Multiple chemical sensitivity

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
(Redirected from MCS)
Jump to: navigation, search

Multiple chemical sensitivity (MCS), also known as idiopathic environmental intolerances (IEI), is an acquired, chronic, multi-system illness, in which people experience a range of symptoms in response to exposure to certain everyday chemicals.

A 2018 scientific review said MCS was "a complex syndrome that manifests as a result of exposure to a low level of various common contaminants."[1]

While a 2019 consensus paper on MCS defined the condition as an "acquired disorder, characterized by recurrent symptoms, affecting multiple organs and systems, which arise in response to a demonstrable exposure to chemicals," even at doses much lower than would cause a reaction in the general population.[2]

Common triggers for MCS symptoms include pesticides, fragranced products, petrochemicals, formaldehyde and mold.[3][4]

What are the symptoms of multiple chemical sensitivity?

There is a consensus that the symptoms of MCS affect multiple organs and body systems,[3][5][6][7] range from mild to disabling[3][7][8] and decrease quality of life.[6][9][8][10][11][12][13][14][15]

Symptoms of MCS include headache, migraine, neurocognitive deficits, dizziness, fatigue, cardiac arrhythmia, tachycardia, hypotension, hypertension, gastrointestinal problems, nausea, vomiting, muscle and joint pain, skin rashes, hives, visual disturbances, seizures, and asthma.[3][7][16][8][9][17][18][19] And a 2010 review of MCS research said that the following symptoms, in this order, were the most reported in MCS: headache, fatigue, confusion, depression, shortness of breath, arthralgia, myalgia, nausea, dizziness, memory problems, gastrointestinal symptoms, respiratory symptoms.[20]

A 2017 review of MCS studies said: “MCS is a syndrome that progresses to increasingly serious stages, with the gradual onset of multiple pathlogies."[1]
What triggers multiple chemical sensitivity symptoms? Everyday personal care products, particularly fragranced products, are common triggers and their near-ubiquitous use makes many public spaces inaccessible to people with severe sensitivities.[21] To address this, fragrance-free policies are becoming more common, especially in healthcare settings. The U.S. Centers for Disease Control has been fragrance free since 2009.[22]
The following substances are common triggers for adverse symptoms people with MCS:
  • pesticides (insecticides and herbicides), biocides and fungicides
  • agricultural chemicals, notably fertilizers
  • mold and mycotoxins
  • synthetic fragrances and products containing fragrance (eg. fragranced deodorant)
  • laundry detergents and fabric softeners
  • cigarette smoke and woodfire smoke
  • petrochemical solvents and plastics
  • formaldehyde
  • some building materials
  • preservatives, food colorings and additives (eg. tartrazine)
  • some medications and anesthetics
  • air pollution (eg. black carbon, nitrogen oxide, ozone)
  • natural essential oils.[1][3][7][5][9][23][16]:17[24][25]

How is multiple chemical sensitivity diagnosed

The 1999 international consensus on MCS is the most common diagnostic criteria for the condition. This consensus was published in The Archives of Environmental Health,[5] as the conclusion of a ten-year study by an international multidisciplinary team of 89 clinicians and researchers with different points of view about MCS.[3] They agreed that the clinical characteristics of MCS should be defined as follows:

  1. a chronic condition,
  2. with symptoms that recur reproducibly
  3. in response to low levels of exposure
  4. to multiple and unrelated chemicals,
  5. which improve or resolve when triggers are removed, and
  6. with symptoms which occur in multiple organ systems.[5][3][26]

The Quick Environmental Exposure and Sensitivity Inventory (QEESI) is a diagnostic tool that is often used to assess a patient for these criteria.[3]

Research papers have concluded that knowledge and education about MCS among health professionals is lacking and that this commonly results in delays in the diagnosis and poor management of the condition.[14][7][8]

ME/CFS and multiple chemical sensitivity

MCS has been called a common comorbidity of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) by several consensus documents:[27][28][29]

  1. The Canadian Consensus Criteria (2003) for diagnosing ME/CFS lists "new sensitivities to food, medications and/or chemicals" as a symptom and MCS as a comorbidity;
  2. The International Consensus Criteria (2011) for diagnosing ME lists "sensitivities to food, medications, odors or chemicals" as a symptom and MCS as a comorbidity; and
  3. A 2019 publication of the U.S. ME/CFS Clinician Coalition lists "chemical sensitivity" as a symptom of ME/CFS and MCS as a comorbidity.[30]

ME/CFS patients who also have MCS are more likely to face difficulties and complexities associated with accessing healthcare, supportive services and accommodation than those who don't. As well, if they have problems tolerating medications, this could complicate the management of their ME/CFS symptoms.

How do you treat multiple chemical sensitivity?

Is there a cure for multiple chemical sensitivity? At this time, there is no clinically proven cure. There is agreement that people with MCS need to avoid triggers to reduce symptoms and the likelihood of the condition worsening over time, which typically happens without avoidance.[1] Medical Oxygen has been shown to reduce the severity of reactions and temporarily improve tolerance in some people.[31][32]

There is no clinically proven cure for MCS.[8][33] There is also no scientific consensus on supportive therapies, "but the literature agrees on the need for patients with MCS to avoid the specific substances that trigger reactions for them and also on the avoidance of xenobiotics in general, to prevent further sensitization."[7][8][16][24][33]

A study, which surveyed more than 900 people with MCS about their experiences managing the condition, found that 95% of respondents thought that "creating a chemical-free living space and chemical avoidance" had been the best strategy out of any management or treatment option they had tried.[7][34]

There is also consensus that a multidisciplinary approach is required for adequately managing the health of someone with MCS.[6][33] Some studies suggest a special focus on correcting any nutritional deficiencies may be beneficial.[6][33][35]

There is evidence that some patients with MCS have poor tissue oxygenation when exposed to triggers,[32] likely because of oxidative stress or because neural inflammation has reduced blood flow.[32][36][37][38] Breathing medical oxygen following accidental chemical exposures is a suggested remedy for these patients.[32] The 2019 consensus and clinical guidelines on MCS said that people with MCS "must be guaranteed, according to their individual needs and level of disability" medical oxygen and the necessary equipment to use it (that is, tubing and a mask from non-triggering materials).[31]

The other aids the 2019 consensus said were necessary for patients with MCS to manage the functional impacts of their condition were: face masks (with HEPA and VOC filters), portable air purifiers for the home and for inside vehicles (made of metal, with HEPA and activated carbon filters) and water purifiers.[31]

Multiple chemical sensitivity and access

“A growing number of people report being affected by sensitivity to chemicals used in the building, maintenance and operation of premises," according to the Australian Human Rights and Equal Opportunity Commission. "This can mean that premises are effectively inaccessible to people with chemical sensitivity.”[39]

Various organisations and workplaces have policies which cite chemical or fragrance sensitivities as a disability access or occupational health and safety issue.[8][21][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] The most influential of these may be the indoor air quality policy of the the U.S. Centers for Disease Control and Prevention (CDC), which says:

  1. "Scented or fragranced products are prohibited at all times in all interior space owned, rented, or leased by CDC;"[22]
  2. "CDC encourages employees to be as fragrance-free as possible when they arrive in the workplace...Employees should avoid using scented detergents and fabric softeners on clothes worn to the office. Many fragrance-free personal care and laundry products are easily available and provide safer alternatives;" and
  3. "Fragrance is not appropriate for a professional work environment, and the use of some products with fragrance may be detrimental to the health of workers with chemical sensitivities, allergies, asthma, and chronic headaches/migraines."[22]

Common ingredients in synthetic fragrance are recognized as irritants for a range of respiratory conditions.[55][56][57][58][59][60][61][62][63][64][65][66] The American Lung Association lists fragrance on their list of "indoor air pollutants" and recommends that healthy workplaces establish fragrance-free policies for employees and visitors."[21]:30 With this in mind, some have called for fragrance-free policies in hospitals and healthcare settings.

Hospital care

Hospitals with fragrance-free policies are common Canada and Sweden.[43][21][8][44][45][46][47][48][49][50][51][52][53][54] Canadian examples include:

  • Mount Sinai Hospital has a fragrance-free policy, which says the hospital "is committed to providing a safe and inclusive environment for all and will strive to eliminate the use of products with scents and fragrances to prevent any adverse reactions in patients, staff and other people working and/or visiting the hospital premises."[45]
  • Kingston General Hospital is fragrance free "for the safety and comfort of those with allergies and sensitivities," and its web site says "other items that you should not use or bring when you visit the hospital include: perfumes and colognes, scented fabric softeners, stain removers and laundry detergents, scented soaps and deodorant, scented shampoos and hair products, scented body powders and lotions."[46]

As well as fragrance-free policies, to prevent adverse reactions and improve health outcomes in hospital settings, patients with MCS often require adjustments in chemical use, medications and anesthetics.[67][68][69][70][71][72][73][74][75][76]

Some states and regions have specific policies for the hospital care of patients with MCS. For example, in Australia, three states and a territory have detailed hospital policies for patients with MCS.[72][71][76][75] As well, some individual hospitals have their own policies for MCS patients.[77][78]

How common is multiple chemical sensitivity?

Multiple chemical sensitivity is not a rare disease. Some studies show it is increasing in prevalence.[9]
While prevalence rates for MCS vary according to the diagnostic criteria used,[2][79] the condition is reported across industrialized countries and the data suggests it affects women more than men.[1][8]:37[80][81][82][83][84][16]:2,39

The most extensive epidemiological study into MCS in the U.S. was in 2005.[2][85] It found that the national prevalence rate for MCS diagnosed by a doctor was 2.5% and self-reported MCS was 11.2%.[2][85][86]

In 2018, the same researchers reported that the prevalence rate of diagnosed MCS had increased by more than 300% and self-reported chemical sensitivity by more than 200% in the previous decade.[2][9] They found that 12.8% of those surveyed reported medically diagnosed MCS and 25.9% reported having chemical sensitivities.[2][9]

A 2014 study by the Canadian Ministry of Health estimated, based on its survey, that 0.9% of Canadian males and 3.3% of Canadian females had a diagnosis of MCS by a health professional.[8]:37[87]

In Denmark, the Ministry of the Environment estimated in 2004 that 10% of the population was sensitive to certain everyday chemicals and that 1% of the population had MCS to a level that was disabling.[88]

While a 2018 study at the University of Melbourne found that 6.5% of Australian adults reported having a medical diagnosis of MCS and that 18.9% reported having adverse reactions to multiple chemicals.[2][25][89][90] The study also found that for 55.4% of those with MCS, the symptoms triggered by chemical exposures could be disabling.[89][9]

These findings show that in the above countries MCS is not a rare disease.

What causes multiple chemical sensitivity?

In 2017, a Canadian government Task Force on Environmental Health said that there had been very little rigorous peer-reviewed research into MCS and almost a complete lack of funding for such research in North America.[8]:53 "Most recently," it said, "some peer-reviewed clinical research has emerged from centres in Italy, Denmark and Japan suggesting that there are fundamental neurobiologic, metabolic, and genetic susceptibility factors that underlie ES (Environmental Sensitivities)/MCS."[8]:53

The Italian consensus on MCS of 2019 said that the current consensus what is the cause of MCS is that it likely has multiple causes—chiefly biochemical and neuro-physiological and also causes related to the limbic system and perhaps also genetic predisposition.[91]

When speaking at an Australian federal parliamentary inquiry into environmental illness, in 2018, Dr Graeme Edwards, the inquiry's representative of Royal Australasian College of Physicians[92] said that there was "relatively good consensus" that causation was multifactorial. "There is no single causative factor," he said. "It is a combination of factors ... unless you have all the pieces of the puzzle lining up, you actually don't get the disease. And because we are talking about multi-dimensional triggers, any one individual, at any one point in time, may not have exposure to all of those triggers to get a pathological result. And therein lies the complexity."[93]:11

These recent statements suggest that earlier depictions of MCS as being either biologically or psychologically caused likely set up a false dichotomy or dilemma.

Toxicological

It has been hypothesized that MCS is caused by exposure to particular chemicals—most commonly certain pesticides.

Professor Martin L. Pall proposed that MCS had a toxicological and biochemical cause, and that "seven individual chemicals or chemical classes—organophosphorus/carbamate, organochloride and pyrethroid pesticides, organic solvents, carbon monoxide, hydrogen sulphide and mercury/mercurial compounds—could initiate MCS through their ability to increase N-methyl-D-aspartate (NMDA) receptor activity."[4][94]
Is multiple chemical sensitivity caused by pesticides? Some MCS researchers think it often is. The most recent consensus paper on MCS (2019) said this hypothesis "had found broad consensus in the scientific community” and was compatible with previous hypotheses.[91]
Pall hypothesized that overactivity of the NMDA receptors, coupled with stress-related increases in nitric oxide and the oxidative product peroxynitrite (known as the NO/ONOO cycle) caused MCS symptoms and worsened the condition.[23][95] He suggested that hypersensitivity occurred because of limbic kindling, neural sensitization, and/or neurogenic inflammation—processes which could be driven by the NO/ONOO cycle.[94]

A 2019 scientific review said that while further research was required to confirm Pall's theory, that his hypothesis "had found broad consensus in the scientific community” and was compatible with previous hypotheses,[91] including Dr. Iris Bell's theory of neuronal sensitization[96][97] and William Meggs’ theory of neurogenic inflammation.[98]

It also said that Pall's theory may explain the comorbidity of MCS and other pathologies hypothesized to be related to the same mechanism, including fibromyalgia (FM) and ME/CFS, and that it might be why MCS symptoms tend to lessen after exposure to inhibitors and/or antagonists of NMDA receptors.[91]The review also said that "pesticides, including herbicides, insecticides and agricultural chemicals, are among the substances most commonly implicated in the activation of MCS cases in the United States."[99]

Pall's theory has also been used to explain why Gulf War veterans, particularly those who were exposed to organophosphate pesticides, have been found to be more likely to have MCS than the general population[100][23] as well as the fact that chemical sensitivities are a known symptom reported in Gulf war syndrome or post-deployment syndrome.[101][102][103]

The U.S. Department of Veterans Affairs concluded that "risk factors that may be associated with predisposing, precipitating, and perpetuating chronic multi system illnesses [including MCS] among veterans" included chemical exposure, and notably chemical exposure in the Gulf War, where some military personel were exposed to nerve agents (like sarin and cyclosarine) and toxic smoke.[102]

Mold and mycotoxin exposures have also been hypothesized to trigger the onset of MCS.[104][105][106][93] Exposure to mold has already been associated with initiating inflammation and higher incidences of certain chronic conditions (like asthma), which are common symptoms of MCS.[107][92][108][109][110]

Neurological

Many common symptoms of MCS are neurological[1][6][3] (for example, "dizziness, seizures, head pain, fainting, loss of coordination"[9]). And neurogenic inflammation and sensitization are widely thought to be mechanisms involved in causing, perpetuating and worsening MCS.[3][96][97][98]

William Meggs said that neurogenic inflammation was a well-defined pathophysiological process, in which chemical irritants triggered nerve fibers to release inflammatory mediators, which led to disease. In a 2017 review, he said that with MCS, an initiating chemical exposure (commonly a respiratory irritant or pesticide) was usually identified in association with the onset of the disease.[98]

Iris Bell researched brain-wave patterns in people with MCS. He showed, in several studies using Electroencephalography (EEG), that people with MCS often had certain abnormal brain wave patterns.[91][111] For example, he found that women with MCS were more likely to have greater resting alpha waves than controls, which he said suggested the possibility of central nervous system hypo-activation.[112]

Multiple neuro-imaging studies have shown that people with MCS often have other neurological abnormalities, including abnormal cerebral perfusion patterns, especially in the autonomic nervous system areas.[91][113][114][115][116][117] These abnormalities have been documented both in studies using Positron emission tomography (PET) and Single-photon emission computed tomography (SPECT) scans.[91][118][119]

In addition to people with MCS having documented neurological abnormalities, neuroplasticity is thought by some researchers to be an important mechanism in the disease. In 2018, a representative of the Royal Australasian College of Physicians said: “It could be a multiple chemical sensitivity phenomenon. It could be an irritable bowel phenomenon. It could be fibromyalgia... The common unifying features in all of these conditions is related to what we do know is happening, which is neuroplasticity in the nervous system. We know that, regardless of the initiating trigger—whether it was an overwhelming infection of a mould related organism or some other viral infection—it sets up, within the biological system called the nervous system, neuroplastic changes. They can be, and have been, documented by evidence based research. We can document that there are changes in the nervous system, and that change in the nervous system results in a change in the sensitivity and responsiveness of the human being.”[93]:12[92]

Immunological

MCS is not an allergy, and subjects with MCS having adverse reactions do not routinely exhibit the immune markers associated with allergies.[20]:21 Nevertheless, certain immune irregularities have been identified in subjects with MCS in a range of studies.[1][91][20]:22

In the 1980s and 1990s, some researchers hypothesized that these immune irregularities suggested that MCS was caused by a chemically induced disturbance of the immune system, which resulted in chronic immune dysfunction.[20]:22[17] While others concluded that allergic or immunotoxicological reactions could be contributing factors in at least a subset of MCS patients.[20]:22[120][121] As more studies were conducted, however, some argued that there was no consistent pattern of immunological reactivity or abnormality in MCS.[20]:22[19][122]

More recently, a French study found that subjects with MCS had higher levels of histamine than controls.[91][123] It also identified damage to the blood-brain barrier in MCS subjects, the production of antibodies against myelin and evidence of inflammatory processes involving the limbic system and thalamus.[91][123] These findings led the research team to conclude that some level of immune activation was likely occurring in the condition.[91][123]

There is also evidence that subjects with MCS are more likely than controls to have real allergies[16]:16 and autoimmune diseases. And the 2019 consensus on MCS notes an association between the condition and Hashimoto's Thyroiditis, Systemic Lupus Erythematosus (SLE), psoriasis and atopic eczema.[124][125][126][127]

Psychological

It has also been hypothesized that multiple chemical sensitivity is a psychological disorder. Psychsomatic, psychiatric and psychological theories of MCS, however, have not been accepted by the most recent medical consensus document on MCS,[2] and the hypothesis that MCS has a psychological cause has attracted considerable criticism.[8][91][17][128][129][130][131][132]

The main arguments used to support the is that MCS has psychological causes have been:

  1. there is no certainty about biological causes of MCS, therefore it must be psychological[133][134]
  2. that nocebo responses may operate in MCS,[135] and
  3. that people with MCS are more likely than controls to have anxiety, depression and the personality trait absorption.[136][137]

The 2019 Italian consensus on MCS concluded that the studies that hypothesize that the condition has a psychological cause "have been the object of strong criticism, both for methodological deficiencies as well as for the conflict of interests of the scientists who propose this thesis."[91] It said there was consensus that MCS reactions could cause psychiatric symptoms through biological processes (eg. neurogenic inflammation) and that symptoms of the condition should not be mistaken for the cause.[91] It also highlighted that "it was researchers at Johns Hopkins University who pointed out that it is ineffective to use personality tests such as MMP2 (i.e. Minnesota Multiphasic Personality Inventory 2) for the study of the pathogenesis of environmental diseases...concluding that the presence of psychological-psychiatric symptoms in patients with MCS was compatible with the objective limitations imposed by the disease, rather than being the cause."[91][129][132]

Other researchers have emphasized that the psychosocial impacts of the disease (especially isolation and stigmatization) are likely to have significant impacts on mental health.[8]:48[132][129][138][14][139][140] One study showed that anxiety and depression typically started in people with MCS post onset of the condition.[141]

The presence of nocebo responses in MCS does not indicate that it is the cause of the disease.[142] Nocebo responses are found in many biologically caused conditions,[143] including asthma, and they have been shown to be especially pronounced in neurological conditions (including migraine and chronic pain).[144]

It is noteworthy that psychological approaches to care in MCS patients have had “very limited success,”[8]:48 and that neither MCS, MCS/ES nor IEI have been included in any edition of the DSM (American Psychiatric Association Diagnostic and Statistical Manual[145]) nor have they been listed among somatoform disorders in the International Classification of Diseases.[146]

In Canada, in 2017, following a three-year government inquiry into environmental illness, it was recommended that a public statement be made by the health department dispelling the misperception that MCS/ES is psychological.[8]:17

Genetic

The 2019 consensus on MCS said that the condition could, at least in part, be caused by genetic alterations affecting detoxification pathways—something which in combination with toxin exposures could make some people more vulnerable to developing MCS than the rest of the population.[91]

Recent Italian studies found that compared to controls, patients with MCS had higher levels of the nitrites and nitrates that are involved in oxidative stress and inflammatory processes, including those that contribute to the oxidative damage of DNA.[91] They also found that the presence of the following genetic polymorphisms were more likely in people with MCS than controls: NOS3, NOS2 and GPX1.[91][147][148]

Other genetic markers known to affect detoxification pathways have been identified as being more common in subjects with MCS than controls,[91][147][148][149][150][151] including polymorphisms and differences in expression of the following: CYP2D6, MTHFR, NAT1, NAT2, GSTM1, and PON1 and PON2.[152][153][154]

These findings could support the hypothesis that MCS is caused by a synergy of environmental exposures to toxic substances and the impaired ability to metabolize toxic substances, due to factors related to genetic predisposition.[91]

Recognition

In 1996, an expert panel at WHO/ICPS (International Classification for Patient Safety) was set up to examine MCS.[155] The panel:

  1. "accepted the existence of a disease of unclear pathogenesis",
  2. proposed that the disease was acquired, that its symptoms were "in close relationship to multiple environmental influences, which are well tolerated by the majority of the population," and that it "could not be explained by a known clinical or psychic disorder,"
  3. suggested that the broader term "idiopathic environmental intolerances" (IEI) be adopted instead of MCS, to incorporate MCS and several other conditions under a single umbrella term.[155]

MCS is not included as a separate, discrete disease by the World Health Organization's (WHO) index of diseases (ICD-11). However, existing disease codes in the ICD-10 can be used for MCS, including:

  1. J68.9: unspecified respiratory conditions due to inhalation of fumes, gas, and chemical vapors; and
  2. T78.4: unspecified allergies (allergic reaction Nitrous Oxide System (NOS)-hypersensitivity NOS-idiosyncrasy NOS)."[1]:139

In the ICD-10-DM and ICD-10-SGB-V, Germany's adaptions of the ICD-10, multiple chemical sensitivity is recognized as a chemical hypersensitivity or intolerance (Chemical-Sensitivity[MCS]-Syndrom, Multiple-) under the code T78.4; this is also in use in Austria.[156][1] Japan also recognizes MCS as a separate disease.[1]:139[33][157] And in some countries, like Sweden, chemical sensitivities are classified as a form of sensory hyperreactivity (CSS-SHR).[9]

And as mentioned above, chemical sensitivities are recognized symptoms of ME/CFS. In 2018, the U.S. Centers for Disease Control and Prevention (CDC) said that ME/CFS patients can have sensitivities to chemicals.[158]

History

In 1956, American allergist Dr. Theron G. Randolph coined the term "environmental illness," to describe symptoms and disorders he observed in some of his patients after they were exposed to various unrelated chemical compounds.[157][155]

Then in 1987, Dr. Mark R. Cullen, also an American allergist, introduced the term MCS in journals of occupational medicine. He proposed that MCS described: an acquired disorder, characterized by recurrent symptoms, affecting multiple organs and systems, which arose in response to a demonstrable exposure to chemicals, even for low doses, much lower than those causing reactions in the general population.[157][155]

Two years later, an international multidisciplinary team of 89 clinicians and researchers commenced a study into MCS, which culminated in the first real international consensus on the condition being agreed upon and published in The Archives of Environmental Health in 1999.[1][5]

In 1996, an expert panel of the World Health Organization/International Classification for Patient Safety (WHO/ICPS) accepted the existence of MCS as a health condition with a cause unknown, and suggested that it be called "idiopathic environmental intolerances"(IEI), a term that incorporates a number of conditions sharing similar symptoms.[155]

In May 2019, the Italian Workgroup on MCS, a group of physicians, research scientists and clinical staff, published a detailed, 30-page consensus paper called the Italian Consensus on MCS.[159] This document may be the most detailed scientific review of research about MCS to date. It goes into detail about ways the condition can be better managed in clinical environments, particularly in hospitals. The workgroup published their consensus in Italian and English, asking for input from MDs and other health professionals, biologists and chemists. At the time of writing, the response to the consensus had not been published.

Controversy

MCS sufferers and the physicians treating them have been subject to campaigns aimed at undermining the veracity of the condition.[160] This has played out in academia and in the media—and, perhaps with the greatest impact on sufferers, on Wikipedia.[161][162][163][164][165][166][167][168] These efforts have created a perception that MCS is a controversial or disputed condition,[131][169] which is not supported by recent academic reviews of MCS research.[3][8][1][6][149]

Some say chemical industry interest groups have funded these efforts, and indeed some of the most vocal writers with anti-MCS stances have also been industry-paid expert witnesses in legal cases involving alleged chemical injuries.[170]

The blogs Quackwatch and Science-Based Medicine (SBM)—related blogs dominated by the same brand of skepticism—are two groups known to have repeatedly published criticism about MCS's recognition as a medical condition, claiming MCS was a "bogus", "fad" or "spurious" diagnosis.[164][171][172][173][174][175][176] Quackwatch's founder, retired psychiatrist Stephen Barrett, has personally written prolifically on the subject of MCS.[177][178][179][180][181][182][183][184][185][186][172][169]

Important contexts for these efforts are that: (1) legal actions—including defamation suits in the U.S.—have alleged that Quackwatch and Barrett have been actively and knowingly promoting inaccurate information on a range of medical conditions on Wikipedia[187][188][189] (of note, in 2003, a California Appeals Court, for example, found Quackwatch's founder “to be biased and unworthy of credibility”[190][189]); and (2) in academia, a 2019 consensus on MCS concluded that the studies that hypothesized MCS was a psychogenic disorder had been the object of strong criticism, in part, for "the conflict of interests of the scientists who proposed this thesis."[91]

While those who have argued that MCS isn't real or is psychologically caused have undoubtedly successfully influenced popular perceptions about the condition,[191] their commentaries are at odds with: (1) the current medical consensus about MCS,[1][5][6][8][16]:31[2][93]:11 (2) conclusions of the most recent academic reviews of MCS research in scientific journals,[1][6] and (3) the recognition of the condition by the WHO/ICPS[155] and by other national and state health agencies, physicians' organizations and hospitals.[1][157][22][16]:17[33][35][73][68][74][72][76][93]:11[155][192][193][194]

In the media

Safe (1995)

Is multiple chemical sensitivity a mental illness? This is a question some critics thought director Todd Haynes was posing in his 1995 film Safe. The film tells the story of Carol, who suddenly develops a mysterious and unexplained environmental illness, and receives little sympathy from her husband and community. But Haynes said that he used MCS as a metaphor for AIDS, and how AIDS sufferers in the 1980s were regarded and treated.[195] In the film he explores stigma, alienation and isolation.

Safe is a cult film, by writer and director Todd Haynes, known for its depiction of MCS as a profoundly alienating and destabilizing condition.[196]

Safe tells the story of Carol White, played by Julianne Moore, a homemaker in Los Angeles, who suddenly develops a range of unexplained symptoms following the renovation of her home. With severe symptoms, which doctors are unable to treat, and a largely indifferent and unsupportive community, Carol ultimately leaves her home and moves to a desert community for people with environmental illness.

“She is so excruciatingly alone,” Moore said of her character at the end of the film.[195] While Haynes said Carol’s isolation was both the answer and the problem for her.[196]

More recently, the social isolation experienced by Carol in Safe has been compared to people's psychosocial experiences during COVID-19 lockdowns.

Afflicted docuseries (2018)

Netflix's 2018 documentary series Afflicted features several patients with MCS.

After its release, Afflicted was accused of misrepresenting patients with chronic illnesses, with several people who featured in the series suing Neflix for defamation.[161]

An open letter to Netflix, signed by over 40 doctors, medical professionals and patient advocates, accused the media-services provider and production company of presenting flawed medical and scientific information. It also said unethical journalistic methods were used in the making of the series and called for it to be taken off Netflix.[197]

Notable studies and publications

  • 1999, Multiple chemical sensitivity: a 1999 consensus[5] - (Full text)
  • 2018, Multiple Chemical Sensitivity: Review of the State of the Art in Epidemiology, Diagnosis, and Future Perspectives - (Full text)
  • 2018, Perspectives on multisensory perception disruption in idiopathic environmental intolerance: a systematic review[6] - (Abstract)
  • 2019, Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS)[159] - (Full text - English)
Original title: Consenso Italiano sulla Sensibilita Chimica Multipla (MCS). Documento di consenso e linee guida sulla Sensibilita Chimica Multipla (MCS) del Gruppo di Studio Italiano sulla MCS - (Full text - Italian)
  • 2016, Association of Odor Thresholds and Responses in Cerebral Blood Flow of the Prefrontal Area during Olfactory Stimulation in Patients with Multiple Chemical Sensitivity[198] - (Full text)

See also

Learn more

References

  1. 1.001.011.021.031.041.051.061.071.081.091.101.111.121.131.14 Rossi, Sabrina; Pitidis, Alessio (Feb 2018). "Multiple Chemical Sensitivity: Review of the State of the Art in Epidemiology, Diagnosis, and Future Perspectives". Journal of Occupational and Environmental Medicine. 60 (2): 138–146. doi:10.1097/JOM.0000000000001215. ISSN 1076-2752. PMC 5794238Freely accessible. PMID 29111991. ...some countries, such as Germany and Austria, and some agencies and provisions in the United States, such as the Environmental protection Agency (EPA) and the American Disability Act (ADA), have recognized this pathology. 
  2. 2.02.12.22.32.42.52.62.72.8 Grouppo di Italiano Studio MCS (May 23, 2019), "2. Epidemiologia" [2. Epidemiology], Consenso Italiano sulla Sensibilita Chimica Multipla (MCS). Documento di consenso e linee guida sulla Sensibilita Chimica Multipla (MCS) del Gruppo di Studio Italiano sulla MCS [Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS] (PDF), Università degli Studi di Milano, Italy 
  3. 3.003.013.023.033.043.053.063.073.083.093.10 Grouppo di Italiano Studio MCS (May 23, 2019), "1. Sensibilitá Chimica Multipla (MCS): Definizione di Caso" [1. Clinical features of the disease], Consenso Italiano sulla Sensibilita Chimica Multipla (MCS). Documento di consenso e linee guida sulla Sensibilita Chimica Multipla (MCS) del Gruppo di Studio Italiano sulla MCS [Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS] (PDF), Università degli Studi di Milano, Italy 
  4. 4.04.1 Grouppo di Italiano Studio MCS (May 23, 2019), "1.2 Scatenamento della MCS" [1.2 Triggering of MCS], Consenso Italiano sulla Sensibilita Chimica Multipla (MCS). Documento di consenso e linee guida sulla Sensibilita Chimica Multipla (MCS) del Gruppo di Studio Italiano sulla MCS [Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS] (PDF), Università degli Studi di Milano, Italy 
  5. 5.05.15.25.35.45.55.6 "Multiple chemical sensitivity: a 1999 consensus". Arch. Environ. Health. 54 (3): 147–9. 1999. doi:10.1080/00039899909602251. PMID 10444033. 
  6. 6.06.16.26.36.46.56.66.76.8 Viziano, A.; Micarelli, A.; Pasquantonio, G.; Della-Morte, D.; Alessandrini, M. (Nov 2018). "Perspectives on multisensory perception disruption in idiopathic environmental intolerance: a systematic review". Int Arch Occup Environ Health. 91 (8): 923–935. doi:10.1007/s00420-018-1346-z. PMID 30088144. 
  7. 7.07.17.27.37.47.57.6 National Industrial Chemicals Notification and Assessment Scheme; Office of Chemical Safety and Environmental Health (2010). A Scientific Review of Multiple Chemical Sensitivity: Identifying Key Research Needs. Canberra, Australia. What is Multiple Chemical Sensitivity. ISBN 978-0-9807221-4-7. Archived from the original on Nov 2010. 
  8. 8.008.018.028.038.048.058.068.078.088.098.108.118.128.138.148.158.168.17 Task Force on Environmental Health (2017), Time for leadership: recognizing and improving care for those with ME/CFS, FM and ES/MCS. Phase 1 report. (PDF), Toronto, Ontario:: Ministry of Health and Long-Term Care 
  9. 9.09.19.29.39.49.59.69.79.8 Steinemann, Anne (Mar 2018). "National Prevalence and Effects of Multiple Chemical Sensitivities". Journal of Occupational and Environmental Medicine. 60 (3): e152–e156. doi:10.1097/JOM.0000000000001272. ISSN 1076-2752. PMC 5865484Freely accessible. PMID 29329146. 
  10. Loria-Kohen, Viviana; Marcos-Pasero, Helena; de la Iglesia, Rocío; Aguilar-Aguilar, Elena; Espinosa-Salinas, Isabel; Herranz, Jesús; Ramírez de Molina, Ana; Reglero, Guillermo (Aug 22, 2017). "Multiple chemical sensitivity: Genotypic characterization, nutritional status and quality of life in 52 patients". Medicina Clinica. 149 (4): 141–146. doi:10.1016/j.medcli.2017.01.022. ISSN 1578-8989. PMID 28283271. 
  11. Gibson, Pamela Reed; Leaf, Britney; Komisarcik, Victoria (Jan 12, 2016). "Unmet medical care needs in persons with multiple chemical sensitivity: A grounded theory of contested illness". Journal of Nursing Education and Practice. 6 (5): 75. doi:10.5430/jnep.v6n5p75. ISSN 1925-4059. 
  12. García-Sierra, Rosa; Álvarez-Moleiro, María (Jul 1, 2014). "Evaluation of suffering in individuals with multiple chemical sensitivity". Clínica y Salud. 25 (2): 95–103. doi:10.1016/j.clysa.2014.06.006. ISSN 1130-5274. 
  13. Alobid, Isam; Nogué, Santiago; Izquierdo-Dominguez, Adriana; Centellas, Silvia; Bernal-Sprekelsen, Manuel; Mullol, Joaquim (Dec 1, 2014). "Multiple chemical sensitivity worsens quality of life and cognitive and sensorial features of sense of smell". European Archives of Oto-Rhino-Laryngology. 271 (12): 3203–3208. doi:10.1007/s00405-014-3015-5. ISSN 1434-4726. 
  14. 14.014.114.2 Gibson, PR; Vogel, VM (Jan 2009). "Sickness-related dysfunction in persons with self-reported multiple chemical sensitivity at four levels of severity". J Clin Nurs. 18 (1): 72–81. doi:10.1111/j.1365-2702.2008.02439.x. 
  15. Koch, Lynn; Vierstra, Courtney; Penix, Ken (Sep 1, 2006). "A Qualitative Investigation of the Psychosocial Impact of Multiple Chemical Sensitivity". Journal of Applied Rehabilitation Counseling. 37 (3): 33–40. doi:10.1891/0047-2220.37.3.33. ISSN 0047-2220. 
  16. 16.016.116.216.316.416.516.6 Valderrama Rodríguez, M; Revilla López, MC; Blas Diez, MP; Vázquez Fernández del Pozo, S; Martín Sánchez, Jl (2015), Actualización de la Evidencia Científica sobre Sensibilidad Química Múltiple (SQM). [Review of the scientific evidence on Multiple Chemical Sensitivity] (PDF), Ministerio de Sanidad, Servicios Sociales e Igualdad. Instituto Aragonés de Ciencias de la Salud. Informes de Evaluación de Tecnologías Sanitarias (IACS) 
  17. 17.017.117.2 Genuis, SJ; Ross, PM; Whysner, J; Covello, VT; Kuschner, M; Rifkind, AB; Sedler, MJ; Trichopoulos, D (May 2013). "Chemical sensitivity: pathophysiology or pathopsychology? Is multiple chemical sensitivity a mental illness?". Clinical Therapeutics (Review). 35 (5): 572–7. doi:10.1016/j.clinthera.2013.04.003. PMID 23642291. The emerging problem of ubiquitous adverse toxicant exposures in modern society has resulted in escalating numbers of individuals developing a CS disorder. As usual in medical history, iconoclastic ideas and emerging evidence regarding novel disease mechanisms, such as the pathogenesis of CS, have been met with controversy, resistance, and sluggish knowledge translation. 
  18. "Olfaction and Symptoms in the Multiple Chemical Sensitivities Syndrome". Preventive Medicine. 28 (5): 467–480. 1999. doi:10.1006/pmed.1998.0469. PMID 10329337. 
  19. 19.019.1 Graveling RA, Pilkington A, George JP, Butler MP, Tannahill SN (1999). "A review of multiple chemical sensitivity". Occupational and Environmental Medicine. 56 (2): 73–85. doi:10.1136/oem.56.2.73. PMC 1757696Freely accessible. PMID 10448311. 
  20. 20.020.120.220.320.420.5 National Industrial Chemicals Notification and Assessment Scheme; Office of Chemical Safety and Environmental Health (2010). A Scientific Review of Multiple Chemical Sensitivity: Identifying Key Research Needs. Canberra, Australia. ISBN 978-0-9807221-4-7. Archived from the original on Nov 2010. 
  21. 21.021.121.221.3 Grenville, Kate. The case against fragrance. Text Publishing. Australia. 2017.
  22. 22.022.122.222.3 Centers for Disease Control Office of Health and Safety (2009), Indoor Environment Quality Policy (PDF), United States, p. 9 
  23. 23.023.123.2 Pall, Martin L. (2007). Explaining "Unexplained illnesses": Disease Paradigm for Chronic Fatigue Syndrome, Multiple Chemical Sensitivity, Fibromyalgia, Post-Traumatic Stress Disorder, Gulf War Syndrome and Others. New York: Routledge & Harrington Park Press. ISBN 978-0789023896. 
  24. 24.024.1 Ziem, Grace E. (Apr 24, 2018). "Multiple Chemical Sensitivity: Treatment and Followup with Avoidance and Control of Chemical Exposures:". Toxicology and Industrial Health. doi:10.1177/074823379200800409. 
  25. 25.025.1 Pigatto, Paolo D.; Guzzi, Gianpaolo (Jun 1, 2019). "Prevalence and risk factors for multiple chemical sensitivity in Australia". Preventive Medicine Reports. 14: 100856. doi:10.1016/j.pmedr.2019.100856. ISSN 2211-3355. 
  26. 26.026.1 Hooper, Malcolm (Nov 27, 2009). "Multiple Chemical Sensitivity" (PDF). In Puri, Bassant; Treasaden, Ian. Psychiatry: An evidence-based text. CRC Press. pp. 793–820. ISBN 978-1-4441-1326-6. 
  27. "Overlapping Conditions – American ME and CFS Society". ammes.org. Retrieved Aug 12, 2018. 
  28. Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip; Powles, A C Peter; Sherkey, Jeffrey A.; van de Sande, Marjorie I. (2003), "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols" (PDF), Journal of Chronic Fatigue Syndrome, 11 (2): 7-115, doi:10.1300/J092v11n01_02 
  29. Carruthers, BM; van de Sande, MI; De Meirleir, KL; Klimas, NG; Broderick, G; Mitchell, T; Staines, D; Powles, ACP; Speight, N; Vallings, R; Bateman, L; Bell, DS; Carlo-Stella, N; Chia, J; Darragh, A; Gerken, A; Jo, D; Lewis, DP; Light, AR; Light, KC; Marshall-Gradisnik, S; McLaren-Howard, J; Mena, I; Miwa, K; Murovska, M; Stevens, SR (2012), Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners (PDF), ISBN 978-0-9739335-3-6 
  30. U.S. ME/CFS Clinician Coalition (Aug 2019). ""Diagnosing and Treating ME/CFS"". .
  31. 31.031.131.2 Grouppo di Italiano Studio MCS (May 23, 2019), "4.2 Ausili terapeutici per soggetti con invalidità per MCS" [4.2 Therapeutic aids for subjects with disabilities for MCS], Consenso Italiano sulla Sensibilita Chimica Multipla (MCS). Documento di consenso e linee guida sulla Sensibilita Chimica Multipla (MCS) del Gruppo di Studio Italiano sulla MCS [Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS] (PDF), Università degli Studi di Milano, Italy 
  32. 32.032.132.232.3 Grouppo di Italiano Studio MCS (May 23, 2019), "4.5 Terapia con ossigeno e camera iperbarica" [4.5 Oxygen therapy and hyperbaric oxygen], Consenso Italiano sulla Sensibilita Chimica Multipla (MCS). Documento di consenso e linee guida sulla Sensibilita Chimica Multipla (MCS) del Gruppo di Studio Italiano sulla MCS [Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS] (PDF), Università degli Studi di Milano, Italy 
  33. 33.033.133.233.333.433.5 Grouppo di Italiano Studio MCS (May 23, 2019), "4.1 "Innanzitutto, non nuocere": l'evitamento chimica ambientale" [4.1 "First, do no harm": environmental chemical avoidance], Consenso Italiano sulla Sensibilita Chimica Multipla (MCS). Documento di consenso e linee guida sulla Sensibilita Chimica Multipla (MCS) del Gruppo di Studio Italiano sulla MCS [Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS] (PDF), Università degli Studi di Milano, Italy, 'Numerous legislative initiatives in the United States, Canada, Australia, Japan and Germany protect the right of MCS patients to work, education, safe housing and social participation through different protocols of environmental chemical avoidance...' [Translated from Italian] 
  34. Gibson, PR; Elms, AN; Ruding, LA (2003). "Perceived treatment efficacy for conventional and alternative therapies reported by persons with multiple chemical sensitivity". Environ Health Perspect. 111: 1498–1504. 
  35. 35.035.1 Victoria Department of Health (2011), Multiple Chemical Sensitivities: A guide for Victorian hospitals 
  36. Horvath, I.; Loukides, S.; Wodehouse, T.; Kharitonov, S. A.; Cole, P. J.; Barnes, P. J. (Oct 1, 1998). "Increased levels of exhaled carbon monoxide in bronchiectasis: a new marker of oxidative stress". Thorax. 53 (10): 867–870. doi:10.1136/thx.53.10.867. ISSN 0040-6376. PMID 10193374. 
  37. Ewing, James F.; Maines, Mahin D. (1993). "Glutathione Depletion Induces Heme Oxygenase-1 (HSP32) mRNA and Protein in Rat Brain". Journal of Neurochemistry. 60 (4): 1512–1519. doi:10.1111/j.1471-4159.1993.tb03315.x. ISSN 1471-4159. 
  38. Gregersen, Per; Klausen, Hans; Elsnab, Charlotte Uldal (1987). "Chronic toxic encephalopathy in solvent-exposed painters in Denmark 1976–1980: Clinical cases and social consequences after a 5-year follow-up". American Journal of Industrial Medicine. 11 (4): 399–417. doi:10.1002/ajim.4700110403. ISSN 1097-0274. 
  39. Australian Human Rights and Equal Opportunity Commission (2007), Australian Human Rights Commission Access: Guidelines and information, Canberra
  40. Grenville, Kate (2017). The case against fragrance (1st ed.). Melbourne Australia: The text publishing company. ISBN 9781925355956. 
  41. Blundell, Sally. The case against fragrance: The potential harm of our perfumed world. Accessed Mar 22, 2017. Accessed 14 Feb 2020. "Canada has a range of fragrance-free hospitals, workplaces and concert venues. Vancouver International Airport has a fragrance-free route through its duty-free shops. Australia’s occupational health and safety regulator Workplace OHS says on its website that it is in the employers’ best interests “to address the issue of perfumes and personal sprays in the workplace” as perfumes and other scents can “adversely affect workers’ health, causing headaches, nausea, dizziness, upper respiratory symptoms, skin irritation and difficulty with concentration”."
  42. "Guidelines on the Use of Perfumes and Scented Products". University of Toronto. Retrieved Jun 10, 2020. 
  43. 43.043.1 Bennett, Holly (Jul 2 2020). Common chemical products making Australians sick, study finds. Melbourne University Press blog. Melbourne, Australia. Accessed 14 Feb 2020. "Professor Steinemann recommends choosing products without any fragrance, and implementing fragrance-free policies in workplaces, health care facilities, schools and other indoor environments."
  44. 44.044.1 Flegel, Ken; Martin, James G. (Nov 3, 2015). "Artificial scents have no place in our hospitals". Canadian Medical Association Journal. 187 (16): 1187–1187. doi:10.1503/cmaj.151097. ISSN 0820-3946. PMC 4627866Freely accessible. PMID 26438018. 
  45. 45.045.145.2 Scented products and fragrances policy Mount Sinai Hospital, Ontario, Canada.
  46. 46.046.146.2 Smoke Free, Scent Sensitive, Latex Sensitive. Kinston Health Sciences Centre. Canada. 2020.
  47. 47.047.1 Visiting the hospital. The Ottawa Hospital. Ottawa, Canada.
  48. 48.048.1 Souris Hospital Patient and Family Information Booklet 2017-2018 Prince Edward Island, Canada.
  49. 49.049.1 St Joseph's healthcare scent free policy St Joseph's healthcare, Hamilton, Canada.
  50. 50.050.1 Scent free policy (2007). Markham Stouffville Hospital. Canada.
  51. 51.051.1 Scent-free policy. Mackenzie Health hospitals. MAD, Ontario, Canada
  52. 52.052.1 Visiting CAMH Ontario, Canada.
  53. 53.053.1 Mission Memorial Hospital British Columbia, Canada
  54. 54.054.1 Patient and Family Guide South Bruce Grey Health Center, Ontario, Canada.
  55. "Section 1: Allergic Sensitivity to Fragrances: A Growing Health Concern" Not so sexy. The health risks of secret ingredients in fragrance The campaign for safe cosmetics. The Environmental Working Group. 2010.
  56. Steinemann, Anne; Goodman, Nigel (Jun 1, 2019). "Fragranced consumer products and effects on asthmatics: an international population-based study". Air Quality, Atmosphere & Health. 12 (6): 643–649. doi:10.1007/s11869-019-00693-w. ISSN 1873-9326. 
  57. Nazaroff, W.W. Welsher, C.J. Cleaning products and air fresheners: exposure to primary and secondary air pollutants. Atmos. Environ., 38 (2004), pp. 2841-2865
  58. Kumar, P.; Caradonna, V.M; Graham, S. Gupta, X. Cai, P.N. Rao, J. Thompson Inhalation challenge effects of perfume scent strips in patients with asthma, Ann. Allergy Asthma Immunol., 75 (5) (1995), pp. 429-433
  59. Elberling J, Linneberg A, Mosbech H, Dirksen A, Frølund L, Madsen F, Nielsen NH, Johansen JD. 2004. A link between skin and airways regarding sensitivity to fragrance products? Br J Dermatol. 151(6): 1197-203.
  60. Elberling J, Lerbaek A, Kyvik KO, Hjelmborg J. A twin study of perfume related respiratory symptoms. Int J Hyg Environ Health. 2009; 212(6): 670-8.
  61. Mendell. M.J. Indoor residential chemical emissions as risk factors for respiratory and allergic effects in children: a review. Indoor Air. 2007; 17(4):259-77.
  62. Schnuch A, Oppel E, Oppel T, Römmelt H, Kramer M, Riu E, Darsow U, Przybilla B, Nowak D, Jörres RA. 2010. Experimental inhalation of fragrance allergens in predisposed subjects: effects on skin and airways. Br J Dermatol.
  63. Neuenschwander U, Guignard F, Hermans I. 2010. Mechanism of the aerobic oxidation of alpha-pinene. ChemSusChem. 3(1): 75-84.
  64. Nielsen GD, Larsen ST, Hougaard KS, Hammer M, Wolkoff P, Clausen PA, Wilkins CK, Alarie Y. 2005. Mechanisms of acute inhalation effects of (+) and (-)-alpha-pinene in BALB/c mice. Basic Clin Pharmacol Toxicol. 96(6):420-8.
  65. Rohr AC, Wilkins CK, Clausen PA, Hammer M, Nielsen GD, Wolkoff P, Spengler JD. 2002. Upper airway and pulmonary effects of oxidation products of (+)-alpha-pinene, d-limonene, and isoprene in BALB/c mice. Inhal Toxicol. 14(7): 663-84.
  66. Venkatachari P, Hopke PK. 2008. Characterization of products formed in the reaction of ozone with alpha-pinene: case for organic peroxides. J Environ Monit. 10(8): 966-74.
  67. [1]Grouppo di Italiano Studio MCS (May 23, 2019), "5. Osdepali per MCS" [5. Hospitals and MCS], [The Italian Consensus] Consenso Italiano sulla Sensibilita Chimica Multipla (MCS). Documento di consenso e linee guida sulla Sensibilita Chimica Multipla (MCS) del Gruppo di Studio Italiano sulla MCS [[Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS]] (PDF), Università degli Studi di Milano, Italy 
  68. 68.068.1 "Mercy Medical Center Process Standards, Multiple Chemical Sensitivity Protocol". 1999. 
  69. Fisher MM, Rose M. Anaesthesia for patients with idiopathic environmental intolerance and chronic fatigue syndrome. Br J Anaesth 2008; 101(4): 486-91.
  70. Rea, William J. 1996 "41 Surgery in the chemically sensitive," Chemical Sensitivity Tools of Diagnosis and Methods of Treatment, Environmental Health Center, Dallas, Texas. CRC Press.
  71. 71.071.1 "Multiple Chemical Sensitivity -- A guide for Victoria hospitals", Victoria Health, Aug 25, 2011 
  72. 72.072.172.2 ACT Department of Health, Canberra, Australia (2018). "Canberra Hospital and Health Services Clinical Procedure: Multiple Chemical Sensitivities". 
  73. 73.073.1 NSW Health (2019). "Fact sheet: Multiple Chemical Sensitivity Disorder". www.health.nsw.gov.au. Retrieved May 14, 2020. 
  74. 74.074.1 Australian Commission on Safety and Quality in Health Care (2017). "National Safety and Quality Health Service Standards Guide for Hospitals" (PDF). Canberra, Australia: NSW health. 
  75. 75.075.1 "Idiopathic Environmental Intolerance or Multiple Chemical Sensitivity Policy Guideline" (PDF), South Australia Health, Adelaide, Australia, Aug 26, 2016 
  76. 76.076.176.2 Multiple Chemical Sensitivity Chemical Hypersensitivity Guideline. Sep 14, 2010. Western Australia Country Health Service. Western Australia.
  77. Multiple Chemical Sensitivity Protocol. Mercy Medical Centers New York and California.09/1999.
  78. Multiple Chemical Sensitivities. Jan 2010. QHC Healthcare, Ontario, Canada.
  79. National Industrial Chemicals Notification and Assessment Scheme; Office of Chemical Safety and Environmental Health (2010). "1.1.2 Studies on the prevalence of MCS in other countries". A Scientific Review of Multiple Chemical Sensitivity: Identifying Key Research Needs. Canberra, Australia. ISBN 978-0-9807221-4-7. Archived from the original on Nov 2010. 
  80. Caress SM, Steinemann AC (May 2004). "Prevalence of Multiple Chemical Sensitivities: A Population-Based Study in the Southeastern United States". Am J Public Health. 94 (5): 746–747. doi:10.2105/ajph.94.5.746. PMC 1448331Freely accessible. PMID 15117694. 
  81. Berg, Nikolaj Drimer; Linneberg, Allan; Dirksen, Asger; Elberling, Jesper (Jul 1, 2008). "Prevalence of self-reported symptoms and consequences related to inhalation of airborne chemicals in a Danish general population". International Archives of Occupational and Environmental Health. 81 (7): 881–887. doi:10.1007/s00420-007-0282-0. ISSN 1432-1246. 
  82. Andersson, Linus; Johansson, Åke; Millqvist, Eva; Nordin, Steven; Bende, Mats (Oct 1, 2008). "Prevalence and risk factors for chemical sensitivity and sensory hyperreactivity in teenagers". International Journal of Hygiene and Environmental Health. 211 (5): 690–697. doi:10.1016/j.ijheh.2008.02.002. ISSN 1438-4639. 
  83. Bloch, Richard M.; Meggs, William J. (Jan 1, 2007). "Comorbidity patterns of self‐reported chemical sensitivity, allergy, and other medical illnesses with anxiety and depression". Journal of Nutritional & Environmental Medicine. 16 (2): 136–148. doi:10.1080/13590840701352823. ISSN 1359-0847. 
  84. Gibson PR, Lockaby SD, Bryant JM (Apr 6, 2016). "Experiences of persons with multiple chemical sensitivity with mental health providers" (PDF). Journal of Multidisciplinary Healthcare. 2016:9: 163–172. 
  85. 85.085.1 Steinemann AC. (2005). "A national population study of the prevalence of multiple chemical sensitivity". Arch Environ Health. 59 (6)): 300–5. 
  86. Caress, SM; Steinemann, AC (Feb 1, 2009). "Asthma and chemical hypersensitivity: prevalence, etiology, and age of onset". Toxicology and Industrial Health. 25 (1): 71–78. doi:10.1177/0748233709102713. ISSN 0748-2337. 
  87. Canadian Community Health Survey (CCHS) 2014, Ministry of Health and Long-Term Care Share File, Statistics Canada.
  88. "Danimarca: nuovo codice per la MCS" [Denmark: A new code for MCS] (in italiano). 2014. Retrieved May 14, 2020. 
  89. 89.089.1 "Common chemical products making Australians sick, study finds". The University of Melbourne Newsroom. Jul 2, 2018. Retrieved Nov 20, 2019. 
  90. [https://www.sciencedirect.com/science/article/pii/S2211335518300457 Steinemann A. Prevalence and effects of multiple chemical sensitivities in Australia. Prev Med Rep 2018; 10: 191-4.
  91. 91.0091.0191.0291.0391.0491.0591.0691.0791.0891.0991.1091.1191.1291.1391.1491.1591.1691.1791.1891.1991.20 Grouppo di Italiano Studio MCS (May 23, 2019), "1.4 Meccanismo proposti per la MCS" [1.4 Proposed mechanisms for MCS], Consenso Italiano sulla Sensibilita Chimica Multipla (MCS). Documento di consenso e linee guida sulla Sensibilita Chimica Multipla (MCS) del Gruppo di Studio Italiano sulla MCS [Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS] (PDF), Università degli Studi di Milano, Italy 
  92. 92.092.192.2 Royal Australasian College of Physicians' Submission to the Australian Parliament’s Health, Aged Care and Sport Committee Inquiry into Biotoxin-related Illnesses in Australia, Aug 2018. “Dr Graeme Edwards represented the RACP at this public hearing and we trust the Committee benefited from his contribution to the discussions.” p.1.
  93. 93.093.193.293.393.4 Biotoxin related illnesses in Australia, comments by Dr Graeme Edwards, Official Committee of the House of Representatives Standing Committee on Health, Aged Care and Sport, Canberra: House of Representatives, Hansard Records, Aug 9, 2018 
  94. 94.094.1 National Industrial Chemicals Notification and Assessment Scheme; Office of Chemical Safety and Environmental Health (2010). "What are the symptoms of MCS". A Scientific Review of Multiple Chemical Sensitivity: Identifying Key Research Needs. Canberra, Australia. ISBN 978-0-9807221-4-7. Archived from the original on Nov 2010. 
  95. Pall ML, Satterlee JD (2001). "Elevated nitric oxide/peroxynitrite mechanism for the common etiology of multiple chemical sensitivity, chronic fatigue syndrome, and Post Traumatic stress disorder". Annals of the New York Academy of Sciences. 933 (1): 323–9. Bibcode:2001NYASA.933..323P. doi:10.1111/j.1749-6632.2001.tb05836.x. PMID 12000033. 
  96. 96.096.1 Bell, Iris R.; Baldwin, Carol M.; Fernandez, Mercedes; Schwartz, Gary E.R. (Apr 1, 1999). "Neural sensitization model for multiple chemical sensitivity: overview of theory and empirical evidence". Toxicology and Industrial Health. 15 (3-4): 295–304. doi:10.1177/074823379901500303. ISSN 0748-2337. 
  97. 97.097.1 Bell, IR; Rossi, J; Gilbert, ME; Kobal, G; Morrow, LA; Newlin, DB; Sorg, BA; Wood, RW (Mar 1, 1997). "Testing the neural sensitization and kindling hypothesis for illness from low levels of environmental chemicals". Environmental Health Perspectives. 105 (suppl 2): 539–547. doi:10.1289/ehp.97105s2539. PMC 1469815Freely accessible. PMID 9167993. 
  98. 98.098.198.2 Meggs, William J. (May 9, 2017). "The Role of Neurogenic Inflammation in Chemical Sensitivity". Ecopsychology. 9 (2): 83–89. doi:10.1089/eco.2016.0045. 
  99. Grouppo di Italiano Studio MCS (May 23, 2019), "4.3" [4.3 Reduction of risk], Consenso Italiano sulla Sensibilita Chimica Multipla (MCS). Documento di consenso e linee guida sulla Sensibilita Chimica Multipla (MCS) del Gruppo di Studio Italiano sulla MCS [Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS] (PDF), Università degli Studi di Milano, Italy 
  100. Reid S, et al. (2001). "Multiple Chemical Sensitivity and Chronic Fatigue Syndrome in British Gulf War Veterans". American Journal of Epidemiology. 153 (6): 604–9. doi:10.1093/aje/153.6.604. PMID 11257069. 
  101. Gronseth GS. Gulf war syndrome: A toxic exposure? A systematic review. Neurol Clin. May 2005;23(2):523-540.
  102. 102.0102.1 U.S. Department of Veterans Affairs, Department of Defense (Oct 2014). "Clinical practice guideline for the management of chronic multisystem illness" (PDF). 
  103. Spelman, Juliette F.; Hunt, Stephen C.; Seal, Karen H.; Burgo-Black, A. Lucile (Sep 1, 2012). "Post Deployment Care for Returning Combat Veterans". Journal of General Internal Medicine. 27 (9): 1200–1209. doi:10.1007/s11606-012-2061-1. ISSN 1525-1497. PMC 3514997Freely accessible. PMID 22648608. 
  104. Rea, William J. (Jun 1, 2018). "A Large Case-series of Successful Treatment of Patients Exposed to Mold and Mycotoxin". Clinical Therapeutics. 40 (6): 889–893. doi:10.1016/j.clinthera.2018.05.003. ISSN 0149-2918. 
  105. Lieberman, Allan; Rea, William; Curtis, Luke (Sep 1, 2006). "Adverse health effects of indoor mold exposure". Journal of Allergy and Clinical Immunology. 118 (3): 763. doi:10.1016/j.jaci.2006.06.037. ISSN 0091-6749. PMID 16950304. 
  106. Vojdani, Aristo; Thrasher, Jack D.; Madison, Roberta A.; Gray, Michael R.; Heuser, Gunnar; Campbell, Andrew W. (Jul 1, 2003). "Antibodies to Molds and Satratoxin in Individuals Exposed in Water-Damaged Buildings". Archives of Environmental Health: An International Journal. 58 (7): 421–432. doi:10.1080/00039896.2003.11879143. ISSN 0003-9896. PMID 15143855. 
  107. Hänninen, Otto O. (2011). "World Health Organisation (WHO) Guidelines for Indoor Air Quality: dampness and mold.". In Adan, Olaf C. G.; Samson, Robert A. Fundamentals of mold growth in indoor environments and strategies for healthy living. Wageningen: Academic Publishers. pp. 277–302. doi:10.3920/978-90-8686-722-6_10. ISBN 978-90-8686-722-6. Toxicological evidence obtained in vivo and in vitro supports these findings, showing the occurrence of diverse inflammatory and toxic responses after exposure to microorganisms – including their spores, metabolites and components isolated from damp buildings. The increasing prevalence of asthma and allergies in many countries increase the number of people susceptible to the effects of dampness and mould in buildings. 
  108. Knibbs, Luke D.; Woldeyohannes, Solomon; Marks, Guy B.; Cowie, Christine T. (2018). "Damp housing, gas stoves, and the burden of childhood asthma in Australia". Medical Journal of Australia. 208 (7): 299–302. doi:10.5694/mja17.00469. ISSN 1326-5377. Exposure to damp housing and gas stoves is common in Australia, and is associated with a considerable proportion of the childhood asthma burden. 
  109. Quansah, Reginald; Jaakkola, Maritta S.; Hugg, Timo T.; Heikkinen, Sirpa A M.; Jaakkola, Jouni J. K. (Nov 7, 2012). "Residential Dampness and Molds and the Risk of Developing Asthma: A Systematic Review and Meta-Analysis". PLoS ONE. 7 (11): e47526. doi:10.1371/journal.pone.0047526. ISSN 1932-6203. PMC 3492391Freely accessible. PMID 23144822. 
  110. Mendell, Mark J; Mirer, Anna G; Cheung, Kerry; Tong, My; Douwes, Jeroen (Jun 1, 2011). "Respiratory and Allergic Health Effects of Dampness, Mold, and Dampness-Related Agents: A Review of the Epidemiologic Evidence". Environmental Health Perspectives. 119 (6): 748–756. doi:10.1289/ehp.1002410. PMC 3114807Freely accessible. PMID 21269928. The authors reported evidence from epidemiologic studies and meta-analyses showed indoor dampness or mould to be associated consistently with increased asthma development and exacerbation, current and ever diagnosis of asthma, dyspnoea, wheeze, cough, respiratory infections, bronchitis, allergic rhinitis, eczema, and upper respiratory tract symptoms. Associations were found in allergic and non-allergic individuals. Evidence strongly suggested causation of asthma “exacerbation” in children. 
  111. Schwartz GE, Bell IR, Dikman ZV, et al. EEG responses to low-level chemicals in normals and cacosmics. Toxicol Ind Health 1994; 10(4-5): 633-43.
  112. Bell IR, Schwartz GE, Hardin EE, Baldwin CM, Kline JP. Differential resting quantitative electroencephalographic alpha patterns in women with environmental chemical intolerance, depressives, and normals. Biol Psychiatry 1998; 43(5): 376-88.
  113. Callender TJ, Morrow L, Subramanian K. Evaluation of chronic neurological sequelae after acute pesticide exposure using SPECT brain scans. Toxicol Environ Health 1994; 41(3): 275-84.
  114. Callender TJ, Morrow L, Subramanian K, Duhon D, Ristov M. Three dimensional brain metabolic imaging in patients with toxic encephalopathy. Environ Res 1993; 60(2): 295-319.
  115. Heuser G, Mena I, Alamos F. NeuroSPECT findings in patients exposed to neurotoxic chemicals. Toxicol Ind Health 1994; 10(4-5): 561-71.
  116. Hillert L, Musabasic V, Berglund H, Ciumas C, Savic I. Odor processing in multiple chemical sensitivity. Hum Brain Mapp 2006; 28(3): 172-82.
  117. Ross GH, Rea WI, Johnson AR, Hickey DC, Simon TR. Neurotoxicity in single photon emission computed tomography brain scans of patients reporting chemical sensitivities. Toxicol Ind Health 1999; 15(3-4): 415-20.
  118. Alessandrini M, Micarelli A, Chiaravalloti A, et al. Involvement of Subcortical Brain Structures During Olfactory Stimulation in Multiple Chemical Sensitivity. Brain Topogr 2 016; 29(2): 243-52.
  119. Chiaravalloti A, Pagani M, Micarelli A, et al. Cortical activity during olfactory stimulation in multiple chemical sensitivity: a (18)F-FDG PET/CT study. Eur J Nucl Med Mol Imaging 2015; 42(5): 733-40
  120. Albright JF, Goldstein RA. Is there evidence of an immunologic basis for multiple chemical sensitivity? Toxicol Ind Health 1992; 8(4): 215-9.
  121. Meggs WJ (1992) MCS and the immune system. Toxicol Ind Health 8(4):203-214.
  122. Labarge XS & McCaffrey RJ (2000) Multiple chemical sensitivity: a review of the theoretical and research literature. Neuropsychol Rev 10(4):183-211.
  123. 123.0123.1123.2 Belpomme D, Campagnac C, Irigaray P. Reliable disease biomarkers characterizing and identifying electrohypersensitivity and multiple chemical sensitivity as two etiopathogenic aspects of a unique pathological disorder. Rev Environ Health 2015; 30(4): 251-71.
  124. Grouppo di Italiano Studio MCS (May 23, 2019), "3.11" [3.11 Rheumatological evaluation], Consenso Italiano sulla Sensibilita Chimica Multipla (MCS). Documento di consenso e linee guida sulla Sensibilita Chimica Multipla (MCS) del Gruppo di Studio Italiano sulla MCS [Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS] (PDF), Università degli Studi di Milano, Italy 
  125. Hybenova M, Hrda P, Prochazkova J, Stejskal V, Sterzl I. The role of environmental factors in autoimmune thyroiditis. Neuro Endocrinol Lett 2010; 31(3): 283-9.
  126. Ziem G, McTamney J. Profile of patients with chemical injury and sensitivity. Environ Health Perspect 1997; 105 Suppl 2: 417-36.
  127. Nogué S, Fernandez-Sola J, Rovira E, Montori E, Fernandez-Huerta JM, Munne P. Multiple chemical sensitivity: study of 52 cases. Med Clin (Barc) 2007; 129(3): 96-8; quiz 9.
  128. Tuuminen, Tamara "Review of the State of the Art in Epidemiology, Diagnosis, and Future Perspectives" Journal of Occupational and Environmental Medicine: August 2018 - Volume 60 - Issue 8 - p e429 doi: 10.1097/JOM.0000000000001369
  129. 129.0129.1129.2 Davidoff, A. L.; Fogarty, L. (Sep 1994). "Psychogenic origins of multiple chemical sensitivities syndrome: a critical review of the research literature". Archives of Environmental Health. 49 (5): 316–325. doi:10.1080/00039896.1994.9954981. ISSN 0003-9896. PMID 7944561. 
  130. Bransfield RC, Friedman KJ. Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses, and Medical Uncertainty. Healthcare (Basel). 2019 Oct 8;7(4). pii: E114. doi: 10.3390/healthcare7040114.
  131. 131.0131.1 Cunich, Simon. MCS--the condition that affects one million Australia SBS television. Sydney, Australia. Updated 14 Aug 2018. [ Is multiple chemical sensitivity real? / Is MCS real?] Prof. Anne Steinemann of Melbourne University: "MCS is a very real physical disease".
  132. 132.0132.1132.2 Davidoff, A. L.; Keyl, P. M. (May 1996). "Symptoms and health status in individuals with multiple chemical sensitivities syndrome from four reported sensitizing exposures and a general population comparison group". Archives of Environmental Health. 51 (3): 201–213. doi:10.1080/00039896.1996.9936017. ISSN 0003-9896. PMID 8687241. 
  133. Gots, Ronald E. (Jan 1, 1995). "Editorial Commentary: Multiple Chemical Sensitivities–Public Policy". Journal of Toxicology: Clinical Toxicology. 33 (2): 111–113. doi:10.3109/15563659509000459. ISSN 0731-3810. PMID 7897748. 
  134. Hainge, Kimberly (Fall 2003), "Multiple chemical sensitivity" (PDF), Pesticide Update, Florida Department of Agriculture & Consumer Services, XXI (1) 
  135. Binkley, K; Kutcher, S (Apr 1997). "Panic response to sodium lactate infusion in patients with multiple chemical sensitivity syndrome". Journal of Allergy and Clinical Immunology. 99 (4): 570–574. doi:10.1016/s0091-6749(97)70086-1. ISSN 0091-6749. 
  136. 10.1016/s0091-6749(97)70086-1 Witthöft M, Rist F, Bailer J (2008). "Evidence for a specific link between the personality trait of absorption and idiopathic environmental intolerance". J. Toxicol. Environ. Health Part A71 (11–12): 795–802. doi: 10.1080/15287390801985687. PMID 18569578
  137. Bailer J, Witthöft M, Paul C, Bayerl C, Rist F (2005). "Evidence for overlap between idiopathic environmental intolerance and somatoform disorders"Psychosom Med67 (6): 921–9. doi: 10.1097/01.psy.0000174170.66109.b7. PMID 16314597]
  138. Gibson PR, Lindberg A. Physicians' perceptions and real practices regarding patient reports of multiple chemical sensitivity. ISRN Nurs 2011; 2011: 838930.
  139. "MCS and EI [Multiple Chemical Sensitivities and Environmental Illness]", The Counseling Center at CELA blog. "Is MCS a mental illness? MCS is not a mental illness." Accessed 18 Feb 2020.
  140. Lavergne, M. Ruth; Cole, Donald C.; Kerr, Kathleen; Marshall, Lynn M. (Feb 2010). "Functional impairment in chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity". Canadian Family Physician. 56 (2): e57–e65. ISSN 0008-350X. PMC 2821254Freely accessible. PMID 20154232. 
  141. Caress, Stanley M; Steinemann, Anne C (Sep 1, 2003). "A review of a two-phase population study of multiple chemical sensitivities". Environmental Health Perspectives. 111 (12): 1490–1497. doi:10.1289/ehp.5940. PMC 1241652Freely accessible. PMID 12948889. The study found that while 37.7% of respondents said that they experienced mental health symptoms after developing sensitivities; only 1.4% (n =1) said that they had had mental health problems prior to becoming sensitive, and 5.8% said they didn’t know whether they had had mental health problems prior. 
  142. Brussels International Scientific Declaration on EHS and MCS (2015). Declaration from the 5th Paris Appeal Congress of 18 May 2015 at the Royal Academy of Medicine, Brussels, Belgium. "The nocebo effect is not a relevant nor a valid explanation when considering scientifically valuable blind provocation studies, since objective biological markers are detectable in patients as well as in animals." 
  143. "The nocebo response", Harvard Health. Harvard Medical School blog, Mar 2014, retrieved Feb 12, 2020 
  144. Bittar, Caroline; Nascimento, Osvaldo J. M. (Jan 2015). "Placebo and nocebo effects in the neurological practice". Arquivos De Neuro-Psiquiatria. 73 (1): 58–63. doi:10.1590/0004-282X20140180. ISSN 1678-4227. PMID 25608129. 
  145. American Psychiatric Association (May 15, 2014). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (5th ed.). American Psychiatric Association. ISBN 978-0890425541. 
  146. "Other somatoform disorders". 2020 ICD-10-CM Diagnosis Code F45.8
  147. 147.0147.1 De Luca C, Gugliandolo A, Calabro C, et al. Role of polymorphisms of inducible nitric oxide synthase and endothelial nitric oxide synthase in idiopathic environmental intolerances. Mediators Inflamm 2015; 2015: 245308.
  148. 148.0148.1 Gugliandolo A, Gangemi C, Calabro C, et al. Assessment of glutathione peroxidase-1 polymorphisms, oxidative stress and DNA damage in sensitivity-related illnesses. Life Sci 2016; 145: 27-33. 78.
  149. 149.0149.1 De Luca C, Raskovic D, Pacifico V, Thai JC, Korkina L. The search for reliable biomarkers of disease in multiple chemical sensitivity and other environmental intolerances. Int J Environ Res Public Health 2011; 8(7): 2770-97.
  150. Caccamo D, Cesareo E, Mariani S, et al. Xenobiotic sensor- and metabolism related gene variants in environmental sensitivity-related illnesses: a survey on the Italian population. Oxid Med Cell Longev 2013; 2013: 831969.
  151. De Luca C, Thai JC, Raskovic D, et al. Metabolic and genetic screening of electromagnetic hypersensitive subjects as a feasible tool for diagnostics and intervention. Mediators Inflamm 2014; 2014: 924184.
  152. D’Attis, S; Massari, S; Mazzei, F; Maio, D; Bozzetti, MP; Vergallo, I; Mauro, S; Minelli, M (2019). "Assessment of CYP2C9, CYP2C19, and CYP2D6 Polymorphisms in Allergic Patients with Chemical Sensitivity". Int Arch Allergy Immunol. pp. 173–186. doi:10.1159/000497322. Retrieved May 14, 2020. 
  153. McKeown-Eyssen G, Baines C, Cole DE, Riley N, Tyndale RF, Marshall L, Jazmaji V (2004). "Case-control study of genotypes in multiple chemical sensitivity: CYP2D6, NAT1, NAT2, PON1, PON2 and MTHFR". Psychosomatic Medicine. 33 (5): 971–8. doi:10.1093/ije/dyh251. PMID 15256524. 
  154. Schnakenberg, Eckart; Fabig, Karl-Rainer; Stanulla, Martin; Strobl, Nils; Lustig, Michael; Fabig, Nathalie; Schloot, Werner (Feb 10, 2007). "A cross-sectional study of self-reported chemical-related sensitivity is associated with gene variants of drug-metabolizing enzymes". Environmental Health. 6 (1): 6. doi:10.1186/1476-069X-6-6. ISSN 1476-069X. 
  155. 155.0155.1155.2155.3155.4155.5155.6 Schwenk, Michael (2004). "Multiple Chemical Sensitivity (MCS) - Scientific and Public-Health Aspects". GMS current topics in otorhinolaryngology, head and neck surgery. 3: Doc05. ISSN 1865-1011. PMC 3199799Freely accessible. PMID 22073047. 
  156. World Health Organization; DIMDI (2011). ICD-10-GM Version 2012 : internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme (in Deutsch) (2012 ed.). Deutscher Ärzteverlag. p. 184. ISBN 978-3-7691-3481-0. 
  157. 157.0157.1157.2157.3 National Industrial Chemicals Notification and Assessment Scheme; Office of Chemical Safety and Environmental Health (2010). "2.5 Does MCS have a disease classification?". A Scientific Review of Multiple Chemical Sensitivity: Identifying Key Research Needs. Canberra, Australia. p. 15. ISBN 978-0-9807221-4-7. Archived from the original on Nov 2010. Recognition of MCS as a disease and disability...In Germany, MCS is included in the alphabetical index of the German version of the International Statistical Classification of Diseases and Related Health Problems (ICD-10-SGB-V), first published in November 2000 by the German Institute of Medical Documentation and Information (DIMDI). At this stage, Austria has adopted the German ICD-10 for its use and therefore MCS is included also in the Austrian ICD-10 
  158. Centers for Disease Control (Nov 19, 2019). "Symptoms of ME/CFS | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)". www.cdc.gov. Retrieved May 14, 2020. 
  159. 159.0159.1 Grouppo di Italiano Studio MCS (May 23, 2019), Consenso Italiano sulla Sensibilita Chimica Multipla (MCS). Documento di consenso e linee guida sulla Sensibilita Chimica Multipla (MCS) del Gruppo di Studio Italiano sulla MCS [Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS] (PDF), Università degli Studi di Milano, Italy 
  160. Oreskes, Naomi; Conway, Erik M. (2011). Merchants of Doubt: How a Handful of Scientists Obscured the Truth on Issues from Tobacco Smoke to Climate Change (2nd ed.). Bloomsbury. 
  161. 161.0161.1 Netflix Sued For Defamation By 'Afflicted' Subjects Who Say Docuseries Painted Them As "Crazy Hypochondriacs". Deadline. Aug 17, 2019. Quote: "a salacious reality television program that questioned the existence of their chronic illnesses and portrayed Plaintiffs as lazy, crazy, hypochondriacs and/or malingerers who were deserving of scorn and who in fact have received scorn and abuse because of Defendants’ cruel and duplicitous actions.”
  162. Dusenberry, Maya. An open letter accuses Netflix's Afflicted of abandoning ethnics and science. PS Mag. 20 Sep 2018. quote=The Netflix series Afflicted promised compassion for sufferers of poorly understood chronic illnesses. Instead, it peddled the tired narrative that their suffering is "all in their heads...I joined a group of physicians, scientists, filmmakers, and writers—including Lena Dunham, Monica Lewinsky, and Mario Carpecchi, a Nobel Laureate in genetics—in signing an open letter to Netflix detailing many ethical missteps, scientific errors, and omissions evident in the series. Allowing Afflicted to remain on the widely watched platform, the letter states, 'will reinforce barriers to appropriate medical care...and add to the stigma and social isolation of an already profoundly marginalized group of people.'"]
  163. Talk page of Wikipedia's multiple chemical sensitivity page, retrieved Feb 12, 2020 
  164. 164.0164.1 Gale, Richard; Null, Gary (Aug 2, 2018), "Can we trust Wikipedia and its medical skepticism?", Progressive Radio Network, retrieved Feb 12, 2020, This article will challenge a relatively recent group of Skeptics that identify themselves as the advocates of Science-Based Medicine (SBM), which is not to be confused with the widely accepted approach to decision-making in medical practice known as Evidence-Based Medicine (EBM). 
  165. Wikipedia captured by skeptics Skeptics about skeptics blog. Accessed Feb 12, 2020. "Wikipedia currently is the area in which dogmatic skeptics are most successful and influential. One of these activist groups is called Guerrilla Skepticism on Wikipedia, founded by Susan Gerbic. Another leader of the online skeptical movement is Tim Farley, who runs the website Skeptical Software Tools...The Wikipedia skeptics work in teams (contrary to Wikipedia rules) and most are well trained."
  166. Skeptical About Skeptics, "Rampant Harassment on Wikipedia", Skeptical About Skeptics, retrieved Feb 12, 2020 
  167. Bundrant, Mike (Apr 15, 2015), "Top 6 Things Wikipedia Health Editors Have Told Me Since Announcing the Book that Challenges Wiki Bias", WikiWarn blog, retrieved Feb 12, 2020 
  168. Orthomolecular News Service (Sep 30, 2020), "The rise and fall of Wikipedia", Greenmedinfo blog, retrieved Feb 12, 2020 
  169. 169.0169.1 Barrett, Stephen (Nov 23, 2016), "Multiple Chemical Sensitivity: A Spurious Diagnosis", Quackwatch blog 
  170. Arizona Centre for Advanced Medicine. Multiple Chemical Sensitivities (MCS) Under Siege, Jun 26, 2013. Quote: "In 1990, the Chemical Manufacturers Association (now the American Chemistry Council) vowed to work to prevent the recognition of MCS out of concern for potential lost profits and increased liability if MCS were to become widely acknowledged (2). It specifically committed to work through physicians and medical associations to accomplish this, stating that it was critical to keep physicians from legitimizing MCS...The industry has enlisted the aid of vocal anti-MCS physicians who promote the myths that people with MCS are “hypochondriacs,” “hysterical,” “neurotic,” suffer from some other psychiatric disorder, belong to a “cult,” or just complain too much. Most of these physicians work for industry as high-paid expert witnesses although their financial ties are usually not disclosed in their journal articles, interviews, or speaking engagements. Therefore, many people, including those in the health care profession, are often led to believe that these physicians’ opinions reflect an honest appraisal of MCS rather than the chemical industry’s agenda. At least one industry expert witness has authored two anti-MCS position papers for prominent medical associations. It is easy to see why these papers are biased against MCS and how by helping to combat MCS in the courts, these position statements are quite lucrative for industry and expert witnesses alike."
  171. Lees-Haley, Paul R (Mar 10, 1998), "Propaganda techniques related to enviromental scares. This article was adapted from Lee-Haley PR. Manipulation of perception in mass tort litigation. 1997", Quackwatch blog 
  172. 172.0172.1 Gavura, Scott (Jul 3, 2014), "Multiple Chemical Sensitivity: Separating facts from fiction", Science-based medicine blog, 'Does multiple chemical sensitivity exist?' The symptoms certainly do, but it’s less clear if they are due to “chemicals.” 
  173. Lees-Haley, Paul R. (Dec 23, 2002), "Mold Neurotoxicity: Validity, Reliability and Baloney", Quackwatch blog 
  174. "Multiple chemical sensitivity suffering is real, diagnosis isn't--Quackbusters"", Probe Newsletter (07-03), Jan 1, 1999 
  175. Hall, Harriet, "Environmental Medicine – Not Your Average Specialty", Blog: Science-based medicine: Exploring issues and controversies in science and medicine, Rea is best known for his promotion of the concept of multiple chemcial sensitivity (MCS), a diagnosis not recognized by the scientific community 
  176. MacBeth, Braden (Nov 26, 2018), Afflicted and the Tragedy of Fake Illnesses 
  177. Barrett, Stephen (Oct 20, 2019), "Questionable Organizations: An Overview", Quackwatch blog, The American Academy of Environmental Medicine, which promotes "clinical ecology" and the bogus concept of multiple chemical sensitivity. 
  178. Barrett, Stephen (Jan 16, 2019), "Vulnerability to Quackery", Quackwatch blog 
  179. Barrett, Stephen (Nov 23, 2016), "Regulatory Actions against AAEM Members", Quackwatch blog, The American Academy of Environmental Medicine (AAEM), which was founded by Theron Randolph in 1965 as the Society for Clinical Ecology...most AAEM members espouse dubious concepts of multiple chemical sensitivity, toxic mold... 
  180. Barrett, Stephen (Jan 22, 2010), "The Bogus Connection between "MCS" and Porphyria", Quackwatch blog 
  181. Barrett, Stephen, "MCS Proclamations", Quackwatch blog 
  182. Barrett, Stephen; Gots, Ronald E, "Gulf War Syndrome", Quackwatch blog, Some sufferers claim to have multiple chemical sensitivity (MCS) 
  183. Barrett, Stephen (Oct 6, 2018), "Be Wary of "Fad" Diagnoses", Quackwatch blog 
  184. Barrett, Stephen (Mar 28, 2019), "Index to "Fad" Diagnoses. What Is a "Fad" Diagnosis?", Quackwatch blog 
  185. Barrett, Stephen (1998), "A Close Look at "Multiple Chemical Sensitivity"", Quackwatch blog 
  186. Barrett, Stephen (Oct 16, 2000), "An Analysis of the National Environmental Justice Advisory Council Enforcement Subcommittee's Resolution #21 on Multiple Chemical Sensitivity", Quackwatch blog 
  187. Amended complaint against WIKIPEDIA to the Supreme Court of the State of New York, Country of New York (PDF), Nov 24, 2009 
  188. "Wikipedia » Skeptical About Skeptics", Skeptical About Skeptics, retrieved Feb 19, 2020 
  189. 189.0189.1 Gale, Richard (Apr 1, 2019), "Stephen Barrett: Wikipedia's Agent Provocateur against natural medicine", Progressive Radio Network 
  190. Stephen Barrett and Medical McCarthyism The Progressive Radio network blog. Accessed Feb 21, 2020]
  191. "Multiple Chemical Sensitivities (MCS) Under Siege", Arizona Centre for Advanced Medicine, Jun 26, 2013 
  192. Australian Human Rights and Equal Opportunity Commission (2007), Australian Human Rights Commission Access: Guidelines and information, Canberra 
  193. Hu, Howard, Banes Cornelia (2018) “Recent insights into 3 underrecognized conditions: Myalgic encephalomyelitis–chronic fatigue syndrome, fibromyalgia, and environmental sensitivities–multiple chemical sensitivity” University of Toronto, Ontario. Canada Family Physician. 2018 Jun; 64(6): 413–415.; PMID: 29898928; PMCID: PMC5999262
  194. Michaels, Bob (2013), "Frequently asked questions about multiple chemical sensitivity" (PDF), Independent Living Research Utilization, Is MCS real -- or just a psychosomatic, boutique disability? Both MCS and EI are very real conditions...The Social Security Administration and U.S. Department of Housing and Urban Development recognize MCS as a disabling condition, as do numerous other government agencies and judicial bodies. 
  195. 195.0195.1 "Todd Haynes and Julianne Moore on Safe". CriterionCollection, YouTube. Retrieved Oct 30, 2019. 
  196. 196.0196.1 ""Todd Haynes Q&A | Safe", Retrospective of Todd Haynes films". YouTube. Nov 25, 2015. Retrieved Oct 30, 2019. 
  197. "Open Letter to Netflix Regarding the "Afflicted" Docuseries". Sep 18, 2018. 
  198. Azuma K, Uchiyama I, Tanigawa M, Bamba I, Azuma M, Takano H, et al. (Dec 9, 2016). "Association of Odor Thresholds and Responses in Cerebral Blood Flow of the Prefrontal Area during Olfactory Stimulation in Patients with Multiple Chemical Sensitivity". PLOS ONE. 11 (12): e0168006. doi:10.1371/journal.pone.0168006. ISSN 1932-6203. 
  199. Williams, Margaret (Nov 10, 2010). "Allergies and Multiple Chemical Sensitivities in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome" (PDF). margaretwilliams.me. 

tachycardia - An unusually rapid heart beat. Can be caused by exercise or illness. A symptom of postural orthostatic tachycardia syndrome (POTS). (Learn more: www.heart.org)

mycotoxin - "a poisonous substance produced by a fungus and especially a mold"

ME/CFS - An acronym that combines myalgic encephalomyelitis with chronic fatigue syndrome. Sometimes they are combined because people have trouble distinguishing one from the other. Sometimes they are combined because people see them as synonyms of each other.

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

adverse reaction - Any unintended or unwanted response to the treatment under investigation in a clinical trial.

mycotoxin - "a poisonous substance produced by a fungus and especially a mold"

central nervous system (CNS) - One of the two parts of the human nervous system, the other part being the peripheral nervous system. The central nervous system consists of the brain and spinal cord, while the peripheral nervous system consists of nerves that travel from the central nervous system into the various organs and tissues of the body.

antibody - Antibodies or immunoglobulin refers to any of a large number of specific proteins produced by B cells that act against an antigen in an immune response.

Diagnostic and Statistical Manual of Mental Disorders (DSM) - A psychiatric reference book published by the American Psychiatric Association, often referred to as "the psychiatrist's Bible". Although the most recent version (DSM-5) purports to be the authoritative guide to the diagnosis of mental disorders, the editors of both previous versions of the manual have heavily criticized the current version due to the climate of secrecy that shrouded the development of the latest version. 69% of the people who worked on DSM-5 reported having ties to the pharmaceutical industry. Dr. Allen Frances, who headed the development of the previous version, warned of dangerous unintended consequences such as new false 'epidemics'. The British Psychological Society criticized DSM-5 diagnoses as "clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements" and expressed a major concern that "clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences". A petition signed by over 13,000 mental health professionals stated that the lowered diagnostic thresholds in DSM-5, combined with entirely subjective criteria based on western social norms, would "lead to inappropriate medical treatment of vulnerable populations". The director of the US National Institute of Mental Health, Dr. Thomas R. Insel, pointed out that the diagnoses in DSM-5 had no scientific validity whatsoever. (Learn more: www.scientificamerican.com)

American Psychiatric Association (APA) - The main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. Not to be confused with the American Psychological Association (also APA).

Diagnostic and Statistical Manual of Mental Disorders (DSM) - A psychiatric reference book published by the American Psychiatric Association, often referred to as "the psychiatrist's Bible". Although the most recent version (DSM-5) purports to be the authoritative guide to the diagnosis of mental disorders, the editors of both previous versions of the manual have heavily criticized the current version due to the climate of secrecy that shrouded the development of the latest version. 69% of the people who worked on DSM-5 reported having ties to the pharmaceutical industry. Dr. Allen Frances, who headed the development of the previous version, warned of dangerous unintended consequences such as new false 'epidemics'. The British Psychological Society criticized DSM-5 diagnoses as "clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements" and expressed a major concern that "clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences". A petition signed by over 13,000 mental health professionals stated that the lowered diagnostic thresholds in DSM-5, combined with entirely subjective criteria based on western social norms, would "lead to inappropriate medical treatment of vulnerable populations". The director of the US National Institute of Mental Health, Dr. Thomas R. Insel, pointed out that the diagnoses in DSM-5 had no scientific validity whatsoever. (Learn more: www.scientificamerican.com)

somatic symptom disorder - A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience. Although "Somatic Symptom Disorder" is the term used by DSM-5, the term "Bodily Distress Disorder" has been proposed for ICD-11. (Learn more: www.psychologytoday.com)

World Health Organization (WHO) - "A specialized agency of the United Nations that is concerned with public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations." The International Statistical Classification of Diseases and Related Health Problems (ICD) is maintained by WHO. (Learn more: en.wikipedia.org)

International Classification of Diseases (ICD) - A system of medical diagnostic codes, created by the World Health Organization (WHO), to classify diseases and other health related conditions for the purpose of international diagnostic consistency. By having common diagnostic codes around the world, health researchers are better able to quantify and track disease burdens. The most current version is called ICD-11. (Learn more: www.who.int)

International Classification of Diseases (ICD) - A system of medical diagnostic codes, created by the World Health Organization (WHO), to classify diseases and other health related conditions for the purpose of international diagnostic consistency. By having common diagnostic codes around the world, health researchers are better able to quantify and track disease burdens. The most current version is called ICD-11. (Learn more: www.who.int)

World Health Organization (WHO) - "A specialized agency of the United Nations that is concerned with public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations." The International Statistical Classification of Diseases and Related Health Problems (ICD) is maintained by WHO. (Learn more: en.wikipedia.org)

bias - Bias in research is "a systematic deviation of an observation from the true clinical state".

chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.

myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

metabolite - A chemical compound produced by, or involved in, metabolism. The term is often used to refer to the degradation products of drugs in the body.

Diagnostic and Statistical Manual of Mental Disorders (DSM) - A psychiatric reference book published by the American Psychiatric Association, often referred to as "the psychiatrist's Bible". Although the most recent version (DSM-5) purports to be the authoritative guide to the diagnosis of mental disorders, the editors of both previous versions of the manual have heavily criticized the current version due to the climate of secrecy that shrouded the development of the latest version. 69% of the people who worked on DSM-5 reported having ties to the pharmaceutical industry. Dr. Allen Frances, who headed the development of the previous version, warned of dangerous unintended consequences such as new false 'epidemics'. The British Psychological Society criticized DSM-5 diagnoses as "clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements" and expressed a major concern that "clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences". A petition signed by over 13,000 mental health professionals stated that the lowered diagnostic thresholds in DSM-5, combined with entirely subjective criteria based on western social norms, would "lead to inappropriate medical treatment of vulnerable populations". The director of the US National Institute of Mental Health, Dr. Thomas R. Insel, pointed out that the diagnoses in DSM-5 had no scientific validity whatsoever. (Learn more: www.scientificamerican.com)

Diagnostic and Statistical Manual of Mental Disorders (DSM) - A psychiatric reference book published by the American Psychiatric Association, often referred to as "the psychiatrist's Bible". Although the most recent version (DSM-5) purports to be the authoritative guide to the diagnosis of mental disorders, the editors of both previous versions of the manual have heavily criticized the current version due to the climate of secrecy that shrouded the development of the latest version. 69% of the people who worked on DSM-5 reported having ties to the pharmaceutical industry. Dr. Allen Frances, who headed the development of the previous version, warned of dangerous unintended consequences such as new false 'epidemics'. The British Psychological Society criticized DSM-5 diagnoses as "clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements" and expressed a major concern that "clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences". A petition signed by over 13,000 mental health professionals stated that the lowered diagnostic thresholds in DSM-5, combined with entirely subjective criteria based on western social norms, would "lead to inappropriate medical treatment of vulnerable populations". The director of the US National Institute of Mental Health, Dr. Thomas R. Insel, pointed out that the diagnoses in DSM-5 had no scientific validity whatsoever. (Learn more: www.scientificamerican.com)

somatic symptom disorder - A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience. Although "Somatic Symptom Disorder" is the term used by DSM-5, the term "Bodily Distress Disorder" has been proposed for ICD-11. (Learn more: www.psychologytoday.com)

somatic symptom disorder - A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience. Although "Somatic Symptom Disorder" is the term used by DSM-5, the term "Bodily Distress Disorder" has been proposed for ICD-11. (Learn more: www.psychologytoday.com)

The information provided at this site is not intended to diagnose or treat any illness.
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.