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Is it the building, the occupant, or both? Using the QEESI © to investigate indoor air concerns. June 7, 2011 Indoor Air 2011 Tatjana Walker, RD, MPH;

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Presentation on theme: "Is it the building, the occupant, or both? Using the QEESI © to investigate indoor air concerns. June 7, 2011 Indoor Air 2011 Tatjana Walker, RD, MPH;"— Presentation transcript:

1 Is it the building, the occupant, or both? Using the QEESI © to investigate indoor air concerns. June 7, 2011 Indoor Air 2011 Tatjana Walker, RD, MPH; Thomas J. Prihoda, PhD; Claudia S. Miller, M.D., M.S. University of Texas School of Medicine at San Antonio

2 Chemical Intolerance About 5% of people report multiple chemical intolerances Do you consider yourself sensitive to everyday chemicals like those in household cleaning supplies, paints, perfumes, soaps, garden sprays, or things like that? (15%)

3 A New Theory of Disease Toxicant-Induced Loss of Tolerance or TILT

4 Evidence That We Are Dealing With a New Disease Mechanism Similar reports from more than a dozen countries different languages, media YET they report similar new onset intolerances to structurally unrelated substances (foods, medications, alcoholic beverages, caffeine) and symptoms affecting multiple organ systems in response to these. This is what Kuhn called a compelling anomaly observations that do not fit known theories of disease Compelling anomalies drive the search for new explanations, paradigms, theories

5 Common Indoor Conditions Linked to TILT (Stage 1) Remodelingnew carpets, glues, cleaners, and other VOC emitters Pesticides Mold Insufficient fresh make-up air

6 Solvents Glues Paints Gasoline Nail polish/remover Pesticides Organophosphates Carbamates, pyridostigmine Pentachlorophenol Pyrethrins Indoor Air Volatile Organic Compounds (VOCs) New carpet Plasticizers Formaldehyde Fragrances Mold VOCs Combustion-related Products Engine exhaust Tobacco smoke Oil well fire smoke Natural gas Tar/asphalt Drugs/Medical Devices Vaccines Anesthetics Implants Antibiotics Chemotherapy Cleaning Agents Phenolic disinfectants Ammonia Bleach TOXICANT-INDUCED LOSS OF TOLERANCE ?

7 TOXICANT-INDUCED LOSS OF TOLERANCE ? Gastrointestinal irritable bowel reflux Connective Tissue/Musculoskeletal fibromyalgia carpal tunnel syndrome temporomandibular joint dysfunction (TMJ) syndrome arthritis lupus and other auto-immune diseases Respiratory asthma Reactive Airways Dysfunction Syndrome (RADS) toluene dlisocyanate (TDI) hypersensitivity Skin eczema hives other rashes, eruptions Miscellaneous Syndromes Chronic Fatigue Syndrome implant syndromes ''Gulf War Syndrome Post/other disaster syndromes Cardiovascular arrhythmias hypertension hypotension Raynaud's phenomenon Neuropsychological Attention Deficit Hyperactivity Disorder (ADHD) depression bipolar disorder panic disorder migraines and other headaches seizures autism Ear, Nose and Throat sinusitis polyps tinnitus recurrent otitis

8 Identifying Toxicant-Induced Loss of Tolerance (TILT)?

9 The QEESI Validated, published questionnaire and screening tool 50 questions, self-administered minutes to administer Research, clinical, building investigations Helps occupants understand their symptoms and intolerances

10 Available for download at:

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14 QEESI Symptom Star Pre- and Post-Exposure Before exposure event Since exposure event

15 Courtesy of Carl E. Grimes QEESI Symptom Stars for 4 People in Sick Buildings

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18 How Can You Use This Information Without Practicing Medicine? Provide link to QEESI for occupants to self-administer Invite affected occupants to take the results to their doctors Some occupants will share the results with you, but dont ask them to In either case, those affected will self-identify and will begin to understand that they may be especially susceptible These are the people who need accommodation Look for physicians you can work withQEESI will help them understand too

19 Tatjana Walker, RD, MPH University of Texas School of Medicine at San Antonio The QEESI is Available for Download at:


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