DESCRIPTIONS OF THE MULTIPLE CHEMICAL SENSITIVITY SYNDROME

An option that exposure to environmental organic chemicals could lead to illnesses was expressed in 1962 in a short book, Human Ecology and Susceptibility to the Chemical Environment, written by a Chicago allergist (Randolph, 1962). The characterization of this illness is presented in Table 1, and this type of sensitivity was presented as being distinct from classical allergic sensitization. Notable features of this description include an adaptation phenomenon, with: (a) sensitive individuals having chronic symptoms while living in the chemical environment which resolve several days after removal from the chemicals, (b) withdrawal symptoms upon removal and (c) "shock reactions" when these individuals are reexposed to chemicals. Patients affected by this disorder have a variety of physical and mental illnesses which can be managed by avoiding incriminated chemicals. A spreading phenomenon was described in which affected individuals become progressively sensitive to more and more chemicals found in indoor air, water, and foods. A set of chemicals which were found in clinical practice to cause illness in some patients is given in Table 2. This work was presented as an opinion based upon the clinical practice of having patients avoid chemicals and foods using trial and error, and no scientific data such as double-blinded studies were presented to substantiate this point of view.

TABLE 1

Randolph's Description of Chemical Sensitivity Disease

Acquired, often after chronic insidious or acute exposure to a petrochemical.

Chemical exposures trigger physical (arthritis, asthma, colitis, etc.) or mental (depression, difficulty with concentration, mania, psychosis, etc.) symptoms.

Specific Adaptation Syndrome. Adaptation to specific chemicals with chronic exposure is followed by maladaptation and chronic illness, withdrawal symptoms when removed from the chemical environment, and "shock reactions" on reexposure.

Spreading phenomena. As an individual becomes maladapted to the chemical environment, intolerance to increasing numbers of environmental chemicals develops.

Avoidance. By avoiding the chemical environment, chronic illnesses may resolve.

A case definition of the Multiple chemical Sensitivity Syndrome based on the experience of occupational medicine specialists around the country has been presented (Cullen, 1989). Table 3 gives the seven criteria presented in this case definition. Common of Tables I and 3 shows considerable overlap, and a discussion of the relationship between the two will be given below.

An operational definition of MCS has been given (Ashford and Miller, 1989, 1991),



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