Journal of Chronic Fatigue Syndrome: Volume 7, Issue 2, 2000

Volume 7, Issue 2, 2000

 * Editorial by Roberto Patarca-Montero
 * Irritant Rhinitis in Allergic, Nonallergic, Control and Chronic Fatigue Syndrome Populations "'Abstract - Background: Irritation symptoms after exposure to “nonspecific” stimuli are often attributed to nonallergic rhinitis (vaso-motor rhinitis). This is a heterogeneous syndrome of exclusion based on nasal symptoms with negative allergy skin tests. Method: Control (n = 114) and Chronic Fatigue Syndrome (CFS, n = 120) subjects scored the severity of nasal congestion and rhinorrhea sensations that they attributed to 9 irritants. The sum was the “Irritant Rhinitis Score” (IRS maximum 72). A positive IRS of > 19 defined “Irritant Rhinitis.” Demographic, allergy skin test and other assessments were done to characterize the Irritant Rhinitis population. Results: Irritant Rhinitis was present in 11% of control and 47% of CFS subjects. In multivariate analysis, positive IRS was correlated with a history of rhinitis complaints, systemic complaints such as fatigue, sensations of congestion and rhinorrhea induced by meteorological conditions, tobacco smoke, odors, perfumes, and other volatile materials, and diagnoses of CFS and Multiple Chemical Sensitivity (MCS). Although atopy was not correlated to Irritant Rhinitis, 51% of allergic rhinitis subjects had a positive IRS. Conclusions: The Irritant Rhinitis Score defined a population with irritant-induced nasal congestion and rhinorrhea who also had significant systemic complaints. Similar neural mechanisms may underlie the spectrum of Irritant Rhinitis, CFS and MCS.'"
 * Tobacco Sensitivity in Chronic Fatigue Syndrome (CFS)"'Abstract - Background: Mechanisms responsible for sensitivity to irritants such as tobacco smoke are poorly understood. A Tobacco Score questionnaire was developed to identify and characterize subjects with this sensitivity. For this pilot study, scores were assessed in populations of self-selected controls and a group with irritant sensitivity (Chronic Fatigue Syndrome, CFS). Method: Subjects graded the severity of 21 symptoms associated with tobacco exposure. Results were compared with other instruments and a measure of pain sensitivity (dolorimetry) in 116 control and 103 CFS subjects. Results: The Tobacco Score was positive in 16% of control and 51% of CFS subjects. Significant correlations were found between Tobacco Score, Irritant Rhinitis Score and history of sinusitis. Intermediate relationships were found with history of allergic rhinitis, Systemic Complaints Score and Multiple Chemical Sensitivity. Factors having no influence included gender, the severity of CFS symptoms, pain thresholds, and allergy skin tests. Conclusions: Tobacco sensitivity was correlated with measures of upper airway irritation and nonallergic sensitivity to triggers such as weather changes. The spectrum of symptoms, high prevalence in CFS, and absence of a relationship to atopy suggest that these nonallergic irritant syndromes may share a common neuropathophysiology.'"
 * The Development of Laboratory-Based Tests in Chronic Pain and Fatigue: 1. Muscle Catabolism and Coagulase Negative Staphylococci Which Produce Membrane Damaging Toxins"'Abstract - Background: The diagnosis of chronic fatigue syndrome (CFS) requires the exclusion of other known fatigue-related diseases because the core symptoms of CFS represent a general host response to many well-defined diseases. The patient set derived by this process is heterogeneous in their polysymptomatic presentation and has proved very difficult to study clinically and scientifically. Objectives: To investigate the alterations in urine excretion and microbiology in patients with CFS. Results: CFS patients had multiple anomalies in their amino acid and organic acid homeostasis. Sub-groups of CFS patients could be delineated on the basis of their urine excretion and their symptom presentation. The most common feature was an active muscle catabolism resulting in a depletion of amino acids and associated organic and keto-acids. The extent of muscle catabolism was directly correlated to pain severity. The carriage of toxin-producing coagulase negative staphylococci (MDT-CoNS) was strongly correlated with the catabolic response and pain severity. Conclusions: An hypothesis has been constructed where an occult pathogen, such as MDT-CoNS, may be an aetiological agent contributing to the sustenance of a chronic fatigue/pain disorder, a comorbid pathogen. Urine analysis offers an opportunity for assessment of muscle catabolism and sub-classification of chronic fatigue patients leading to a number of management options. The detection of MDT-CoNS identifies potentially treatable agents that contribute to the fatigue and pain condition.'"
 * The Development of Laboratory-Based Tests in Chronic Pain and Fatigue: 2. Essential Fatty Acids and Cholesterol"'Abstract - Objectives: To investigate fatty acid and sterol homeostasis in patients with CFS. Methods: Plasma samples were collected from CFS and control subjects and analyzed for lipid composition by GC-MS metabolic profiling techniques. Results: CFS patients had significantly different profiles of fatty acids and sterols compared with control subjects. The 1st and 2nd most important factors discriminating the CFS patients from the controls, were a decrease in elaidic acid (frims-9-octadecenoic acid) and an increase in stearic acid (octadecanoic acid), respectively. The CFS patients also had lower levels of cholesterol, which has potential impact on membrane integrity and function, steroid hormone synthesis, energy metabolism and bile production. The CFS patients could also be subdivided into subgroups based on their fatty acid and sterol composition. The results of cluster analyses and multivariate analyses revealed that several types of homeostasis exist in different types of CFS patients, whereas the control group was largely homogeneous. Viral infections can contribute to the nature of the lipid-based anomalies in CFS patients and lipid profiles from patients with prior viral infections could be differentiated from those without viral histories. Conclusions: The assessment of fatty acids and sterols in fasting plasma samples can indicate essential fatty acid deficits, suggest appropriate types of essential fatty acid oils for formulations, indicate potential cholesterol deficit-associated anomalies, provide evidence for mitochondrial dysfunction and categorize CFS patients into biochemical subgroups. These evaluations provide a basis for devising individually tailored patient management protocols.'"
 * Chronic Fatigue Syndrome: A Dysfunction of the Hypothalamic-Pituitary-Adrenal Axis "'Abstract - Chronic fatigue syndrome is a severe, often disabling disorder with prevalence as high as 422 cases per 100,000 in the United States. Aside from the adverse effects to patients' quality of life, sequela of the disorder include a negative impact on the economy as well as a burden on public health care costs. Some avenues of current research into the possible genesis of the syndrome are neurally mediated hypotension, viral pathogen, immunological disorders, lymphocyte enzyme system abnormalities, or a purely psychological root. This paper is a review of the literatures as to a neuroendocrinologic cause, namely dysfunction of the hypothalamic-pituitary-adrenal axis.'"
 * Functional Somatic Syndromes - A Matter of Stress Response Patterns?"'Abstract - This hypothesis deals with reactions described in functional somatic syndromes and postulates that these reactions be described in terms of active/passive and external/internal. The reflex character of these reactions explain the variation in symptom intensity which in turn is projected to doctors as feelings of lacking understanding, especially when disease parameters are normal.'"
 * Book Review