Profile of patients with chemical
injury and sensitivity.
Ziem G, McTamney J.
Occupational and Environmental Medicine, Baltimore, Maryland, USA.
Patients reporting sensitivity to multiple chemicals at levels usually
tolerated by the healthy population were administered standardized
questionnaires to evaluate their symptoms and the exposures that aggravated
these symptoms. Many patients were referred for medical tests. It is thought
that patients with chemical sensitivity have organ abnormalities involving the
liver, nervous system (brain, including limbic, peripheral, autonomic), immune
system, and porphyrin metabolism, probably reflecting chemical injury to these
systems. Laboratory results are not consistent with a psychologic origin of
chemical sensitivity. Substantial overlap between chemical sensitivity,
fibromyalgia, and chronic fatigue syndrome exists: the latter two conditions
often involve chemical sensitivity and may even be the same disorder. Other
disorders commonly seen in chemical sensitivity patients include headache
(often migraine), chronic fatigue, musculoskeletal aching, chronic respiratory
inflammation (rhinitis, sinusitis, laryngitis, asthma), attention deficit, and
hyperactivity (affected younger children). Less common disorders include
tremor, seizures, and mitral valve prolapse. Patients with these overlapping
disorders should be evaluated for chemical sensitivity and excluded from
control groups in future research. Agents whose exposures are associated with
symptoms and suspected of causing onset of chemical sensitivity with chronic
illness include gasoline, kerosene, natural gas, pesticides (especially
chlordane and chlorpyrifos), solvents, new carpet and other renovation
materials, adhesives/glues, fiberglass, carbonless copy paper, fabric softener,
formaldehyde and glutaraldehyde, carpet shampoos (lauryl sulfate) and other
cleaning agents, isocyanates, combustion products (poorly vented gas heaters,
overheated batteries), and medications (dinitrochlorobenzene for warts,
intranasally packed neosynephrine, prolonged antibiotics, and general
anesthesia with petrochemicals). Multiple mechanisms of chemical injury that
magnify response to exposures in chemically sensitive patients can include
neurogenic inflammation (respiratory, gastrointestinal, genitourinary),
kindling and time-dependent sensitization (neurologic), impaired porphyrin
metabolism (multiple organs), and immune activation.
PMID: 9167975 [PubMed - indexed for MEDLINE]