2019 Chemical Intolerance Symposium Abstracts
What Might We Learn from Clinical and Animal Studies?
Joseph Brain
Cecil K. and Philip Drinker Professor of Environmental Physiology, Harvard T.H. Chan School of Public Health
We confront a mystery or at least a complicated question. How can an exposure to a toxin have persistent and lifelong effects? How can a single or series of exposures change the dose-response curve to that toxin and to related toxins for months, years, or decades? This is not a new question. Biomedical science has documented the lifelong consequences of exposures in utero and early childhood on subsequent responses. Our quest is also a subset of a larger question. When we are exposed repeatedly to a substance, a gas or particle, do we respond the same way each time? Our instincts tell us that responses vary with time. Abundant diseases, especially asthma, show that when repeatedly exposed we either adapt or become sensitized. Unfortunately, many animal studies are characterized by rodents or other species being exposed to a toxin for the first time. Most published scientific experiments ignore the fact that animals will change their responses with repeated exposures.
We examined how mice respond to exposures of Stachybotrys chartarum a toxic but common mold which often appears after floods and other conditions lead to warm wet wood or cellulose. When mice who had experienced mold in their lungs for two months were challenged with mold and mold extracts, their responses were very different from naïve mice who were experiencing mold exposures for the first time. Depending on what parameters we measured we saw evidence of both adaptation and especially sensitization. The changes we observed showed a shift from Type 1 inflammation after an acute exposure to Type 2 after multiple exposures to S. chartarum. This session emphasizes not only animal studies but clinical studies of humans. Many of you have cohorts of humans exposed to characterized toxins in their day-to-day lives. It is not possible to expose naïve humans to toxins and compare their response to individuals who have been repeatedly exposed to that toxin or something else. We have developed a novel approach that allows us to perform ex vivo studies which validates what we can learn by in vitro cell studies and an in vivo animal studies. Peripheral blood mononuclear cells were isolated from blood from 33 patients with a history of mold exposures and from 17 matched controls. When these cultured human cells were incubated with mold mycotoxin or with mold extract, there was a difference in the chemokines and cytokines released into the culture medium between mold exposed and control humans. These enhanced responses were seen even in cells recovered from humans whose mold exposures had stopped for more than 6 months.
I believe that smell is a key ingredient in many cases of acquired intolerance. People rarely complain about this condition in response to agents that they cannot smell. Responses to toxins may involve conditioned responses. Conditioned responses can be documented with measurements of biomarkers in blood and changes in heart rate and breathing as well as cognition. These responses are real, they have an effect on those who experience them, and we need to take them seriously. Let us take advantage of the new tools we have to answer our questions and to test our hypotheses. We should not expect a single story, a single mechanism. We know there are many kinds of cardiovascular deaths, there are many forms of asthma, and there are many kinds of cancer. Why should this be different? We must be open to a variety of risk factors and a variety of expressions of this malady.
Brain Imaging Studies for CI Research
Torben Sigsgaard
Professor, MD, PhD, FERS[i], of Environmental & Occupational Medicine, Head of the research group of Environment Occupation and Health, Institute of Public Health & Head of the PhD program in Public Health at Faculty of Health, Aarhus University, DK.
Torben Sigsgaard is past Vice Chair of the Scientific Committee for the Danish Work Environment Fund, past President for the Danish Society of Agricultural Medicine. Chairs the Occupational & Environmental Health Assembly of the European Respiratory Society. He is editor of Clinical Respiratory Medicine and on the editorial board of several Journals including European respiratory Journal, Annals of work Exposure & Health, AAEM. Presently he is a member of the advisory board Health in Homes at Realdania, President: The Board for a Healthy Indoor Environment. Member of the Board of the National Research Centre for the Working Environment, the Standing Expert Committee on "Pollution, Environment and Health". Danish EPA and the Standing Expert Committee on "Pesticides” Danish EPA
Prof. Sigsgaard was the head of the Danish Centre for Indoor air and Health in Dwellings with more than 40 researchers working actively within the field of indoor air and health from 2010-16. His research interest covers the outdoor, indoor and occupational environment. The translational methods span epidemiology, exposure estimations and human toxicology. Within these environments, the organic components including microorganisms and allergens are the core of his research. The group hosts one of the best human exposure facilities in the world, and indoor air research has been performed here for more than 50 years. Since the outset, one aspect in professor Sigsgaard’s studies has been individual susceptibility, which has been addressed in a range of OEH-projects. Further Professor Sigsgaard is the head of the graduate program in Public Health at the PhD school of HEALTH, AU, and as such responsible for a prevalence of approximately 100 PhD students within this field of research. Sigsgaard has been the initiator of supervisor training at AU HEALTH and is still engaged in the development of pedagogic skills for supervisors at the PhD school.
Objectives and Organization of Workshop, Major Themes & Issues for Discussion
John Spengler
Akira Yamaguchi Professor of Environmental Health and Human Habitation, Harvard T.H. Chan School of Public Health
John D. Spengler has conducted research in the areas of personal monitoring, air pollution health effects, aerosol characterization, indoor air pollution and air pollution meteorology. Prof. Spengler has been active in professional education workshops, distance learning and short courses on topics that include pollution prevention and indoor environmental quality management for schools, offices and hospitals. He serves as an advisor to several global organizations, including the World Health Organization, where he contributes information on indoor air pollution, personal exposure and air pollution epidemiology. He has served as either a member or consultant on various U.S. EPA Science Advisory Board committees. He co-founded the Harvard Green Campus Initiative in 2000, chaired the university-wide committee on Harvard Sustainability Principles, and served on President Faust’s Harvard Greenhouse Gases Taskforce to develop the university’s carbon reduction goals and strategies. In 2003, Prof. Spengler received a Heinz Award for the Environment. In 2008, he received the Max von Pettenkofer award for distinguished contributions in indoor air science from the International Society of Indoor Air Quality and Climate’s Academy of Fellows. Most recently, he received a 2012 Haagen-Smit Prize. This annual prize is given to two outstanding papers published in the journal Atmospheric Environment. The award recognized a 1985 paper co-authored by Dr. Spengler and Dr. George Thurston, a 1983 Harvard graduate, titled “Quantitative Assess-ment of Source Contributions to Inhalable Particular Matter Pollution in Metropolitan Boston”. He currently directs the Hoffman Program for Chemicals and Health, and the Harvard JPB Environmental Health Fellowship program.
Neuropsychological Assessment with Chemically Intolerant Patients
Roberta F. White
Professor, Environmental Health, Boston University School of Public Health
Roberta F. White is a transdisciplinary scientist whose research focuses on the effects of exposure to industrial pollutants on brain function. Initially trained as a clinical psychologist/ neuropsychologist, her work employs cognitive and behavioral test measures and neuroimaging techniques to identify pollutant effects on the central nervous system.
Combining the fields of public health, behavioral neuroscience, and epidemiology as well as clinical neuropsychology, Professor White has explored the effects of occupational lead and solvent exposures on cognitive and affective expressions of brain function; elucidated prenatal effects of exposure to methylmercury and polychlorinated biphenyls on cognitive function and neuropsychological outcomes; identified chemical exposures that are associated with the occurrence of Gulf War Illness (GWI) following the Gulf War in 1991, and un- covered cognitive and neuroimaging evidence of structural brain damage associated with GWI and sarin exposure in the GW veteran population. Her work has had significant public health impact in setting standards for occupational exposure to lead, environmental expo- sure to methylmercury in utero, and acceptance of GWI as a physical illness related to chemical exposures in War theatre.
Professor White has written extensively on the clinical correlates of encephalopathies caused by exposure to chemical pollutants and co- wrote the World Health Organization criteria for diagnosis of solvent encephalopathy that are used internationally. She was Scientific Director of the Congressionally mandated Research Advisory Committee on Gulf War Illness from 2008-2015, which advises the Veterans Administration on its GWI research portfolio.
Advancement in Sensor and Smartphone-based Technologies
Jose Guillermo (Memo) Cedeño
Research Associate, Harvard T.H. Chan School of Public Health
Ubiquitous low-cost sensor technology has enabled scalable research protocols to answer important epidemiological questions. In combination with smartphone applications and other solutions to track physical activity and behavior, these tools open new possibilities to the MCS research agenda. I will discuss the use of a platform-based approach to conduct ecologic momentary assessment studies that could characterize environments, physiological responses, and objective and subjective outcomes from patients. By using smartphone apps as the central piece of the data collection process, researchers can easily follow large, multi-center study cohorts with high participation rates and low study administration burden. This study platform also permits the fast deployment of study protocols, making it ideal for fast response to critical events (e.g., chemical spills, natural disasters) which could represent an acute exposure and potentially an initiating event to chemical sensitization.
Large Population Studies in Sweden and Denmark
Thomas M. Dantoft
Project Manager, DanFunD Study. Center for Clinical Research and Prevention. Copenhagen University Hospital - Frederiksberg The Capital Region of Denmark
Thomas Dantoft is Project Manager for DanFunD (Danish Study of Functional Disorders), the world’s largest general population-based study of functional somatic syndromes. The study is funded by grants from the Danish foundations TrygFonden and The Lundbeck Foundation. Using data from the DanFunD study, Dr. Dantoft is involved in various research projects with the aim to unravel the epidemiology of functional somatic syndrome. Thomas Dantoft also has a special interest in multiple chemical sensitivity through a collaboration with researchers at Umeaa University in Sweden. Thomas Dantoft has an MSc. Eng. in biotechnology from Aalborg University and a PhD from DTU, Technical University of Denmark and The Danish Research Centre for Chemical Sensitivities (now closed) at Gentofte University Hospital. The primary aim of Thomas Dantoft’s PhD was to examine inflammatory biomarkers in persons with multiple chemical sensitivity.
Chemical Intolerance: Olfactory Correlates
Richard Doty
Professor of Psychology in Otorhinolaryngology: Head and Neck Surgery, University
of Pennsylvania; Director, University of Pennsylvania Smell and Taste Center
Altered olfactory function has been reported in patients experiencing chemical intolerance. Reactivity to chemicals in such patients has been suggested to be due to chemically-induced immunologic changes (e.g., allergies), neurotoxicity, genetic predispositions, damage to the olfactory neuroepithelium, and psychologic or cognitive processes. To date, there is little evidence that measures of olfactory sensitivity, notably odor threshold sensitivity, are altered in patients with chemical intolerance. However, ratings of the intensity and pleasantness of odorants appear to be impacted, and may reflect complex and often idiosyncratic associations between sensory and cognitive processes. Notably, there is evidence that many individuals who exhibit high reactivity to odorants also exhibit high reactivity to sounds, suggesting more generalized neural processes than commonly appreciated. In this presentation I will discuss findings from studies assessing relationships between reactivity to environmental odors and a range of psychological and cognitive measures, including conditioned responses to unpleasant stimuli that can trigger somatic episodes. I will emphasize the concept that responsiveness to odorants in patients with chemical intolerances may reflect, in many cases, top-down neurological processes.
The Role of Microbiome in Immunoregulation
Matt Frank
Senior Research Associate, University of Colorado Boulder
Matt is a senior research associate in the Department of Psychology and Neuroscience at the University of Colorado Boulder. His work, which is largely preclinical, has encompassed studying the role of neuroinflammation and microglia in stress, aging, drugs of abuse and chronic pain states. Much of this work has focused on stress- induced sensitization of neuroinflammatory responses to later occurring immune challenges, and the mechanisms involved in these phenomena. He has found that these mechanisms of neuoinflammatory sensitization involve alarmins and microglia checkpoint receptors in the brain. Recently, his research interests have turned to how stress dysregulates the microbiome and gut-immune-brain signaling. Stress- induced dysregulation of the microbiome is thought to compromise immunoregulation in the brain, which leads to sensitization of neuroinflammatory processes. Recent research from his laboratory has examined the exciting possibility of utilizing a psychobiotic approach (Mycobacterium vaccae) to enhance immunoregulation in the brain and the periphery, thereby desensitizing inflammatory processes. In light of his on- going research in this area, he feels that a psychobiotic approach may thus hold promise in mitigating sensitization of inflammatory processes in patients suffering from Multiple Chemical Sensitivity.
Mold Exposures and Their Immunological Effects
Dori Germolec
Group Leader, Systems Toxicology, National Institute of Environmental Health Sciences
Dori Germolec received her B.A. and M.A. degrees from Duke University and her Ph.D. in toxicology from North Carolina State University. From 1995 to 2006 she served as the group leader of the Environmental Immunology Laboratory at the National Institute of Environmental Health Sciences, examining the role of growth promoting cytokines in inflammation and cancer. Since 2006 she has worked full-time within the National Toxicology Program (NTP), where she currently serves as the Deputy Branch Chief for Toxicology. As the Immunology discipline lead she is responsible for the NTP’s efforts to validate test methods and to assess the potential for chemicals to modulate immune responses in humans and rodent models. Dr. Germolec also serves as a project lead within the NTP and designs and conducts rodent studies to evaluate the health effects of exposure to molds, mycotoxins, environmental contaminants and natural products. Her scientific activities have yielded over 200 publications in various areas of toxicology, resulting in the receipt of two NIH Merit Awards, The Society of Toxicology Best Publication Award in 1995 and a Best Publication Award from the Immunotoxicology Specialty Section in 2015. In 2004 she received the Outstanding Young Investigator Award from the Immunotoxicology Specialty Section of the SOT and in 2017 she was recognized with the Vos Award for Career Achievement in Immunotoxicology. Dr. Germolec is an adjunct faculty member in the Department of Molecular Biomedical Sciences in the College of Veterinary Medicine at North Carolina State University.
Mold Exposures and Their Immunological Effects
Brett J. Green
Research Biologist, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV
Personal exposure to fungal bioaerosols continues to be a major public health concern in the United States especially for residents of damp/contaminated indoor environments or residents returning to flood damaged homes following natural disasters such as hurricanes or flooding events. Increased community awareness of fungal exposures followed Hurricane Harvey where many homes in the Houston metropolitan area sustained significant flood damage and were inevitably contaminated with fungi. Fungi implicated in indoor contamination include filamentous forms known as “molds” and more recently unicellular forms termed “yeasts”. Recent epidemiological studies and published consensus reports have shown that indoor dampness and fungal exposure are important variables that influence respiratory health. The distribution of aerosolized fungi can be significantly higher in contaminated indoor and occupational environments and may induce diverse health problems, particularly in the immunocompromised. Typically, inhaled fungi are efficiently removed by host defense mechanisms, but the effect of repeated exposures on the development of allergic airway disease has remained inadequately characterized. There is also limited toxicological data on the consequences of long-term respiratory exposures to fungi. In this session, participants will be introduced to the field of mycology and the fungi that are identified using traditional and contemporary exposure assessment methods. This session will additionally introduce participants to the development of a unique aerosolization system used in animal model studies of repeated fungal exposure conducted in collaboration between the National Toxicology Program and NIOSH. Repeated inhalation exposure to Aspergillus fumigatus and Stachybotrys chartarum will be discussed. Further, the health hazards of additional fungal components such as fungal volatile organic compounds and fungal fragments will be reviewed and the potential implications for chemical intolerance discussed.
Personal MCS History
Bill Hayward
Founder & CEO, Hayward Score; Chief Sustainability Officer, Hayward Lumber
Bill is the founder of Hayward Score as well as the CEO and Chief Sustainability Officer of Hayward Lumber, a 95-year-old California lumber and building material supplier. Since 2008, when he, his wife, and their newborn daughter became sick in their “dream home,” Bill has been focused on combining building science and medical science into a compelling strategy to transform home construction so that homes will no longer degrade human health.
Evaluating, Treating and Managing Disabilities of Patients with Chemical Intolerance
Howard Hu
Affiliate Professor, University of Washington School of Public Health; Adjunct Professor, University of Michigan
Dr. Hu is a physician-scientist, internist and preventive medicine specialist, with a doc-oral degree in epidemiology (Albert Einstein College of Medicine; Boston City Hospital; Harvard School of Public Health). He has been a senior tenured Professor and Director of NIH-funded projects and Centers at the Harvard School of Public Health and Brigham & Women’s Hospital in Boston (1988-2006); the University of Michigan and University of Michigan Health System (2006-2012), where he was also Chair of the Department of Environmental Health Sciences; and the University of Toronto, where he was also the Founding Dean of the Dalla Lana School of Public Health (2012-2018). Dr. Hu has led international teams of scientists investigating the environmental, nutritional, social, psychosocial, genetic and epigenetic determinants of chronic disease and impaired child development in birth cohort and aging cohort studies in the U.S., Mexico, India, China, and elsewhere around the world. His team’s work has generated over 300 publications and won several awards, such as the 1999 Progress and Achievement Award from the U.S. NIH/ NIEHS, the 2011 Award of Excellence from the American Public Health Association, and the 2015 John Goldsmith Award for Outstanding Contributions from the International Society for Environmental Epidemiology. With regards to Environmental Sensitivities/Multiple Chemical Sensitivity (ES/MCS), he conducted related clinical research in the 1990’s, following over 300 patients with the disorder at academic occupational/environmental medicine clinics at Harvard, Michigan and Toronto. He chaired the 2016-2018 Ontario Provincial committee focused on improving the understanding and management of ES/MCS as well as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia.
Chemical Sensitivity/TILT from a Patient Perspective
Mark Cree Jackson
Sr. Product Manager, Indoor Environmental Quality, Daikin North America
Marilyn Hoffman and I met several times in Boston and found that she and I shared several similar experiences of the impact of environmental incitants. One of Marilyn’s frustrations, despite her financial resources, was her inability to obtain housing that optimized her health. I am pleased that Marilyn was able to establish the Marilyn Brachman Hoffman Foundation and The Hoffman Program on Chemicals and Health to further research into TILT. My hope is that through her work and legacy more can be learned about this complex medley of medical maladies and others may be able to create housing to optimize their health and performance. I am honored to have been asked to participate in this conference with Bill Hayward whose life has also been impacted by his environment and who works tirelessly to improve understanding and creation of optimal living environments. I will discuss my medical history, onset of chemical sensitivity, potential causes, and impact on my life, medical treatment and social support. Dealing with a medley of medical maladies related to chemical sensitivity over 30+ years provides a unique perspective on the relationship between human health and the environment. It provides a practical education on how the environment impacts at least one individual from moment-to-moment as well as motivation to learn more to help others avoid or reduce the impact of indoor environments on their health.
Increased Reporting of MCS Symptoms Following Complex Exposures
Howard Kipen
Professor, Department of Occupational and Environmental Health, Rutgers University School of Public Health
The prevalence of Multiple Chemical Sensitivities (MCS), and potentially related constructs of poorly explained symptoms (e.g., CFS or Systemic Exertion Intolerance), have been assessed following significant exposure events and disasters. These apparently epidemic, rather than endemic, presentations may inform about incidence, etiology, and aspects of pathophysiology. Outbreaks of unexplained symptoms not characterized as MCS per se but following non-chemical exposure may also be informative. No relevant data have been generated in rescue workers or community dwellers related to the events of 9/11. Data will be presented on the prevalence of MCS following complex exposures such as the 1990-1991Gulf War, although different investigators used differing definitions based on telephone interviews. Black et al (2000) completed telephone interviews with 3695 Iowans and found an overall MCS prevalence of 3.4% with 5.4% in deployed and 2.6% in the non-deployed. Reid et al (2001) found MCS in 1.3% of UK Gulf War veterans vs. 0.2% in era veterans. Reported exposure to pesticides had an OR of 12.3. Our own unpublished data on a random sample of US deployed and non-deployed soldiers showed, depending on definition, an MCS prevalence of 1.2 to 2.7% in deployed troops compared with 0.8 to 1.4% in non-deployed. The anthrax mail exposures on Capitol Hill demonstrated a high rate of post-event symptoms independent of actual anthrax exposure (Chaio et al, 2018). In a Gulf War registry study, symptoms were shown to persist for over 5 years (Ozakinci et al, 2006). The importance of prospective, population-based studies as well as objective measures of exposure is critical.
TILT: Clinical and Research Perspectives on Patient Diagnosis and Care
Claudia Miller
Professor Emeritus, Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio
Toxicant-Induced Loss of Tolerance (TILT) is a two-stage disease process first described in 1996, distilled from the collective observations of physicians and researchers in over a dozen countries. In Stage I (Initiation), following an initial exposure event, a subset of individuals develops multisystem symptoms and multiple chemical, food, and drug intolerances that never bothered them previously and do not bother most people. In Stage II (Triggering), tiny amounts of structurally unrelated substances trigger a broad range of multisystem symptoms which wax and wane depending upon exposures. Based upon our studies of groups exposed to pesticides, remodeling, and the Gulf War, we designed the Quick Environmental Exposure and Sensitivity Inventory (QEESI). The QEESI has expanded worldwide awareness of TILT. Its four scales, Chemical Exposures, Other Exposures, Symptoms, Impact of Sensitivities, and a Masking Index. The latter identifies ongoing exposures that may hide exposure-symptom relationships. Findings from the QEESI can serve in lieu of a case definition for CI because it provides a quantifiable, uniform method, for comparing patients and groups of patients. It has been used internationally in ~50 PubMed studies. Worldwide, this problem has had different names, some of which attribute onset to psychological causes. In contrast, Toxicant-Induced Loss of Tolerance, calls for investigation of potential initiators, such as exposures to: construction or remodeling, solvents, pesticides, combustion products, implants, or mold.
An Animal Model of Gulf War Syndrome Potentially Applicable to Development of Animal Models of CI
James O’ Callaghan
Molecular Neurotoxicology Laboratory, Health Effects Laboratory Division, Centers for Disease Control and Prevention-NIOSH, Morgantown, WV 2650
Veterans of the 1991 Gulf War (GW) were exposed to physiological stressors, prophylactic medicines, insecticides, insect repellants, and nerve agents, among other unknown chemicals and mixtures. Approximately 200,000 of these GW veterans returned with clinical symptoms that include chronic fatigue, headache, cognitive impairment, depression, muscle and joint pain, and gastrointestinal issues, among others. This multi‐symptom illness that persists in ill veterans today has been termed Gulf War Illness or Gulf War Syndrome (GWS). The constellation of symptoms associated with GWS resembles those associated with “sickness behavior.” Neuroinflammation, a condition characterized by the elaboration of proinflammatory mediators within the central nervous system, serves as the molecular basis of sickness behavior. Neuroinflammation and sickness behavior phenotypes can be evaluated in animal models with the data obtained being translatable to the human condition. Thus, we developed an animal model of GWS with the long-term goal of developing therapeutic interventions to treat ill GW veterans. When we subjected mice and rats to “in theater” exposure conditions using diisopropyl fluorophosphate (DFP) as a sarin surrogate, along with various organophosphate insecticides, neuroinflammation was observed throughout the brain. Furthermore, when these exposures were coupled with a stressor mimic, using exogenous corticosterone, the resultant neuroinflammation was exacerbated in degree and duration. Consistent with these animal data, exercise as a physiological stressor results in post-exertional malaise in veterans suffering from Gulf War Illness. These outcomes demonstrate the potential for recurrent stressors in the environment to greatly exacerbate and prolong chronic chemically-induced neuroinflammatory disorders. As is widely acknowledged, the complexity of these disorders remains a barrier to the development of therapeutic approaches
Environmental House Calls to Identify Potential Symptom Triggers in Chemically Intolerant Individuals
Raymond Palmer
University of Texas Health Science Center at San Antonio, San Antonio, TX
Participants in the Environmental House Call (EHC) study were enrolled from a busy primary care clinic. Participants were eligible to receive an EHC if they were chemically intolerant, as determined by scores of 40 or more points on the Chemical Intolerance (CI) and Symptom Scales of the Quick Environmental Exposure and Sensitivity Inventory (QEESI) – a globally validated diagnostic tool for CI. The EHC protocol involves a home walk-through assessment, indoor air quality (IAQ) measurements (including volatile organic compounds, mold, allergens, particulates, as well as temperature and humidity), laboratory analyses, and counseling/education as part of an individualized action plan to reduce symptom triggers. Pre- and post-intervention IAQ and symptom assessments were taken to determine which changes in the home were made, and whether symptom scores on the QEESI changed over a six-to-eight-month period. Frequent triggers identified in the homes were fragrance emitting devices (e.g., air fresheners), cleaning products, personal care products, and pesticides. Over 80% of house call participants reported improvement in cognitive, affective, gastrointestinal, neuromuscular, and/or head-related symptoms (e.g., headaches). Regression analysis showed reduction in VOCs significantly predicted symptom improvement. Genetic and cytokine effect modifiers were also identified. For example, some participants with normal functioning cytochrome p450 phenotypes (e.g., HTR2A, a serotonin receptor implicated in fibromyalgia and depression), improved more in cognitive, head-related, and gastrointestinal symptoms than participants with lower functioning HTR2A. This presentation will include a case study outlining specific changes made in the home environment and the associated symptom changes in that participant, and will illustrate use of the QEESI Symptom Star. The Symptom Star is a visual clinical and research tool for depicting improvement, or worsening, of symptoms following particular interventions or therapies in CI individuals.
How Might Epidemiological Investigations be Useful to Understanding Chemical Intolerance: Promise and Limitations
Jonathan M. Samet
MD, MS, Dean and Professor, Colorado School of Public Health Aurora, Colorado
“Back to the future”? In 1992, I chaired a workshop on Multiple Chemical Sensitivity (MCS) convened by the National Research Council that brought together a large, interdisciplinary group to address a topic that was highly controversial at the time. The summary from those considering epidemiological approaches began with: “The initial purpose and goal of epidemiologic research would be to establish the magnitude of the problem caused by the MCS phenomenon in the population and to characterize the cases sufficiently for further work. Full use of epidemiologic methods to study this issue is handicapped by the lack of a precise, agreed upon case definition. The lack of understanding of mechanisms and of the exposure patterns involved also restrict epidemiologic approaches at this time.” Although written almost three decades ago, these challenges remain and the proposed agenda of research, including a multi-site case-control study and population-based research was never enacted. These same approaches remain relevant and could be complemented with the new tools for phenotypic characterization (e.g., imaging) and exposure assessment (e.g., metabolomics) that are now available. A starting point would be a comprehensive characterization of MCS in the 21st century, in the setting of a different set of exposures and exposure circumstances than in the 1980s and 1990s when this syndrome was first described. Such characterization is a needed first step in refining questionnaires and determining the array of approaches needed for defining phenotypes. The basic epidemiological approaches remain relevant, and the case-control design is an appropriate starting point for addressing etiology. Biomarkers and imaging could provide mechanistic insights. Such research will not take place, however, absent support and a planning and steering mechanism.
CHEMICAL INTOLERANCE SYMPOSIUM PRESENTED BY THE MARILYN BRACHMAN HOFFMAN FOUNDATION IN PARTNERSHIP WITH THE HOFFMAN PROGRAM ON CHEMICALS AND HEALTH
Supporting Documents
These are links to articles or other resources provided by 2019 Symposium presenters. These materials are not comprehensively reflective of the subjects discussed at the Symposium.
Could Probiotics Be Used to Mitigate Neuroinflammation?
Comprehensive Gulf War Illness Research Program: Some Thoughts
Recent insights into three underrecognized conditions
Microbial 'Old Friends', immunoregulation and stress resilience
Prevalence of People Reporting Sensitivities to Chemicals in a Population based Survey
Summary of Public Comments Received for the Multiple Chemical Sensitivity Report
National Prevalence and Effects of Multiple Chemical Sensitivities
The Quick Environmental Exposure and Sensitivity Inventory, or QEESI©
Recognizing and Improving Care for those with ME/CFS, FM and ES/MCS
Evaluating Individuals · Reporting Sensitivities to Multiple Chemicals