This workshop was conducted at the request of the Environmental Protection Agency. This volume contains the papers prepared and presented by individual workshop participants; the papers have not undergone peer review.
Board on Environmental Studies and Toxicology
Commission on Life Sciences
National Research Council
NATIONAL ACADEMY PRESS
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Multiple Chemical Sensitivities: A Workshop Multiple Chemical Sensitivities A Workshop This workshop was conducted at the request of the Environmental Protection Agency. This volume contains the papers prepared and presented by individual workshop participants; the papers have not undergone peer review. Board on Environmental Studies and Toxicology Commission on Life Sciences National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1992
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Multiple Chemical Sensitivities: A Workshop NATIONAL ACADEMY PRESS 2101 Constitution Ave., N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. Procedures approved by the Report Review Committee of the National Research Council provide that reports be reviewed by a group other than the authors. This report has not received such a review. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Frank Press is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Robert M. White is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Frank Press and Dr. Robert M. White are chairman and vice chairman, respectively, of the National Research Council. The project was supported by the Environmental Protection Agency; the National Institute of Environmental Health Sciences; and the Comprehensive Environmental Response, Compensation, and Liability Act Trust Fund through cooperative agreement with the Agency for Toxic Substances and Disease Registry, U.S. Public Health Service, Department of Health and Human Services. Library of Congress Catalog Card No. 92-80854 International Standard Book No. 0-309-04736-6 Additional copies of this report are available from the National Academy Press, 2101 Constitution Avenue, N.W., Washington, D.C. 20418 S582 Printed in the United States of America
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Multiple Chemical Sensitivities: A Workshop TABLE OF CONTENTS Introduction, Jonathan Samet and Devra Lee Davis 1 Research Protocols for Clinical Evaluation, 5 Working Group I Exposures and Mechanisms, 9 Working Group II Epidemiology, 11 Working Group III Key Concepts: Chemical Sensitization, Michael D. Lebowitz 13 Multiple Chemical Sensitivity-What is it?, Roy L. DeHart 35 Case Definitions for Multiple Chemical Sensitivity, Nicholas A. Ashford and Claudia S. Miller 41 Allergy and Multiple Chemical Sensitivities (MCS) Distinguished, Claudia S. Miller and Nicholas A. Ashford 47 Design of Animal Models to Probe the Mechanisms of Hypersensitivity, Meryl Karol 65 Antigen Specific and Antigen Non-Specific Immunization, Robert Burrell 77
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Multiple Chemical Sensitivities: A Workshop Neuropsychiatric and Biopsychosocial Mechanisms in Multiple Chemical Sensitivity: An Olfactory-Limbic System Model, Iris R. Bell 89 Neurobehavioral and Psychosocial Aspects of Multiple Chemical Sensitivity, Nancy Fiedler and Howard Kipen 109 Diagnostic Markers of Multiple Chemical Sensitivity, Gunnar Heuser, A. Wojdani, and S. Heuser 117 Possible Mechanisms for Multiple Chemical Sensitivity: The Limbic System and Others, Claudia S. Miller and Nicholas A. Ashford 139 Developing Clinical Research Protocols for Studying Chemical Sensitivities, William Meggs 151 Immunological Mechanisms of Disease and the Multiple Chemical Sensitivity Syndrome, William Meggs 155 Considerations for the Diagnosis of Chemical Sensitivity, William J. Rea, Alfred R. Johnson, Gerald H. Ross, Joel R. Butler, Ervin J. Fenyves, Bertie Griffiths, and John Laseter 169 Occupational Asthma, Laura S. Welch 193 List of Contributors, 197 List of Participants, 199