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''Hi,'' ''I joined MEpedia solely to work on pages related to Multiple Chemical Sensitivity (MCS)—a common comorbid condition with ME'' == <big id="What_are_the_symptoms_of_multiple_chemical_sensitivity.3F">ALETHEIA'S SANDBOX (this is where I work on content)</big> ==<!-- Definition and symptoms --> '''Multiple chemical sensitivity''' ('''MCS'''), also known as '''idiopathic environmental intolerances''' ('''IEI'''), is a chronic acquired illness, in which sufferers report a range of symptoms when exposed to certain everyday chemicals. One 2018 scientific review said the condition was "a complex syndrome that manifests as a result of exposure to a low level of various common contaminants."<ref name="Rossi2018">{{Cite journal | last =Rossi | first = Sabrina|author-link= | last2=Pitidis | first2=Alessio|author-link2= | last3 = | first3 = |author-link3= | last4 = | first4 = |author-link4= | last5 = | first5 = | authorlink5 = | last6 = | first6 = |author-link6= | last7 = | first7 = | last8 = |first8 = |date=Feb 2018|title=Multiple Chemical Sensitivity: Review of the State of the Art in Epidemiology, Diagnosis, and Future Perspectives|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5794238/|journal=Journal of Occupational and Environmental Medicine|volume=60|issue=2|pages=138–146|doi=10.1097/JOM.0000000000001215|issn=1076-2752|pmc=5794238|pmid=29111991|access-date=|quote=...|via=}}</ref> While another review, from the same year, said it was characterized by "susceptibility to a wide spectrum of environmental compounds, causing symptoms involving various organs and a decrease in quality of life."<ref name="pmid30088144" /> Commonly reported triggers for MCS symptoms include products like perfume, fresh paint fumes, tobacco smoke and mold.<ref name="Valderrama2015" /><ref name=":49" /><ref name=":50">{{Cite journal | last =Pigatto | first = Paolo D. | last2=Guzzi | first2=Gianpaolo|date=2019-06-01|title=Prevalence and risk factors for multiple chemical sensitivity in Australia|url=http://www.sciencedirect.com/science/article/pii/S2211335519300415|journal=Preventive Medicine Reports|language=en|volume=14|pages=100856|doi=10.1016/j.pmedr.2019.100856|issn=2211-3355}}</ref> ==Symptoms == The symptoms of MCS have been reported to affect multiple organs and body systems and to range from mild to disabling.<ref name="Rossi2018" /><ref name="pmid30088144" /><ref name="Valderrama2015" /><ref name=":7">{{Citation | last =Task Force on Environmental Health|date=2017|url=http://www.health.gov.on.ca/en/common/ministry/publications/reports/environmental_health_2017/task_force_on_environmental_health_report.pdf|title=Time for leadership: recognizing and improving care for those with ME/CFS, FM and ES/MCS. Phase 1 report. |location=Toronto, Ontario:|publisher=Ministry of Health and Long-Term Care}}</ref><ref name=":6">{{Cite book | at=What is Multiple Chemical Sensitivity|isbn=978-0-9807221-4-7|url=http://test.nicnas.gov.au/Media/Latest_News/MCS.asp|title=A Scientific Review of Multiple Chemical Sensitivity: Identifying Key Research Needs|date=2010 | last =National Industrial Chemicals Notification and Assessment Scheme | last2=Office of Chemical Safety and Environmental Health|location=Canberra, Australia|dead-url=y|archive-date=Nov 2010|archive-url=https://web.archive.org.au/awa/20160615131255mp_/https://www.nicnas.gov.au/__data/assets/word_doc/0015/17223/MCS-Final-Report-for-publication-November-2010-hardcopy-version.docx}}</ref><ref name="pmid10444033">{{cite journal|year=1999|title=Multiple chemical sensitivity: a 1999 consensus|journal=Arch. Environ. Health|volume=54|issue=3|pages=147–9|doi=10.1080/00039899909602251|pmid=10444033|url=https://semanticscholar.org/paper/5d389fb8a204e089ce22e9cc7720aa8507581c2f}}</ref> A report from a national government inquiry into MCS found that the following symptoms—in this order—were the most commonly reported in MCS: headache, fatigue, confusion, depression, shortness of breath, arthralgia, myalgia, nausea, dizziness, memory problems, gastrointestinal symptoms, respiratory symptoms.<ref name="NICNAS">{{Cite book | isbn=978-0-9807221-4-7|url=http://test.nicnas.gov.au/Media/Latest_News/MCS.asp|title=A Scientific Review of Multiple Chemical Sensitivity: Identifying Key Research Needs|date=2010 | last =National Industrial Chemicals Notification and Assessment Scheme | last2=Office of Chemical Safety and Environmental Health|location=Canberra, Australia|dead-url=y|archive-date=Nov 2010|archive-url=https://web.archive.org.au/awa/20160615131255mp_/https://www.nicnas.gov.au/__data/assets/word_doc/0015/17223/MCS-Final-Report-for-publication-November-2010-hardcopy-version.docx}}</ref> Other commonly reported symptoms of MCS include: cardiac arrhythmia, tachycardia, hypotension, hypertension, nausea, vomiting, skin rashes, visual disturbances, seizures, asthma and anaphylaxis.<ref name="Valderrama2015" /><ref name=":7" /><ref name=":6" /><ref name="Steinemann2018">{{Cite journal | last =Steinemann | first = Anne|author-link= | last2= | first2=|author-link2=|date=Mar 2018|title=National Prevalence and Effects of Multiple Chemical Sensitivities|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865484/|journal=Journal of Occupational and Environmental Medicine|volume=60|issue=3|pages=e152–e156|doi=10.1097/JOM.0000000000001272|issn=1076-2752|pmc=5865484|pmid=29329146|access-date=|quote=|via=}}</ref><ref name="Genuis2013">{{cite journal | last1=Genuis | first1 = SJ|date=May 2013|title=Chemical sensitivity: pathophysiology or pathopsychology? Is multiple chemical sensitivity a mental illness?|journal=Clinical Therapeutics (Review)|volume=35|issue=5|pages=572–7|doi=10.1016/j.clinthera.2013.04.003|pmid=23642291|url=https://www.ncbi.nlm.nih.gov/pubmed/23642291 | last2=Ross | first2=PM|pmc=|quote=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. | last3 = Whysner | first3 = J | last4 = Covello | first4 = VT | last5 = Kuschner | first5 = M | last6 = Rifkind | first6 = AB | last7 = Sedler | first7 = MJ | last8 = Trichopoulos|first8 = D|author-link= | authorlink5 = |via=}}</ref> A 2018 review of MCS studies said: “MCS is a syndrome that progresses to increasingly serious stages, with the gradual onset of multiple pathlogies."<ref name="Rossi2018" /> The following substances have been reported as common triggers for MCS symptoms: * synthetic fragrances, * tobacco smoke, * some pesticides, biocides and fungicides, * some laundry detergents and fabric softeners, * some petrochemical solvents (fumes from paint and polyurethane), * formaldehyde, * fumes from some building materials (particleboard and glues), * some food additives and colorings (eg. tartrazine), * some medications, and * some anesthetics.<ref name="Rossi2018" /><ref name="Valderrama2015">{{citation | last =Valderrama Rodríguez| first = M | last2=Revilla López | first2=MC | last3 = Blas Diez | first3 = MP | last4 = Vázquez Fernández del Pozo | first4 = S | last5 = Martín Sánchez | first5 = Jl|title=Actualización de la Evidencia Científica sobre Sensibilidad Química Múltiple (SQM). |publisher=Ministerio de Sanidad, Servicios Sociales e Igualdad. Instituto Aragonés de Ciencias de la Salud. Informes de Evaluación de Tecnologías Sanitarias (IACS)|date=2015|trans-title=Review of the scientific evidence on Multiple Chemical Sensitivity|url=https://www.sergas.es/Asistencia-sanitaria/Documents/953/Actualizaci%C3%B3n%20de%20la%20evidencia%20cient%C3%ADfica%20sobre%20sensibilidad%20qu%C3%ADmica%20m%C3%BAltiple.pdf}}</ref><ref name=":49">{{Cite journal | last =Ziem | first = Grace E.|author-link=|date=2018-04-24|title=Multiple Chemical Sensitivity: Treatment and Followup with Avoidance and Control of Chemical Exposures:|url=https://journals.sagepub.com/doi/pdf/10.1177/074823379200800409|journal=Toxicology and Industrial Health|language=en|volume=|issue=|pages=|doi=10.1177/074823379200800409|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref name=":50" /><ref name=":6" /><ref name="pmid10444033" /><ref name="Steinemann2018" /> ==Diagnosis == A 1999 international consensus on MCS is the most common diagnostic criteria used to diagnose the condition. This consensus was published in ''The Archives of Environmental Health,'' 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.<ref name="pmid10444033" /> The team agreed that the clinical characteristics of MCS should be defined as follows: #a chronic condition, #with symptoms that recur reproducibly #in response to low levels of exposure #to multiple and unrelated chemicals, #which improve or resolve when triggers are removed, and #with symptoms which occur in multiple organ systems.<ref name="pmid10444033" /><ref name=":1">{{Cite book | title=Psychiatry: An evidence-based text|pages=793-820|isbn=978-1-4441-1326-6|edition=|language=en|title-link=|url=https://books.google.com/books/about/Psychiatry_An_evidence_based_text.html?id=LkbOBQAAQBAJ|access-date=|date=2009-11-27|publisher=CRC Press | last =Hooper| first = Malcolm|author-link=Malcolm Hooper | last2= | first2=|author-link2= | last3 = | first3 = |author-link3= | last4 = | first4 = |author-link4= | last5 = | first5 = | authorlink5 = | last6 = | first6 = |author-link6= | last7 = | first7 = |author-link7= | last8 = |first8 = |author-link8= | last9 = | first9 = |author-link9=|veditors=|others=|doi=|oclc=|quote=|archive-url=|archive-date=|location=|editor-last=Puri|editor-first=Bassant|editor1-link=|editor-last2=Treasaden|editor-first2=Ian|chapter=Multiple Chemical Sensitivity|chapter-url=https://www.mcs-aware.org/images/resources/Malcolm_Hooper_MCS_annotated_by_Gillian.pdf}}</ref><ref name="Rossi2018" /><ref name="pmid30088144" /><ref name="Valderrama2015" /> The Quick Environmental Exposure and Sensitivity Inventory (QEESI) is a diagnostic tool that is often used to assess a patient for these criteria.<ref name="Valderrama2015" /><ref name=":6" /><ref name="Gibson2009">{{Cite journal | last =Gibson | first = PR|author-link= | last2=Vogel | first2=VM|author-link2=|date=Jan 2009|title=Sickness-related dysfunction in persons with self-reported multiple chemical sensitivity at four levels of severity|url=https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2702.2008.02439.x|journal=J Clin Nurs.|volume=18|issue=1|pages=72-81|doi=10.1111/j.1365-2702.2008.02439.x|pmc=|pmid=|access-date=|quote=|via=}}</ref> MCS has also been identified as a common comorbidity of chronic fatigue syndrome (CFS) by several CS consensus documents: # The 2003 Canadian Consensus Criteria<ref>[[Bruce Carruthers|Carruthers, Bruce M.]]; [[Anil Kumar Jain|Jain, Anil Kumar]]; [[Kenny De Meirleir|De Meirleir, Kenny L.]]; [[Daniel Peterson|Peterson, Daniel L.]]; [[Nancy Klimas|Klimas, Nancy G.]]; [[Martin Lerner|Lerner, A. Martin]]; [[Alison Bested|Bested, Alison C.]]; [[Pierre Flor-Henry|Flor-Henry, Pierre]]; [[Pradip Joshi|Joshi, Pradip]]; [[A C Peter Powles|Powles, A C Peter]]; [[Jeffrey Sherkey|Sherkey, Jeffrey A.]]; [[Marjorie van de Sande|van de Sande, Marjorie I.]] (2003), [http://www.meresearch.org.uk/wp-content/uploads/2012/11/2003-Carruthers-Canadian-Definition-JCFS.pdf "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols"] (PDF), ''Journal of Chronic Fatigue Syndrome'', '''11''' (2): 7-115, [[Digital object identifier|doi]]:[https://doi.org/10.1300%2FJ092v11n01_02 10.1300/J092v11n01_02]</ref> lists "new sensitivities to food, medications and/or chemicals" as a symptom and MCS as a comorbidity; # The 2011 International Consensus Criteria<ref>[[Bruce Carruthers|Carruthers, Bruce M.]]; [[Marjorie van de Sande|van de Sande, Marjorie I.]]; [[Kenny De Meirleir|De Meirleir, Kenny L.]]; [[Nancy Klimas|Klimas, Nancy G.]]; [[Gordon Broderick|Broderick, Gordon]]; [[Terry Mitchell|Mitchell, Terry]]; [[Donald Staines|Staines, Donald]]; [[A C Peter Powles|Powles, A. C. Peter]]; [[Nigel Speight|Speight, Nigel]]; [[Rosamund Vallings|Vallings, Rosamund]]; [[Lucinda Bateman|Bateman, Lucinda]]; [[Barbara Baumgarten-Austrheim|Baumgarten-Austrheim, Barbara]]; [[David Bell|Bell, David]]; [[Nicoletta Carlo-Stella|Carlo-Stella, Nicoletta]]; [[John Chia|Chia, John]]; [[Austin Darragh|Darragh, Austin]]; [[Daehyun Jo|Jo, Daehyun]]; [[Donald Lewis|Lewis, Donald]]; [[Alan Light|Light, Alan]]; [[Sonya Marshall-Gradisnik|Marshall-Gradisnik, Sonya]]; [[Ismael Mena|Mena, Ismael]]; [[Judy Mikovits|Mikovits, Judy]]; [[Kunihisa Miwa|Miwa, Kunihisa]]; [[Modra Murovska|Murovska, Modra]]; [[Martin Pall|Pall, Martin]]; [[Staci Stevens|Stevens, Staci]] (Aug 22, 2011). [https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2796.2011.02428.x "Myalgic encephalomyelitis: International Consensus Criteria"]. ''Journal of Internal Medicine''. '''270''' (4): 327–338. [[Digital object identifier|doi]]:[https://doi.org/10.1111%2Fj.1365-2796.2011.02428.x 10.1111/j.1365-2796.2011.02428.x]. [[International Standard Serial Number|ISSN]] [https://www.worldcat.org/issn/0954-6820 0954-6820]. [[PubMed Central|PMC]] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427890 3427890] . [[PubMed Identifier|PMID]] [[pubmed:21777306|21777306]].</ref> lists "sensitivities to food, medications, odors or chemicals" as a symptom and MCS as a comorbidity; and # A 2019 publication of the U.S. CFS Clinician Coalition lists "chemical sensitivity" as a symptom of CFS and MCS as a comorbidity.<ref>U.S. ME/CFS Clinician Coalition (Aug 2019). [https://drive.google.com/file/d/1SG7hlJTCSDrDHqvioPMq-cX-rgRKXjfk/view][https://drive.google.com/file/d/1SG7hlJTCSDrDHqvioPMq-cX-rgRKXjfk/view "Diagnosing and Treating ME/CFS"]</ref> ==Management == There is no clinically proven cure for MCS.<ref name="Rossi2018" /><ref name="pmid30088144" /><ref name=":7" /> There is also no consensus on supportive therapies. But the literature does agree on the need for patients with MCS to avoid the specific substances that they have found trigger reactions for them.<ref name="Rossi2018" /><ref name="pmid30088144" /><ref name="Valderrama2015" /><ref name=":49" /><ref name=":7" /><ref name=":6" /><ref name="Genuis2013" /> There is also consensus that a multidisciplinary approach is required for adequately managing the health of someone with MCS.<ref name="Rossi2018" /><ref name="pmid30088144" /> Some studies suggest a special focus on correcting any nutritional deficiencies may be beneficial,<ref name="pmid30088144" /> while some clinicians recommend using medical Oxygen to reduce the severity of symptoms during unavoidable or following accidental exposures to triggering substances.<ref name=":6" /> 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.<ref name=":6" /><ref>{{cite journal | last =Gibson | first = PR | last2=Elms | first2=AN | last3 =Ruding | first3 = LA|date=2003|title =Perceived treatment efficacy for conventional and alternative therapies reported by persons with multiple chemical sensitivity|journal =Environ Health Perspect|volume=111|pages =1498-1504|url=https://ehp.niehs.nih.gov/doi/abs/10.1289/ehp.5936}}</ref> == Epidemiology == While prevalence rates for MCS vary according to the diagnostic criteria used,<ref name="pmid30088144" /><ref>{{Cite book | chapter=1.1.2 Studies on the prevalence of MCS in other countries|isbn=978-0-9807221-4-7|url=http://test.nicnas.gov.au/Media/Latest_News/MCS.asp|title=A Scientific Review of Multiple Chemical Sensitivity: Identifying Key Research Needs|date=2010 | last =National Industrial Chemicals Notification and Assessment Scheme | last2=Office of Chemical Safety and Environmental Health|location=Canberra, Australia|dead-url=y|archive-date=Nov 2010|archive-url=https://web.archive.org.au/awa/20160615131255mp_/https://www.nicnas.gov.au/__data/assets/word_doc/0015/17223/MCS-Final-Report-for-publication-November-2010-hardcopy-version.docx}}</ref> the condition is reported across industrialized countries and the data suggests it affects women more than men.<ref name="Rossi2018" /><ref name="pmid30088144" /><ref name="Valderrama2015" /><ref name="Carress2004">{{Cite journal|vauthors=Caress SM, Steinemann AC|date=May 2004|title=Prevalence of Multiple Chemical Sensitivities: A Population-Based Study in the Southeastern United States|journal=Am J Public Health|volume=94|issue=5|pages=746–747|pmc=1448331|pmid=15117694|doi=10.2105/ajph.94.5.746|url=https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.94.5.746}}</ref><ref name="Berg2008">{{Cite journal | last =Berg| first = Nikolaj Drimer | last2=Linneberg | first2=Allan | last3 = Dirksen | first3 = Asger | last4 = Elberling | first4 = Jesper|date=2008-07-01|title=Prevalence of self-reported symptoms and consequences related to inhalation of airborne chemicals in a Danish general population|url=https://doi.org/10.1007/s00420-007-0282-0|journal=International Archives of Occupational and Environmental Health|language=en|volume=81|issue=7|pages=881–887|doi=10.1007/s00420-007-0282-0|issn=1432-1246}}</ref><ref>{{Cite journal | last =Andersson | first = Linus | last2=Johansson | first2=Åke | last3 = Millqvist | first3 = Eva | last4 = Nordin | first4 = Steven | last5 = Bende | first5 = Mats|date=2008-10-01|title=Prevalence and risk factors for chemical sensitivity and sensory hyperreactivity in teenagers|url=http://www.sciencedirect.com/science/article/pii/S1438463908000199|journal=International Journal of Hygiene and Environmental Health|language=en|volume=211|issue=5|pages=690–697|doi=10.1016/j.ijheh.2008.02.002|issn=1438-4639}}</ref> The most extensive epidemiological study into MCS in the U.S. was in 2005.<ref name="Steinemann2005">{{Cite journal|url=https://www.tandfonline.com/doi/abs/10.3200/AEOH.58.6.300-305 | last =Steinemann AC.|title=A national population study of the prevalence of multiple chemical sensitivity|journal=Arch Environ Health |date=2005|volume=59|issue=6)|pages=300-5}}</ref> It found that the national prevalence rate for MCS diagnosed by a doctor was 2.5% and self-reported MCS was 11.2%.<ref name="Steinemann2005" /><ref>{{Cite journal | last =Caress | first = SM | last2=Steinemann | first2=AC|date=2009-02-01|title=Asthma and chemical hypersensitivity: prevalence, etiology, and age of onset|url=https://doi.org/10.1177/0748233709102713|journal=Toxicology and Industrial Health|language=en|volume=25|issue=1|pages=71–78|doi=10.1177/0748233709102713|issn=0748-2337}}</ref> 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.<ref name="Steinemann2018" /> They found that 12.8% of those surveyed reported medically diagnosed MCS and 25.9% reported having chemical sensitivities.<ref name="Steinemann2018" /> 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.<ref name=":7" /><ref>Canadian Community Health Survey (CCHS) 2014, Ministry of Health and Long-Term Care Share File, Statistics Canada.</ref> 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.<ref>{{Cite web|url=https://www.infoamica.it/danimarca-nuovo-codice-per-la-mcs/|title=Danimarca: nuovo codice per la MCS | last = | first = |authorlink= | last2= | first2= | authorlink2=|date=2014|website=|language=it-IT|trans-title=Denmark: A new code for MCS|archive-url=|archive-date=|dead-url=|access-date=2020-05-14}}</ref> 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.<ref name=":50">{{Cite journal | last =Pigatto | first = Paolo D. | last2=Guzzi | first2=Gianpaolo|date=2019-06-01|title=Prevalence and risk factors for multiple chemical sensitivity in Australia|url=http://www.sciencedirect.com/science/article/pii/S2211335519300415|journal=Preventive Medicine Reports|language=en|volume=14|pages=100856|doi=10.1016/j.pmedr.2019.100856|issn=2211-3355}}</ref><ref name=":21">{{Cite news|url=https://about.unimelb.edu.au/newsroom/news/2018/july/common-chemical-products-making-australians-sick-study-finds|title=Common chemical products making Australians sick, study finds | last = | first = |date=Jul 2, 2018|work=The University of Melbourne Newsroom|access-date=Nov 20, 2019}}</ref><ref>[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.</ref> The study also found that for 55.4% of those with MCS, the symptoms triggered by chemical exposures could be disabling.<ref name=":21" /><ref name="Steinemann2018" /> These findings show that in the above countries MCS is not a rare condition. == Recognition == In 1996, an expert panel at [[World Health Organization|WHO]]/ICPS (International Classification for Patient Safety) was set up to examine MCS.<ref name=":45" /> The panel: # "accepted the existence of a disease of unclear pathogenesis", # 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," # 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.<ref name=":45" /> 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: # '''J68.9''': unspecified respiratory conditions due to inhalation of fumes, gas, and chemical vapors; and # '''T78.4''': unspecified allergies (allergic reaction Nitrous Oxide System (NOS)-hypersensitivity NOS-idiosyncrasy NOS)."<ref name="Rossi2018" />{{Rp|139}} In the '''ICD-10-DM''' and '''ICD-10-SGB-V''', [[Germany|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]].<ref>{{Cite book | title=ICD-10-GM Version 2012 : internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme|pages=184|isbn=978-3-7691-3481-0|edition=2012|volume=|language=de|title-link=|url=https://books.google.co.uk/books?id=E2Sy_nN0O8sC&lpg=PT53&ots=dgNsEl1meY&dq=%C3%9Cberempfindlichkeit%20T78.4%20multiple%20chemical%20sensitivity&pg=PT53#v=onepage&q=%C3%9Cberempfindlichkeit%20T78.4%20multiple%20chemical%20sensitivity&f=false|access-date=|date=2011|publisher=Deutscher Ärzteverlag | last =World Health Organization | first = |author-link=World Health Organization | last2=DIMDI | first2=|author-link2= | last3 = | first3 = |author-link3= | last4 = | first4 = |author-link4= | last5 = | first5 = | authorlink5 = | last6 = | first6 = |author-link6= | last7 = | first7 = |author-link7= | last8 = |first8 = |author-link8= | last9 = | first9 = |author-link9=|veditors=|others=|doi=|oclc=|quote=|archive-url=|archive-date=|location=|editor-last=|editor-first=|editor1-link=|editor-last2=|editor-first2=}}</ref><ref name="Rossi2018" /> Japan also recognizes MCS as a separate disease.<ref name="Rossi2018" />{{Rp|139}}<ref name=":10">{{citation|trans-chapter=4.1 "First, do no harm": environmental chemical avoidance|chapter=4.1 "Innanzitutto, non nuocere": l'evitamento chimica ambientale|url=https://www.infoamica.it/wp-content/uploads/2019/07/Consenso-MCS-20-giugno-2019.pdf|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|trans-title=Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS | last =Grouppo di Italiano Studio MCS|location=Università degli Studi di Milano, Italy|date=2019-05-23|quote='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]}}</ref><ref name=":41">{{Cite book | isbn=978-0-9807221-4-7|url=http://test.nicnas.gov.au/Media/Latest_News/MCS.asp|title=A Scientific Review of Multiple Chemical Sensitivity: Identifying Key Research Needs|date=2010 | last =National Industrial Chemicals Notification and Assessment Scheme | last2=Office of Chemical Safety and Environmental Health|location=Canberra, Australia|page=15|dead-url=y|archive-date=Nov 2010|archive-url=https://web.archive.org.au/awa/20160615131255mp_/https://www.nicnas.gov.au/__data/assets/word_doc/0015/17223/MCS-Final-Report-for-publication-November-2010-hardcopy-version.docx|chapter=2.5 Does MCS have a disease classification?|quote=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}}</ref> And in some countries, like [[Sweden]], chemical sensitivities are classified as a form of sensory hyperreactivity (CSS-SHR).<ref name="Steinemann2018" /> And as mentioned [[Multiple chemical sensitivity#MCS in ME and ME.2FCFS|above]], chemical sensitivities are recognized symptoms of ME/CFS. In 2018, the U.S. [[Centers for Disease Control and Prevention|Centers for Disease Control and Prevention]] (CDC) said that ME/CFS patients can have sensitivities to chemicals.<ref>{{Cite web|url=https://www.cdc.gov/me-cfs/symptoms-diagnosis/symptoms.html|title=Symptoms of ME/CFS {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | last =Centers for Disease Control | first = |authorlink=Centers for Disease Control and Prevention | last2= | first2= | authorlink2=|date=2019-11-19|website=www.cdc.gov|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-05-14}}</ref> == 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.<ref name=":41" /><ref name=":45">{{Cite journal | last =Schwenk| first = Michael|date=2004|title=Multiple Chemical Sensitivity (MCS) - Scientific and Public-Health Aspects|url=https://www.ncbi.nlm.nih.gov/pubmed/22073047|journal=GMS current topics in otorhinolaryngology, head and neck surgery|volume=3|pages=Doc05|issn=1865-1011|pmc=3199799|pmid=22073047}}</ref> 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.<ref name=":41" /><ref name=":45" /> 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.<ref name="Rossi2018" /><ref name="pmid10444033" /> 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.<ref name=":45" /> 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.''<ref name="ItalianConsensus">{{citation|url=https://www.infoamica.it/wp-content/uploads/2019/07/Consenso-MCS-20-giugno-2019.pdf|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|trans-title=Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS | last =Grouppo di Italiano Studio MCS|location=Università degli Studi di Milano, Italy|date=2019-05-23}}</ref> 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. ==Causes == 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.<ref name=":7" />{{Rp|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."<ref name=":7" />{{Rp|53}} 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<ref name=":40">''[https://www.racp.edu.au/docs/default-source/advocacy-library/racp-submission-to-the-australian-parliament-s-health-aged-care-and-sport-committee-inquiry-into-biotoxin-related-illnesses-in-australia.pdf?sfvrsn=7ae3131a_4 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.</ref> 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."<ref name="Hansard9Aug2018">{{citation|url=https://parlinfo.aph.gov.au/parlInfo/download/committees/commrep/e7694a12-573a-4e51-933d-46fe0f9a9a3d/toc_pdf/Standing%20Committee%20on%20Health,%20Aged%20Care%20and%20Sport_2018_08_09_6406_Official.pdf;fileType=application%2Fpdf#search=%22committees/commrep/e7694a12-573a-4e51-933d-46fe0f9a9a3d/0001%22|title=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|date=Aug 9, 2018|location=Canberra|publisher=House of Representatives, Hansard Records}}</ref>{{Rp|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 Pall|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."<ref name=":9">{{citation|chapter=1.2 Scatenamento della MCS|trans-chapter=1.2 Triggering of MCS|url=https://www.infoamica.it/wp-content/uploads/2019/07/Consenso-MCS-20-giugno-2019.pdf|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|trans-title=Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS | last =Grouppo di Italiano Studio MCS|location=Università degli Studi di Milano, Italy|date=2019-05-23}}</ref><ref name=":5">{{Cite book | chapter=What are the symptoms of MCS|isbn=978-0-9807221-4-7|url=http://test.nicnas.gov.au/Media/Latest_News/MCS.asp|title=A Scientific Review of Multiple Chemical Sensitivity: Identifying Key Research Needs|date=2010 | last =National Industrial Chemicals Notification and Assessment Scheme | last2=Office of Chemical Safety and Environmental Health|location=Canberra, Australia||dead-url=y|archive-date=Nov 2010|archive-url=https://web.archive.org.au/awa/20160615131255mp_/https://www.nicnas.gov.au/__data/assets/word_doc/0015/17223/MCS-Final-Report-for-publication-November-2010-hardcopy-version.docx}}</ref> Pall hypothesized that overactivity of the NMDA receptors, coupled with stress-related increases in [[nitric oxide]] and the oxidative product [[peroxynitrite]] (known as the [[Nitric oxide hypothesis|NO/ONOO cycle]]) caused MCS symptoms and worsened the condition.<ref name=":15">{{Cite book | title=[[Explaining "Unexplained Illnesses"|Explaining "Unexplained illnesses": Disease Paradigm for Chronic Fatigue Syndrome, Multiple Chemical Sensitivity, Fibromyalgia, Post-Traumatic Stress Disorder, Gulf War Syndrome and Others]] | last =Pall| first = Martin L.|publisher=Routledge & Harrington Park Press|year=2007|isbn=978-0789023896|location=New York}}</ref><ref>{{Cite journal|vauthors=Pall ML, Satterlee JD|date=2001|title=Elevated nitric oxide/peroxynitrite mechanism for the common etiology of multiple chemical sensitivity, chronic fatigue syndrome, and Post Traumatic stress disorder|url=https://semanticscholar.org/paper/d804ba7af6079f3d70cf1f4feb43d17d4e22a021|journal=Annals of the New York Academy of Sciences|volume=933|issue=1|pages=323–9|via=|doi=10.1111/j.1749-6632.2001.tb05836.x|pmid=12000033|bibcode=2001NYASA.933..323P}}</ref> He suggestedthat hypersensitivity occurred because of limbic kindling, neural sensitization, and/or neurogenic inflammation—processes which could be driven by the NO/ONOO cycle.<ref name=":5" /> 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,<ref name=":4">{{citation|trans-chapter=1.4 Proposed mechanisms for MCS|chapter=1.4 Meccanismo proposti per la MCS|url=https://www.infoamica.it/wp-content/uploads/2019/07/Consenso-MCS-20-giugno-2019.pdf|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|trans-title=Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS | last =Grouppo di Italiano Studio MCS|location=Università degli Studi di Milano, Italy|date=2019-05-23}}</ref> including Dr. Iris Bell's theory of neuronal sensitization<ref name=":17">{{Cite journal | last =Bell | first = Iris R. | last2=Baldwin | first2=Carol M. | last3 = Fernandez | first3 = Mercedes | last4 = Schwartz | first4 = Gary E.R.|date=1999-04-01|title=Neural sensitization model for multiple chemical sensitivity: overview of theory and empirical evidence|url=https://doi.org/10.1177/074823379901500303|journal=Toxicology and Industrial Health|language=en|volume=15|issue=3-4|pages=295–304|doi=10.1177/074823379901500303|issn=0748-2337}}</ref><ref name=":18">{{Cite journal | last =Bell | first = IR|author-link= | last2=Rossi | first2=J|author-link2= | last3 = Gilbert | first3 = ME|author-link3= | last4 = Kobal | first4 = G|author-link4= | last5 = Morrow | first5 = LA | authorlink5 = | last6 = Newlin | first6 = DB|author-link6= | last7 = Sorg | first7 = BA | last8 = Wood|first8 = RW|date=1997-03-01|title=Testing the neural sensitization and kindling hypothesis for illness from low levels of environmental chemicals.|url=https://ehp.niehs.nih.gov/doi/abs/10.1289/ehp.97105s2539|journal=Environmental Health Perspectives|volume=105|issue=suppl 2|pages=539–547|doi=10.1289/ehp.97105s2539|pmc = 1469815|pmid=9167993|access-date=|quote=|via=}}</ref> and William Meggs’ theory of neurogenic inflammation.<ref name=":16">{{Cite journal | last =Meggs | first = William J.|date=2017-05-09|title=The Role of Neurogenic Inflammation in Chemical Sensitivity|url=https://www.liebertpub.com/doi/full/10.1089/eco.2016.0045|journal=Ecopsychology|volume=9|issue=2|pages=83–89|doi=10.1089/eco.2016.0045}}</ref> 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.<ref name=":4" />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."<ref name="4.3">{{citation|chapter=4.3|trans-chapter=4.3 Reduction of risk|url=https://www.infoamica.it/wp-content/uploads/2019/07/Consenso-MCS-20-giugno-2019.pdf|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|trans-title=Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS | last =Grouppo di Italiano Studio MCS|location=Università degli Studi di Milano, Italy|date=2019-05-23}}</ref> 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<ref>{{cite journal|vauthors=Reid S, et al|year=|title=Multiple Chemical Sensitivity and Chronic Fatigue Syndrome in British Gulf War Veterans|url=https://doi.org/10.1093%2Faje%2F153.6.604|journal=American Journal of Epidemiology|volume=153|issue=6|pages=604–9|doi=10.1093/aje/153.6.604|pmid=11257069 | last = | first = | last2= | first2=|date=2001|pmc=|quote= | last3 = | first3 = | last4 = | first4 = | last5 = | first5 = | last6 = | first6 = | last7 = | first7 = | last8 = |first8 = |author-link= | authorlink5 = |via=}}</ref><ref name=":15" /> as well as the fact that chemical sensitivities are a known symptom reported in Gulf war syndrome or post-deployment syndrome.<ref>[https://europepmc.org/abstract/med/15757795 Gronseth GS. Gulf war syndrome: A toxic exposure? A systematic review. ''Neurol Clin''. May 2005;23(2):523-540.]</ref><ref name=":48">{{Cite web|url=https://www.healthquality.va.gov/guidelines/MR/cmi/VADoDCMICPG2014.pdf|title=Clinical practice guideline for the management of chronic multisystem illness | last =U.S. Department of Veterans Affairs, Department of Defense|date=Oct 2014}}</ref><ref>{{Cite journal | last =Spelman | first = Juliette F. | last2=Hunt | first2=Stephen C. | last3 = Seal | first3 = Karen H. | last4 = Burgo-Black | first4 = A. Lucile|date=2012-09-01|title=Post Deployment Care for Returning Combat Veterans|url=https://doi.org/10.1007/s11606-012-2061-1|journal=Journal of General Internal Medicine|language=en|volume=27|issue=9|pages=1200–1209|doi=10.1007/s11606-012-2061-1|issn=1525-1497|pmc = 3514997|pmid=22648608}}</ref> 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.<ref name=":48" /> [[Mold]] and mycotoxin exposures have also been hypothesized to trigger the onset of MCS.<ref name="Rea2010">{{Cite journal | last =Rea | first = William J.|date=2018-06-01|title=A Large Case-series of Successful Treatment of Patients Exposed to Mold and Mycotoxin|url=http://www.sciencedirect.com/science/article/pii/S0149291818301899|journal=Clinical Therapeutics|language=en|volume=40|issue=6|pages=889–893|doi=10.1016/j.clinthera.2018.05.003|issn=0149-2918}}</ref><ref>{{Cite journal | last =Lieberman | first = Allan | last2=Rea | first2=William | last3 = Curtis | first3 = Luke|date=2006-09-01|title=Adverse health effects of indoor mold exposure|url=https://www.jacionline.org/article/S0091-6749(06)01396-0/abstract|journal=Journal of Allergy and Clinical Immunology|language=English|volume=118|issue=3|pages=763|doi=10.1016/j.jaci.2006.06.037|issn=0091-6749|pmid=16950304}}</ref><ref>{{Cite journal | last =Vojdani | first = Aristo | last2=Thrasher | first2=Jack D. | last3 = Madison | first3 = Roberta A. | last4 = Gray | first4 = Michael R. | last5 = Heuser | first5 = Gunnar | last6 = Campbell | first6 = Andrew W.|date=2003-07-01|title=Antibodies to Molds and Satratoxin in Individuals Exposed in Water-Damaged Buildings|url=https://doi.org/10.1080/00039896.2003.11879143|journal=Archives of Environmental Health: An International Journal|volume=58|issue=7|pages=421–432|doi=10.1080/00039896.2003.11879143|issn=0003-9896|pmid=15143855}}</ref><ref name="Hansard9Aug2018" /> 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.<ref>{{Cite book | last=Hänninen | first = Otto O.|author-link= | last2= | first2=|author-link2=|date=2011|editor-last=Adan|editor-first=Olaf C. G. |editor2-last=Samson|editor2-first=Robert A.|title=Fundamentals of mold growth in indoor environments and strategies for healthy living.|url=https://doi.org/10.3920/978-90-8686-722-6_10|journal=|chapter=World Health Organisation (WHO) Guidelines for Indoor Air Quality: dampness and mold.|language=en|location=Wageningen|publisher=Academic Publishers|pages=277–302|doi=10.3920/978-90-8686-722-6_10|isbn=978-90-8686-722-6|access-date=|quote=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.|via=|ISBN=}}</ref><ref name=":40" /><ref name="Knibbs2018">{{Cite journal | last =Knibbs | first = Luke D.|author-link= | last2=Woldeyohannes | first2=Solomon|author-link2= | last3 = Marks | first3 = Guy B.|author-link3= | last4 = Cowie | first4 = Christine T.|author-link4= | last5 = | first5 = | authorlink5 = | last6 = | first6 = |author-link6= | last7 = | first7 = | last8 = |first8 = |date=2018|title=Damp housing, gas stoves, and the burden of childhood asthma in Australia|url=https://onlinelibrary.wiley.com/doi/abs/10.5694/mja17.00469|journal=Medical Journal of Australia|language=en|volume=208|issue=7|pages=299–302|doi=10.5694/mja17.00469|issn=1326-5377|pmc=|pmid=|access-date=|quote=Exposure to damp housing and gas stoves is common in Australia, and is associated with a considerable proportion of the childhood asthma burden.|via=}}</ref><ref>{{Cite journal | last =Quansah | first = Reginald | last2=Jaakkola | first2=Maritta S. | last3 = Hugg | first3 = Timo T. | last4 = Heikkinen | first4 = Sirpa A M. | last5 = Jaakkola | first5 = Jouni J.K.|date=2012-11-07|title=Residential Dampness and Molds and the Risk of Developing Asthma: A Systematic Review and Meta-Analysis|url=https://journals.plos.org/plosone/article/file?type=printable&id=10.1371/journal.pone.0047526|journal=PLoS ONE|volume=7|issue=11|pages=e47526|doi=10.1371/journal.pone.0047526|issn=1932-6203|pmc = 3492391|pmid=23144822}}</ref><ref>{{Cite journal | last =Mendell| first = Mark J|author-link= | last2=Mirer | first2=Anna G|author-link2= | last3 = Cheung | first3 = Kerry | author-link3= | last4 = Tong | first4 = My | author-link4= | last5 = Douwes | first5 = Jeroen | authorlink5 = | last6 = | first6 = |author-link6= | last7 = | first7 = | last8 = |first8 = |date=2011-06-01|title=Respiratory and Allergic Health Effects of Dampness, Mold, and Dampness-Related Agents: A Review of the Epidemiologic Evidence|url=https://ehp.niehs.nih.gov/doi/full/10.1289/ehp.1002410|journal=Environmental Health Perspectives|volume=119|issue=6|pages=748–756|doi=10.1289/ehp.1002410|pmc = 3114807|pmid=21269928|access-date=|quote=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.|via=}}</ref> {{See also|Mold illness}} === Neurological === Many common symptoms of MCS are neurological<ref name="Rossi2018" /><ref name="pmid30088144" /><ref name=":0">{{citation|chapter=1. Sensibilitá Chimica Multipla (MCS): Definizione di Caso|trans-chapter=1. Clinical features of the disease|url=https://www.infoamica.it/wp-content/uploads/2019/07/Consenso-MCS-20-giugno-2019.pdf|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|trans-title=Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS | last =Grouppo di Italiano Studio MCS|location=Università degli Studi di Milano, Italy|date=2019-05-23}}</ref> (for example, "dizziness, seizures, head pain, fainting, loss of coordination"<ref name="Steinemann2018" />). And neurogenic inflammation and sensitization are widely thought to be mechanisms involved in causing, perpetuating and worsening MCS.<ref name=":0" /><ref name=":17" /><ref name=":18" /><ref name=":16" /> William Meggs said that [[Neuroinflammation|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.<ref name=":16" /> 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.<ref name=":4" /><ref>[https://europepmc.org/abstract/med/7778120 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.]</ref> 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.<ref>[https://www.sciencedirect.com/science/article/pii/S000632239700245X 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.]</ref> 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|autonomic nervous system areas]].<ref name=":4" /><ref>[https://www.tandfonline.com/doi/abs/10.1080/15287399409531843 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.]</ref><ref>[https://www.sciencedirect.com/science/article/pii/B9780120597857500478 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.]</ref><ref>[https://europepmc.org/abstract/med/7778114 Heuser G, Mena I, Alamos F. NeuroSPECT findings in patients exposed to neurotoxic chemicals. ''Toxicol Ind Health'' 1994; 10(4-5): 561-71.]</ref><ref>[https://onlinelibrary.wiley.com/doi/abs/10.1002/hbm.20266 Hillert L, Musabasic V, Berglund H, Ciumas C, Savic I. Odor processing in multiple chemical sensitivity. ''Hum Brain Mapp'' 2006; 28(3): 172-82.]</ref><ref>[https://journals.sagepub.com/doi/abs/10.1177/074823379901500316 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.]</ref> These abnormalities have been documented both in studies using [[Positron emission tomography]] (PET) and [[Single-photon emission computed tomography]] (SPECT) scans.<ref name=":4" /><ref>[https://link.springer.com/article/10.1007/s10548-015-0453-3 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.]</ref><ref>[https://link.springer.com/article/10.1007/s00259-014-2969-2 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]</ref> 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.”<ref name="Hansard9Aug2018" />{{Rp|12}}<ref name=":40" /> ===Immunological=== MCS is not an allergy, and subjects with MCS having adverse reactions do not routinely exhibit the immune markers associated with allergies.<ref name="NICNAS" />{{Rp|21}} Nevertheless, certain immune irregularities have been identified in subjects with MCS in a range of studies.<ref name="Rossi2018" /><ref name=":4" /><ref name="NICNAS" />{{Rp|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.<ref name="NICNAS" />{{Rp|22}}<ref name="Genuis2013" /> While others concluded that allergic or immunotoxicological reactions could be contributing factors in at least a subset of MCS patients.<ref name="NICNAS" />{{Rp|22}}<ref>Albright JF, Goldstein RA. Is there evidence of an immunologic basis for multiple chemical sensitivity? Toxicol Ind Health 1992; 8(4): 215-9.</ref><ref>Meggs WJ (1992) MCS and the immune system. Toxicol Ind Health 8(4):203-214.</ref> As more studies were conducted, however, some argued that there was no consistent pattern of immunological reactivity or abnormality in MCS.<ref name="NICNAS" />{{Rp|22}}<ref name="Graveling1999">{{cite journal|vauthors=Graveling RA, Pilkington A, George JP, Butler MP, Tannahill SN|year=1999|title=A review of multiple chemical sensitivity|url=https://www.ncbi.nlm.nih.gov/pubmed/10448311|journal=Occupational and Environmental Medicine|volume=56|issue=2|pages=73–85|doi=10.1136/oem.56.2.73|pmc=1757696|pmid=10448311}}</ref><ref>[https://link.springer.com/article/10.1023/A:1026460726965 Labarge XS & McCaffrey RJ (2000) Multiple chemical sensitivity: a review of the theoretical and research literature. Neuropsychol Rev 10(4):183-211.]</ref> More recently, a French study found that subjects with MCS had higher levels of histamine than controls.<ref name=":4" /><ref name=":26">[https://www.degruyter.com/view/j/reveh.2015.30.issue-4/reveh-2015-0027/reveh-2015-0027.xml 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.]</ref> 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.<ref name=":4" /><ref name=":26" /> These findings led the research team to conclude that some level of immune activation was likely occurring in the condition.<ref name=":4" /><ref name=":26" /> There is also evidence that subjects with MCS are more likely than controls to have real allergies<ref name="Valderrama2015" />{{Rp|16}} and autoimmune diseases. And the 2019 consensus on MCS notes an association between the condition and [[Hashimoto's thyroiditis|Hashimoto's Thyroiditis]], [[Systemic lupus erythematosus|Systemic Lupus Erythematosus (SLE)]], [[psoriasis]] and atopic [[eczema]].<ref>{{citation|trans-chapter =3.11 Rheumatological evaluation|chapter=3.11|url=https://www.infoamica.it/wp-content/uploads/2019/07/Consenso-MCS-20-giugno-2019.pdf|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|trans-title=Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS | last =Grouppo di Italiano Studio MCS|location=Università degli Studi di Milano, Italy|date=2019-05-23}}</ref><ref>[https://www.ncbi.nlm.nih.gov/pubmed/20588228 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.]</ref><ref>[https://ehp.niehs.nih.gov/doi/abs/10.1289/ehp.97105s2417 Ziem G, McTamney J. Profile of patients with chemical injury and sensitivity. Environ Health Perspect 1997; 105 Suppl 2: 417-36.]</ref><ref>[https://europepmc.org/abstract/med/17594860 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.]</ref> === 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,<ref name=":12">{{citation|chapter=2. Epidemiologia|trans-chapter=2. Epidemiology|url=https://www.infoamica.it/wp-content/uploads/2019/07/Consenso-MCS-20-giugno-2019.pdf|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|trans-title=Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS) by the Italian Workgroup on MCS | last =Grouppo di Italiano Studio MCS|location=Università degli Studi di Milano, Italy|date=2019-05-23}}</ref> and the hypothesis that MCS has a psychological cause has attracted considerable criticism.<ref name=":7" /><ref name=":4" /><ref name="Genuis2013" /><ref>[https://journals.lww.com/joem/FullText/2018/08000/Multiple_Chemical_Sensitivity___Review_of_the.23.aspx 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]</ref><ref name="Davidoff1994">{{Cite journal | last =Davidoff | first = A.L. | author-link= | last2=Fogarty| first2 = L.|author-link2= | last3 = | first3 = |author-link3= | last4 = | first4 = |author-link4= | last5 = | first5 = | authorlink5 = | last6 = | first6 = |author-link6= | last7 = | first7 = | last8 = |first8 = |date=Sep 1994|title=Psychogenic origins of multiple chemical sensitivities syndrome: a critical review of the research literature|url=https://www.ncbi.nlm.nih.gov/pubmed/7944561|journal=Archives of Environmental Health|volume=49|issue=5|pages=316–325|doi=10.1080/00039896.1994.9954981|issn=0003-9896|pmc=|pmid=7944561|access-date=|quote=|via=}}</ref><ref>[https://www.mdpi.com/548534 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.]</ref><ref name="SBS">Cunich, Simon. [https://www.sbs.com.au/news/the-feed/mcs-the-condition-that-affects-one-million-australians-but-is-dismissed-by-doctors 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".''</ref><ref name="Davidoff1996">{{Cite journal | last =Davidoff | first = A.L. | author-link= | last2=Keyl | first2=P.M. | author-link2= | last3 = | first3 = |author-link3= | last4 = | first4 = |author-link4= | last5 = | first5 = | authorlink5 = | last6 = | first6 = |author-link6= | last7 = | first7 = | last8 = |first8 = |date=May 1996|title=Symptoms and health status in individuals with multiple chemical sensitivities syndrome from four reported sensitizing exposures and a general population comparison group|url=https://www.ncbi.nlm.nih.gov/pubmed/8687241|journal=Archives of Environmental Health|volume=51|issue=3|pages=201–213|doi=10.1080/00039896.1996.9936017|issn=0003-9896|pmc=|pmid=8687241|access-date=|quote=|via=}}</ref> The main arguments used to support the is that MCS has psychological causes have been: # there is no certainty about biological causes of MCS, therefore it must be psychological<ref>{{Cite journal | last =Gots | first = Ronald E.|date=1995-01-01|title=Editorial Commentary: Multiple Chemical Sensitivities–Public Policy|url=https://doi.org/10.3109/15563659509000459|journal=Journal of Toxicology: Clinical Toxicology|volume=33|issue=2|pages=111–113|doi=10.3109/15563659509000459|issn=0731-3810|pmid=7897748}}</ref><ref>{{citation|first =Kimberly | last =Hainge|url=https://www.ncagr.gov/SPCAP/pesticides/UpdateFall03.pdf|work=Pesticide Update|publisher=Florida Department of Agriculture & Consumer Services|volume=XXI|issue=1|date=Fall 2003|title=Multiple chemical sensitivity}}</ref> # that nocebo responses may operate in MCS,<ref>{{Cite journal | last =Binkley | first = K|author-link= | last2=Kutcher | first2=S|author-link2= | last3 = | first3 = |author-link3= | last4 = | first4 = |author-link4= | last5 = | first5 = | authorlink5 = | last6 = | first6 = |author-link6= | last7 = | first7 = | last8 = |first8 = |date=Apr 1997|title=Panic response to sodium lactate infusion in patients with multiple chemical sensitivity syndrome|url=https://doi.org/10.1016/s0091-6749(97)70086-1|journal=Journal of Allergy and Clinical Immunology|volume=99|issue=4|pages=570–574|doi=10.1016/s0091-6749(97)70086-1|issn=0091-6749|pmc=|pmid=|access-date=|quote=|via=}}</ref> and # that people with MCS are more likely than controls to have anxiety, depression and the personality trait absorption.<ref>[https://doi.org/10.1016%2Fs0091-6749%2897%2970086-1 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 A''. '''71''' (11–12): 795–802. doi: 10.1080/15287390801985687. PMID 18569578]</ref><ref>[http://www.psychosomaticmedicine.org/cgi/pmidlookup?view=long&pmid=16314597 Bailer J, Witthöft M, Paul C, Bayerl C, Rist F (2005). "Evidence for overlap between idiopathic environmental intolerance and somatoform disorders"]. ''Psychosom Med''. '''67''' (6): 921–9. doi: 10.1097/01.psy.0000174170.66109.b7. PMID 16314597]</ref> 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."<ref name=":4" /> 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.<ref name=":4" /> 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."<ref name=":4" /><ref name="Davidoff1994" /><ref name="Davidoff1996" /> Other researchers have emphasized that the psychosocial impacts of the disease (especially isolation and stigmatization) are likely to have significant impacts on mental health.<ref name=":7" />{{Rp|48}}<ref name="Davidoff1996" /><ref name="Davidoff1994" /><ref>[http://downloads.hindawi.com/journals/isrn.nursing/2011/838930.pdf Gibson PR, Lindberg A. Physicians' perceptions and real practices regarding patient reports of multiple chemical sensitivity. ISRN Nurs 2011; 2011: 838930.]</ref><ref name="Gibson2009" /><ref>"MCS and EI [Multiple Chemical Sensitivities and Environmental Illness]", [https://counselingatcela.com/ The Counseling Center at CELA] blog. "Is MCS a mental illness? MCS is not a mental illness." Accessed 18 Feb 2020.</ref><ref name="PMC2821254">{{Cite journal | last =Lavergne| first = M. Ruth|author-link= | last2=Cole | first2=Donald C.|author-link2= | last3 = Kerr | first3 = Kathleen|author-link3= | last4 = Marshall | first4 = Lynn M.|author-link4= | last5 = | first5 = | authorlink5 = | last6 = | first6 = |author-link6= | last7 = | first7 = | last8 = |first8 = |date=Feb 2010|title=Functional impairment in chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821254/|journal=Canadian Family Physician|volume=56|issue=2|pages=e57–e65|doi=|issn=0008-350X|pmc=2821254|pmid=20154232|access-date=|quote=|via=}}</ref> One study showed that anxiety and depression typically started in people with MCS post onset of the condition.<ref>{{Cite journal | last =Caress | first = Stanley M|author-link= | last2=Steinemann | first2=Anne C|author-link2= | last3 = | first3 = |author-link3= | last4 = | first4 = |author-link4= | last5 = | first5 = | authorlink5 = | last6 = | first6 = |author-link6= | last7 = | first7 = | last8 = |first8 = |date=2003-09-01|title=A review of a two-phase population study of multiple chemical sensitivities.|url=https://ehp.niehs.nih.gov/doi/10.1289/ehp.5940|journal=Environmental Health Perspectives|volume=111|issue=12|pages=1490–1497|doi=10.1289/ehp.5940|pmc = 1241652|pmid=12948889|access-date=|quote=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.|via=}}</ref> The presence of [[nocebo]] responses in MCS does not indicate that it is the cause of the disease.<ref>''[http://eceri-institute.org/fichiers/1441982765_Statement_EN_DEFINITIF.pdf 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."'' </ref> Nocebo responses are found in many biologically caused conditions,<ref>{{citation|url =https://www.health.harvard.edu/newsletter_article/The_nocebo_response|title = The nocebo response|website=Harvard Health. Harvard Medical School blog|date =Mar 2014|access-date=Feb 12, 2020}}</ref> including asthma, and they have been shown to be especially pronounced in neurological conditions (including [[migraine]] and chronic pain).<ref>{{Cite journal | last =Bittar | first = Caroline|author-link= | last2=Nascimento | first2=Osvaldo J.M. | author-link2= | last3 = | first3 = |author-link3= | last4 = | first4 = |author-link4= | last5 = | first5 = | authorlink5 = | last6 = | first6 = |author-link6= | last7 = | first7 = | last8 = |first8 = |date=Jan 2015|title=Placebo and nocebo effects in the neurological practice|url=https://www.ncbi.nlm.nih.gov/pubmed/25608129|journal=Arquivos De Neuro-Psiquiatria|volume=73|issue=1|pages=58–63|doi=10.1590/0004-282X20140180|issn=1678-4227|pmc=|pmid=25608129|access-date=|quote=|via=}}</ref> It is noteworthy that psychological approaches to care in MCS patients have had “very limited success,”<ref name=":7" />{{Rp|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''<ref>{{Cite book | title=Diagnostic and Statistical Manual of Mental Disorders (DSM-5)|pages=|isbn=978-0890425541|edition=5th|volume=|language=|title-link=|url=|access-date=|date=May 15, 2014|publisher=American Psychiatric Association | last =American Psychiatric Association | first = |author-link= | last2= | first2=|author-link2= | last3 = | first3 = |author-link3= | last4 = | first4 = |author-link4= | last5 = | first5 = | authorlink5 = | last6 = | first6 = |author-link6= | last7 = | first7 = |author-link7= | last8 = |first8 = |author-link8= | last9 = | first9 = |author-link9=|veditors=|others=|doi=|oclc=|quote=|archive-url=|archive-date=|location=|editor-last=|editor-first=|editor1-link=|editor-last2=|editor-first2=}}</ref>) nor have they been listed among somatoform disorders in the [[ICD-10|International Classification of Diseases]].<ref>[https://www.icd10data.com/ICD10CM/Codes/F01-F99/F40-F48/F45-/F45.8 "Other somatoform disorders". 2020 ICD-10-CM Diagnosis Code F45.8]</ref> 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.<ref name=":7" />{{Rp|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.<ref name=":4" /> 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.<ref name=":4" /> They also found that the presence of the following genetic polymorphisms were more likely in people with MCS than controls: NOS3, NOS2 and GPX1.<ref name=":4" /><ref name=":23">[https://www.hindawi.com/journals/mi/2015/245308/abs/ 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.]</ref><ref name=":24">[https://www.sciencedirect.com/science/article/pii/S0024320515301211 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.]</ref> Other genetic markers known to affect detoxification pathways have been identified as being more common in subjects with MCS than controls,<ref name=":4" /><ref name=":23" /><ref name=":24" /><ref name="DeLuca2011">[https://www.mdpi.com/1660-4601/8/7/2770 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.]</ref><ref>[http://downloads.hindawi.com/journals/oximed/2013/831969.pdf 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.]</ref><ref>[https://www.hindawi.com/journals/mi/2014/924184/abs/ 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.]</ref> including polymorphisms and differences in expression of the following: [[CYP2D6]], [[MTHFR]], [[NAT1]], [[NAT2]], [[GSTM1]], and [[PON1]] and [[PON2]].<ref>{{Cite web|url=https://www.karger.com/Article/FullText/497322|title=Assessment of CYP2C9, CYP2C19, and CYP2D6 Polymorphisms in Allergic Patients with Chemical Sensitivity | last =D’Attis | first = S|authorlink= | last2=Massari | first2=S | authorlink2=|date=2019|website=|pages=173–186|doi=10.1159/000497322|archive-url=|archive-date=|dead-url=|access-date=2020-05-14 | last3 = Mazzei | first3 = F | last4 = Maio | first4 = D | last5 = Bozzetti | first5 = MP | last6 = Vergallo | first6 = I | last7 = Mauro | first7 = S | last8 = Minelli|first8 = M|journal=Int Arch Allergy Immunol|volume=179|issue=}}</ref><ref name="McKeown et al. 2004">{{cite journal |vauthors=McKeown-Eyssen G, Baines C, Cole DE, Riley N, Tyndale RF, Marshall L, Jazmaji V | title = Case-control study of genotypes in multiple chemical sensitivity: CYP2D6, NAT1, NAT2, PON1, PON2 and MTHFR | volume = 33| issue = 5 | pages = 971–8 | pmid = 15256524 | doi = 10.1093/ije/dyh251 | journal = Psychosomatic Medicine |url=https://doi.org/10.1093%2Fije%2Fdyh251 | last = | first = | last2= | first2=|date=2004|pmc=|quote= | last3 = | first3 = | last4 = | first4 = | last5 = | first5 = | last6 = | first6 = | last7 = | first7 = | last8 = |first8 = |via= }}</ref><ref name="Schnackenberget">{{Cite journal | last =Schnakenberg | first = Eckart | last2=Fabig | first2=Karl-Rainer | last3 = Stanulla | first3 = Martin | last4 = Strobl | first4 = Nils | last5 = Lustig | first5 = Michael | last6 = Fabig | first6 = Nathalie | last7 = Schloot | first7 = Werner|date=2007-02-10|title=A cross-sectional study of self-reported chemical-related sensitivity is associated with gene variants of drug-metabolizing enzymes|url=https://doi.org/10.1186/1476-069X-6-6|journal=Environmental Health|volume=6|issue=1|pages=6|doi=10.1186/1476-069X-6-6|issn=1476-069X}}</ref> 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.<ref name=":4" /> ==In the media== ===Safe (1995) === ''Safe'' is a cult film, by writer and director Todd Haynes, known for its depiction of MCS as a profoundly alienating and destabilizing condition.<ref name=":13">{{Cite web|url=https://www.youtube.com/channel/UCOzFilLNcgrGzAeECAbUFCQ|title="Todd Haynes Q&A {{!}} Safe", Retrospective of Todd Haynes films | last = | first = |date=Nov 25, 2015|website=YouTube|archive-url=|archive-date=|access-date=Oct 30, 2019}}</ref> ''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.<ref name=":14">{{Cite web|url=https://www.youtube.com/watch?v=EZmjaC8cN10|title=Todd Haynes and Julianne Moore on Safe | last = | first = |date=|website=CriterionCollection, YouTube|archive-url=|archive-date=|access-date=Oct 30, 2019}}</ref> While Haynes said Carol’s isolation was both the answer and the problem for her.<ref name=":13" /><div role="note" class="hatnote navigation-not-searchable"></div> ==Notable studies and publications== *1999, Multiple chemical sensitivity: a 1999 consensus<ref name="pmid10444033" /> - [https://semanticscholar.org/paper/5d389fb8a204e089ce22e9cc7720aa8507581c2f (Full text)] *2018, Multiple Chemical Sensitivity: Review of the State of the Art in Epidemiology, Diagnosis, and Future Perspectives - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5794238/ (Full text)] * 2018, Perspectives on multisensory perception disruption in idiopathic environmental intolerance: a systematic review<ref name="pmid30088144">{{Cite journal | last1=Viziano | first1 = A. | last2=Micarelli | first2=A. | last3 = Pasquantonio | first3 = G. | last4 = Della-Morte | first4 = D. | last5 = Alessandrini | first5 = M.|date=Nov 2018|title=Perspectives on multisensory perception disruption in idiopathic environmental intolerance: a systematic review|journal=Int Arch Occup Environ Health|volume=91|issue=8|pages=923–935|doi=10.1007/s00420-018-1346-z|pmid=30088144|url=https://www.ncbi.nlm.nih.gov/pubmed/30088144|pmc=|quote= | last6 = }}</ref> - [https://www.ncbi.nlm.nih.gov/pubmed/30088144 (Abstract)] *2019, Italian Consensus on Multiple Chemical Sensitivity (MCS) -- Consensus Document and Guidelines on Multiple Chemical Sensitivity (MCS)<ref name="ItalianConsensus" /> - [https://www.infoamica.it/wp-content/uploads/2019/07/CONSENSO-MCS-ENGLISH.pdf (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'' - [https://www.infoamica.it/wp-content/uploads/2019/07/Consenso-MCS-20-giugno-2019.pdf (Full text - Italian)] == See also == * [[Sick building syndrome]] * [[Mold illness]] * [[Gulf War Illness]] * [[New allergies and intolerances]] * [[Psychologization]] == Learn more == *[https://www.mcs-aware.org/images/resources/Malcolm_Hooper_MCS_annotated_by_Gillian.pdf Multiple Chemical Sensitivity]<ref name=":1" /> (book chapter) - Malcolm Hooper *2010, [http://www.margaretwilliams.me/2010/allergies-and-mcs-in-mecfs.pdf Allergies and Multiple Chemical Sensitivity in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome]<ref>{{Cite web|url=http://www.margaretwilliams.me/2010/allergies-and-mcs-in-mecfs.pdf|title=Allergies and Multiple Chemical Sensitivities in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | last =Williams| first = Margaret|author-link=Margaret Williams|date=Nov 10, 2010|website=margaretwilliams.me|archive-url=|archive-date=|dead-url=|access-date=}}</ref> - Margaret Williams *2019, [https://www.infoamica.it/wp-content/uploads/2019/07/CONSENSO-MCS-ENGLISH.pdf Italian Consensus on Multiple Chemical Sensitivity (English translation)] *[https://www.msdmanuals.com/en-gb/home/special-subjects/idiopathic-environmental-intolerance/idiopathic-environmental-intolerance Idiopathic environmental intolerance] - MSD Manuals [[:Category:Sensitivity signs and symptoms]] [[:Category:Neurological signs and symptoms]] [[:Category:Immune signs and symptoms]] [[:Category:Sensitivity signs and symptoms]] [[:Category:Diagnoses]] [[:Category:Environmental toxicology]] == Cut content == They have also been found to decrease the quality of life of sufferers.<ref name="Rossi2018" /><ref name="pmid30088144" /><ref name=":7" /><ref name="Valderrama2015" /><ref name="Steinemann2018" /><ref>{{Cite journal | last =Loria-Kohen | first = Viviana | last2=Marcos-Pasero | first2=Helena | last3 = de la Iglesia | first3 = Rocío | last4 = Aguilar-Aguilar | first4 = Elena | last5 = Espinosa-Salinas | first5 = Isabel | last6 = Herranz | first6 = Jesús | last7 = Ramírez de Molina | first7 = Ana | last8 = Reglero|first8 = Guillermo|date=2017-08-22|title=Multiple chemical sensitivity: Genotypic characterization, nutritional status and quality of life in 52 patients|url=https://www.ncbi.nlm.nih.gov/pubmed/28283271|journal=Medicina Clinica|volume=149|issue=4|pages=141–146|doi=10.1016/j.medcli.2017.01.022|issn=1578-8989|pmid=28283271}}</ref><ref>{{Cite journal | last =Gibson | first = Pamela Reed | last2=Leaf | first2=Britney | last3 = Komisarcik | first3 = Victoria|date=2016-01-12|title=Unmet medical care needs in persons with multiple chemical sensitivity: A grounded theory of contested illness|url=http://www.sciedupress.com/journal/index.php/jnep/article/view/8165|journal=Journal of Nursing Education and Practice|language=en|volume=6|issue=5|pages=75|doi=10.5430/jnep.v6n5p75|issn=1925-4059}}</ref><ref>{{Cite journal | last =García-Sierra | first = Rosa | last2=Álvarez-Moleiro | first2=María|date=2014-07-01|title=Evaluation of suffering in individuals with multiple chemical sensitivity|url=http://www.sciencedirect.com/science/article/pii/S1130527414000073|journal=Clínica y Salud|language=en|volume=25|issue=2|pages=95–103|doi=10.1016/j.clysa.2014.06.006|issn=1130-5274}}</ref><ref>{{Cite journal | last =Alobid | first = Isam | last2=Nogué | first2=Santiago | last3 = Izquierdo-Dominguez | first3 = Adriana | last4 = Centellas | first4 = Silvia | last5 = Bernal-Sprekelsen | first5 = Manuel | last6 = Mullol | first6 = Joaquim|date=2014-12-01|title=Multiple chemical sensitivity worsens quality of life and cognitive and sensorial features of sense of smell|url=https://doi.org/10.1007/s00405-014-3015-5|journal=European Archives of Oto-Rhino-Laryngology|language=en|volume=271|issue=12|pages=3203–3208|doi=10.1007/s00405-014-3015-5|issn=1434-4726}}</ref><ref name="Gibson2009" /><ref>{{Cite journal | last =Koch | first = Lynn | last2=Vierstra | first2=Courtney | last3 = Penix | first3 = Ken|date=2006-09-01|title=A Qualitative Investigation of the Psychosocial Impact of Multiple Chemical Sensitivity|url=https://connect.springerpub.com/content|journal=Journal of Applied Rehabilitation Counseling|language=en|volume=37|issue=3|pages=33–40|doi=10.1891/0047-2220.37.3.33|issn=0047-2220}}</ref> == References == {{reflist}}
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