neurologic changes include limbic kindling and time-dependent neurologic sensitization These events have been documented only with pharmacologic doses and only in animals, not in humans and not at the low doses purported to cause MCS Physical Three basic physical mechanisms have been proposed to explain MCS: allergy, direct toxic effects and neurobiologic sensitization. Allergy. Followers of the clinical ecology movement believe chemical exposure causes the development of allergy to low levels of many chemicals, not just the initiating one. Supporters point to a spectrum of immune system tests that have been found to be abnormal in patients with MCS syndrome. However, there are many problems with these tests, such as wide natural variation in the test results, few reference standards to determine what statistically "normal" is and lack of reproducibility. Finally, careful studies comparing patients with MCS and control patients have found no differences on immunologic testing.16 Thus, it is not possible to rely on immunologic testing to demonstrate the etiology of MCS. Toxicologic Effects. Others propose a toxicologic effect of low-dose exposure--in effect, poisoning. However, objective evidence for such an effect is lacking.17 Patients with MCS experience symptoms at levels of chemical exposure far lower than those considered toxic. Neurobiologic Sensitization. The third proposed physical mechanism is that affected persons develop increasing neurologic sensitivity to the adverse effects of chemicals.18,19 Animal models for such neurologic changes include limbic kindling and time-dependent neurologic sensitization. In these models, animals repeatedly exposed to seizure-inducing chemicals or electrical stimulation have been found to develop lower thresholds for seizure induction than the thresholds observed before exposure. With other stimuli, animals have been found to have an amplification of the response to the stimulus over time.20 However, these events have been documented only with pharmacologic doses and only in animals, not in humans and not at the low doses purported to cause MCS.

Sensitivity This sensitivity, in the case of MCS, to unrelated toxicants does, however, have several unproven, but seemingly sound theories to explain it including: Enzyme depletion Conditioning Immune system disorders This sensitivity,(in the case of MCS), to unrelated toxicants does, however, have several unproven, but seemingly sound theories to explain it including: enzyme depletion conditioning immune system disorders

Enzyme Depletion Enzymes are also used to detoxify a wide range of synthetic chemicals If the enzymes are depleted or damaged by health problems, then they are unable to metabolize these toxicants efficiently, so leading to the problems associated with MCS Many types of enzyme deficiency can be inherited Some (fairly tentative) evidence to suppose that MCS may affect other members of the same family detoxification of all manner of naturally occurring toxins is carried out in humans by enzymes in the liver. These same enzymes are also used to detoxify a wide range of synthetic chemicals, but, if the enzymes are depleted or damaged by health problems, then they are unable to metabolize these toxicants efficiently, so leading to the problems associated with Multiple Chemical Sensitivity. Enzyme depletion is used to great effect with some types of pesticide, where the action of the primary poison is augmented by the use of an enzyme blocker so that the poison cannot be metabolized properly, remains in the body of the organism longer, and so is much more highly toxic than it would otherwise be. Many types of enzyme deficiency can be inherited & this may lead one to suppose that MCS may affect other members of the same family and, in fact, there is some (fairly tentative) evidence to support this view.

Conditioning Two unrelated events occur at the same time and one event becomes associated with the other When the first event is later repeated, the second event also manifests itself for the sufferer For example, if on a particular day the patient is already feeling slightly unwell and if, coincidentally, the patient is exposed to (say) paint fumes, then the paint fumes may genuinely make the patient feel unwell and possibly nauseous A subsequent exposure to the same paint fumes - or a similarly strong solvent odor - may produce a strong feeling of nausea for the patient, who, moments before, felt perfectly well there may be an additional psychological aspect to Multiple Chemical Sensitivity called "conditioning" & this is not to say that MCS is "all in the mind" - as it quite definitely is not - but conditioning could certainly exacerbate severely a pre-existing sensitivity. Conditioning happens when two unrelated events occur at the same time and one event becomes associated with the other. When the first event is later repeated, the second event also manifests itself for the sufferer. For example, if on a particular day the patient is already feeling slightly unwell and if, coincidentally, the patient is exposed to (say) paint fumes, then the paint fumes may genuinely make the patient feel unwell and possibly nauseous. A subsequent exposure to the same paint fumes - or a similarly strong solvent odour - may produce a strong feeling of nausea for the patient, who, moments before, felt perfectly well. This is an example of conditioning and is a "real" phenomenon; this phenomenon also has real & useful effects, such as an aid to quit smoking or as an aid to dieting, for example. Related to this, the reaction to a similar but not identical trigger is called Generalisation; it's effects may be very real but it is not a true allergic (IgE) response. This response has been likened to the assault victim who comes to fear anyone who resembles their attacker: their fear is real, but the threat may not be. These effects of Conditioning & Generalisation may explain why the MCS sufferer seems, over a period of time, to react to an ever-lengthening list of excitants or triggers, including actual toxicants or a place or situation which may be (or may be perceived to be), problematic - for these patients, a course of Desensitization treatment may be appropriate.

Immune System Damage Some researchers are of the opinion that MCS is due to immune system damage or malfunction, which could give rise to a sensitivity to all sorts of triggers rather than a specific reaction to one toxicant Another important and debilitating feature of MCS - and which tends to complicate MCS diagnosis & treatment still further - is it's ability to apparently augment the effects of other problems experienced by the patient - problems such as common allergies, asthma, depression, food intolerances etc, & these problems of augmentation are reported by about half of all MCS sufferers some researchers are of the opinion that Multiple Chemical Sensitivity is due to immune system damage or malfunction, which could give rise to a sensitivity to all sorts of triggers rather than a specific reaction to one toxicant. A number of types of toxic chemicals have been implicated in major single exposures for people who then subsequently became MCS sufferers AND which are known to be Immune System disruptors; these include organochlorines, formaldehyde, pesticides, herbicides, organophosphates & others. Another important and debilitating feature of MCS - and which tends to complicate MCS diagnosis & treatment still further - is it's ability to apparently augment the effects of other problems experienced by the patient - problems such as common allergies, asthma, depression, food intolerances etc, & these problems of augmentation are reported by about half of all MCS sufferers.

Sensitively Scepticism
Main aspect of MCS sensitivity that is NOT fully understood is that the MSC sufferer reacts similarly and in an allergic fashion to a whole range of completely unrelated toxicants "chemicals“ Solvents Perfumes VOCs Odors etc. These very low levels of irritant will often be totally undetectable to the average person and to them will be totally harmless. Meanwhile, the main aspect of Multiple Chemical Sensitivity that is NOT fully understood - and that is regarded with such great scepticism - is that the MSC sufferer reacts similarly and in an allergic fashion to a whole raft of completely unrelated toxicants – typically "chemicals", solvents, perfumes, VOCs, odours, smoke, house dust mites, pollen, etc.

MCS Triggers Can change over time Vary between people
A person who was not reactive to a particular substance may or may not react when exposed to the same substance at a later time Vary between people Not all people react to all triggers

MCS Epidemiology Most patients ( %) complaining of MCS syndrome are women Most present between the ages of 30 and 50 years The question of whether MCS is becoming more or less common is unanswered As is the question of whether it is preventable Epidemiology Most patients (85 to 90 %) complaining of MCS syndrome are women. Most present between the ages of 30 and 50 years. Much additional basic descriptive and epidemiologic information is still unknown. The incidence and prevalence are unknown. The question of whether MCS is becoming more or less common is unanswered, as is the question of whether it is preventable. The natural history and biologic outcomes of MCS are unknown, and descriptions of MCS in primary care settings have not been reported. Selected patients from specialty settings comprise reports of the syndrome.14

Avoidance of “Triggers”
Patients often significantly alter their behavior in an attempt to avoid presumed precipitants of symptoms 97 % of the patients had stopped activities outside the home 91 % had limited their travel 89 % had limited their contact with friends 77 % had left a job Lax 1995 Patients often significantly alter their behavior in an attempt to avoid presumed precipitants of symptoms. They may have withdrawn from activities, friends and family in an attempt to eliminate chemical exposures. In one study12 of 35 patients with occupationally related MCS evaluated in an occupational medicine clinic, 97 % of the patients had stopped activities outside the home, 91 % had limited their travel, 89 % had limited their contact with friends and 77 % had left a job. Many changed home routines: 97 % had stopped using cleaning compounds, 69 % removed home furnishings and 63 % limited their contact with family members. In their personal care, 94 % stopped using fragrances, 91 % changed their diet and 86 % changed the type of clothing they wore.

Avoidance of “Triggers”
Many changed home routines: 97 % had stopped using cleaning compounds 69 % removed home furnishings 63 % limited their contact with family members In their personal care: 94 % stopped using fragrances 91 % changed their diet 86 % changed the type of clothing they wore Lax 1995 Patients often significantly alter their behavior in an attempt to avoid presumed precipitants of symptoms. They may have withdrawn from activities, friends and family in an attempt to eliminate chemical exposures. In one study12 of 35 patients with occupationally related MCS evaluated in an occupational medicine clinic, 97 % of the patients had stopped activities outside the home, 91 % had limited their travel, 89 % had limited their contact with friends and 77 % had left a job. Many changed home routines: 97 % had stopped using cleaning compounds, 69 % removed home furnishings and 63 % limited their contact with family members. In their personal care, 94 % stopped using fragrances, 91 % changed their diet and 86 % changed the type of clothing they wore.

MCS Debate Validity of MCS as a distinct disease entity
What role, if any, the biochemical mechanisms of specific chemicals have in the onset of this condition

No diagnostic criteria for it No set of signs and symptoms which are always found in persons who believe they are chemically sensitive No objective blood or other laboratory test for MCS

Who gets MCS? 5% of U.S. population has severe MCS
Greatly reduced quality of life 15-30% have less severe problems Women four times as likely to be affected as men Average age of onset is during 40’s

Coping with MCS No cure at present Treatment – avoid exposure
Isolation General lack of acknowledgment of MCS within medical community

MCS & Society Multiple chemical sensitivity is not simply a medical concern of diagnosis and treatment, but it is becoming a major social and economic issue with a strong activist agenda Chemical Sensitivity: The Truth About Environmental Illness (Barrett and Gots 1998) Multiple chemical sensitivity is not simply a medical concern of diagnosis and treatment, but it is becoming a major social and economic issue with a strong activist agenda. In their book, Chemical Sensitivity: The Truth About Environmental Illness, Barrett and Gots7 address this issue. Advocates of multiple chemical sensitivity have successfully sought sympathy and support by attacking the chemical industry and others as the source of their plight. Numerous activist organizations publish newsletters and maintain Web sites that identify physicians and lawyers who support the chemical causality of their illnesses. A newsletter reports legislative, public policy and court decisions that support multiple chemical sensitivity as a legitimate disease or disability.8

MCS & Society Advocates of multiple chemical sensitivity have successfully sought sympathy and support by attacking the chemical industry and others as the source of their plight Numerous activist organizations publish newsletters and maintain Web sites that identify physicians and lawyers who support the chemical causality of their illnesses A newsletter reports legislative, public policy and court decisions that support multiple chemical sensitivity as a legitimate disease or disability -- Our toxic times. Chemical Injury Information Network, White Sulphur Springs, Montana Multiple chemical sensitivity is not simply a medical concern of diagnosis and treatment, but it is becoming a major social and economic issue with a strong activist agenda. In their book, Chemical Sensitivity: The Truth About Environmental Illness, Barrett and Gots7 address this issue. Advocates of multiple chemical sensitivity have successfully sought sympathy and support by attacking the chemical industry and others as the source of their plight. Numerous activist organizations publish newsletters and maintain Web sites that identify physicians and lawyers who support the chemical causality of their illnesses. A newsletter reports legislative, public policy and court decisions that support multiple chemical sensitivity as a legitimate disease or disability.8

Debated Topics Whether MCS is a distinct disease entity
Its etiology (or etiologies) Its pathophysiology How to define the condition How it should be treated How it should be approached in legal & legislative arenas

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