2Chemical IntoleranceAbout 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%)We should begin by defining chemical intolerance. We prefer the term chemical intolerance to the other terms in use. Another common term, Multiple Chemical Sensitivity, is particularly problematic in the medical community, because the term sensitivity implies an immunologic sensitization involving IgE. Although a limited number of chemicals are sensitizing, in general the complaints of people with chemical intolerance are not related to allergic sensitization.
3A New Theory of Disease— Toxicant-Induced Loss of Tolerance or “TILT” In fact, what Dr. Miller and her colleague Dr. Nicholas Ashford noted, is that chemical intolerances are just one facet of a larger underlying dynamic called TILT or Toxicant Induced Loss of Tolerance.
4Evidence That We Are Dealing With a New Disease Mechanism Similar reports from more than a dozen countries—different languages, mediaYET 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 diseaseCompelling anomalies drive the search for new explanations, paradigms, theories
5Common Indoor Conditions Linked to TILT (Stage 1) Remodeling—new carpets, glues, cleaners, and other VOC emittersPesticidesMoldInsufficient fresh make-up air
6TOXICANT-INDUCED LOSS OF TOLERANCE ? SolventsGluesPaintsGasolineNail polish/removerIndoor Air Volatile Organic Compounds (VOCs)New carpetPlasticizersFormaldehydeFragrancesMold VOCsDrugs/Medical DevicesVaccinesAnestheticsImplantsAntibioticsChemotherapyTOXICANT-INDUCEDLOSS OFTOLERANCE?Combustion-related ProductsEngine exhaustTobacco smokeOil well fire smokeNatural gasTar/asphaltCleaning AgentsPhenolic disinfectantsAmmoniaBleachPesticidesOrganophosphatesCarbamates, pyridostigminePentachlorophenolPyrethrins
7TOXICANT-INDUCED LOSS OF TOLERANCE ? NeuropsychologicalAttention Deficit HyperactivityDisorder (ADHD)depressionbipolar disorderpanic disordermigraines and other headachesseizuresautismEar, Nose and Throatsinusitispolypstinnitusrecurrent otitisCardiovasculararrhythmiashypertensionhypotensionRaynaud's phenomenonMiscellaneous SyndromesChronic Fatigue Syndromeimplant syndromes''Gulf War Syndrome“Post/other disastersyndromesRespiratoryasthmaReactive Airways DysfunctionSyndrome (RADS)toluene dlisocyanate(TDI) hypersensitivityTOXICANT-INDUCEDLOSS OFTOLERANCE?Skineczemahivesother rashes,eruptionsGastrointestinalirritable bowelrefluxConnective Tissue/Musculoskeletalfibromyalgiacarpal tunnel syndrometemporomandibular jointdysfunction (TMJ) syndromearthritislupus and other auto-immune diseases
8Identifying Toxicant-Induced Loss of Tolerance (TILT)?
9The QEESI Validated, published questionnaire and screening tool 50 questions, self-administered12-15 minutes to administerResearch, clinical, building investigationsHelps occupants understand their symptoms and intolerances
18How Can You Use This Information Without “Practicing Medicine”? Provide link to QEESI for occupants to self-administerInvite affected occupants to take the results to their doctorsSome occupants will share the results with you, but don’t ask them toIn either case, those affected will self-identify and will begin to understand that they may be especially susceptibleThese are the people who need accommodationLook for physicians you can work with—QEESI will help them understand too
19Tatjana Walker, RD, MPHUniversity of Texas School of Medicine at San AntonioThe QEESI is Available for Download at: