Multiple chemical sensitivity

from Wikipedia, the free encyclopedia
Classification according to ICD-10
T78.4 Allergy, unspecified
ICD-10 online (WHO version 2019)

The multiple chemical sensitivity or multiple chemical intolerance (abbreviated MCS from English Multiple Chemical Sensitivity ) is a chronic multi-system disease with z. T. severe intolerance to various volatile chemicals, such as. B. fragrances , cigarette smoke , solvents or exhaust gases. The concentrations of these symptom-triggering substances are far below the threshold concentration that would cause irritation or toxic effects in healthy people. MCS is not recognized as an independent disease by numerous international professional associations such as the WHO or the AMA . In Germany, the ICD-10-GM classification under T78.4 was determined by the German Institute for Medical Documentation and Information .

Definition and basics

Names such as Multiple Chemical Sensitivity Syndrome (MCS Syndrome), multiple chemical sensitivity , multiple chemical intolerance , multiple chemical hypersensitivity , multiple chemical sensitivity , multiple chemical sensitivity , idiopathic environmental intolerances (IEI), idiopathic environmental intolerance, idiopathic environmental intolerance are synonymous or in the same context . idiopathic chemical sensitivity, environmental disease, eco-syndrome used.

The MCS consensus criteria according to Bartha et al.

  1. Symptoms are reproducible with repeated chemical exposures .
  2. The course of the disease is chronic.
  3. Symptoms are triggered by low exposure levels that are generally tolerated by other people or that were tolerated before the onset of the disease.
  4. Symptoms improve or go away completely if the triggers are avoided or removed.
  5. The symptoms are triggered by various chemically unrelated substances.
  6. Several organs or organ systems are affected by symptoms. [Added 1999]

According to Martin Pall , the criteria established by Cullen need to be revised. Numerous diagnostic laboratory tests are available today. The symptoms caused by central nervous system hypersensitivity should also be considered.

The course of the disease is divided into two phases: During sensitization phase I , exposure to one or more chemicals leads to an unspecific reduction in sensitivity to chemicals. In sensitization phase II , symptoms occur after renewed exposure even to low chemical concentrations. The duration from first contact to illness can apply for 2 to 4.3 years. The triggering substances of phase I and II do not have to be identical. Phase I can be initiated by a substance with a high concentration or several low-concentration mixtures. Objective laboratory results can be determined using the basophil degranulation test or the lymphocyte transformation test.

Clinical picture

MCS sufferers usually have a variety of unspecific complaints such as shortness of breath , burning eyes, diffuse pain , skin and mucous membrane problems, concentration disorders , headaches , gastrointestinal complaints, chronic fatigue , muscle weakness , edema , loss of memory , dizziness , feelings of anxiety or depression . In addition, there are often sensitivity to smell, taste disturbances, noises in the ears (tinnitus), decreased performance and a feeling of exhaustion. The complaints last for over 6 months. As a rule, the symptoms increase over time, as do the number of substances that those affected perceive as triggering.

Studies have shown that MCS sufferers are more susceptible to infection, intolerance to textiles and a significantly increased feeling of annoyance from emissions from building materials, wall and floor coverings, paint, furniture, dental materials, consumer goods and environmental chemicals than the control group. A psychosocial cause was negated by the patient.

Incompatibilities with volatile and gaseous drugs lead to a limitation of the medical treatment options. Thus, anesthetics and anesthetics such as thiopental , lidocaine or morphine poorly or not at all tolerated. The application of these substances can therefore lead to narrowing of the upper airways with shortness of breath, disorders in the cardiovascular system, orthostatic intolerance , prolonged panic attacks, shaking attacks, muscle and extremity pain, tiredness, feeling weak, feeling exhausted and nausea with nausea. In order to avoid these symptoms, the operation is carried out with a reduced dose and the increased pain burden on the patient is compulsorily accepted.

MCS can be divided into four degrees of severity, although it should be noted that symptoms can still be very different in severity. With the highest severity, symptoms such as severe exhaustion, general weakness, concentration and memory disorders, and muscle pain come to the fore. At this stage, the patients are unable to work and their daily livelihood is severely restricted. Are the patients, e.g. B. for financial reasons not able to renovate their surroundings, especially the apartment, accordingly, sometimes several times, this can mean that daily things such as shopping, food preparation and personal hygiene can no longer be carried out independently. This final stage corresponds to care levels II to III. in this context, an increased suicidality can be assumed.

causes

Risk factors

Contact with diverse, environmental exposure factors increases the frequency of chronic inflammatory diseases such as MCS. In addition to pollution and mold exposure, electromagnetic fields are increasingly coming into play due to the expansion of mobile communications.

Some areas in everyday life pose a particular health risk:

  • Chemically unbound plasticizers (mainly phthalates ) in food packaging, toys for children or medical utensils such as infusion sets or catheters. As plasticizers in packaging films, phthalates are easily stored in foods with a high fat content.
  • Fumigation of freight containers during overseas transports with pesticides / halogenated hydrocarbons such as dibromoethane or dichloroethane
  • Use of insecticides / pyrethroids in the private sector but also in aircraft cabins or train wagons
  • easy access to toxic pesticides, disinfectants and biocides in cleaning agents in supermarkets and drugstores
  • Contamination of food with up to 16 different pesticides in order to comply with the limit values. However, these limits are often exceeded.
  • synthetic fragrances in soaps, detergents, dishwashing detergents and cleaning agents
  • Computers and electronic devices with flame retardants such as diphenyl ether , tetrabromo-bisphenol-A or trialkyl phosphates , which outgas during operation
  • Outgassing flame retardants, insecticides and fungicides as well as plasticizers and plastic monomers in floor coverings, furniture and textiles. Phthalates, for example, are chemically unbound and therefore constantly release gas in small quantities and, like PCBs or dioxins, can accumulate or deposit on wall surfaces. When the temperature rises (e.g. heating in winter), they evaporate again and lead to short-term high exposure.
  • increasing proportion of flavorings , emulsifiers , colorings , synthetic sweeteners and sugar in industrial foods
  • Expansion of waste incineration plants as well as incineration of hazardous waste in waste-to-energy plants, which ideally still just comply with the limit values. Small amounts of chlorinated dioxins and biphenyls released into the environment are allowed, but extrapolated to one year, accumulations in the gram range are possible. In humans, the substances are stored in adipose tissue, the accumulation is favored by the chemical stability and they also have a long half-life.
  • Production and use of persistent organic pollutants and CMR substances
  • Wood preservatives ( lindane ) in the living room

There are a large number of studies on the MCS prevalence in collectives who fell ill after increased exposure to harmful substances. The percentage of people with subsequent chemical intolerances or MCS in these groups was between 25% and 60%.

MCS is more common in people with additional chronic conditions. Vulnerability of those affected is suspected here:

  • Asthma and the hyperresponsive bronchial system
  • allergic disposition
  • other intolerances (food, medication)
  • post-traumatic stress disorder
  • psychosocial stress
  • anxious disposition or anxiety disorders
  • female gender

The MCS risk is disproportionately increased when several of the risk factors are present (e.g. exposure to solvents, allergic disposition and stress). Income, social status, or ethnicity, however, do not affect the frequency of MCS.

Work or environmental disturbance

MCS as a work-related or environmental disorder (with possible genetic involvement), such as: poisoning , malfunction of the nervous , immune , endocrine system or respiratory tract , lowering of the nervous trigger thresholds for abnormal sensations, pain and dysfunction. Chemical triggers of MCS can include: a. Solvents , pesticides , certain metals and their alloys , combustion products and other mixtures of pollutants .

Multifactorial and multilevel disorder

After an initial exposure to mostly neurotoxic pollutants, unspecific symptoms of a neurotoxic effect (e.g. solvent syndrome) initially occur; this effect should be largely reversible after the end of exposure. Due to additional stressors (e.g. psychosocial stress, fear) or in sensitive population groups (e.g. multiple allergies, asthma) and long exposure times, the disorder turns into a chronic form over the years, in which fewer and fewer chemicals are sufficient to remove the To produce symptoms (= bio-psycho-social model).

Psychogenic model

The nature of the exposure explains why environmental medicine patients so often receive psychiatric diagnoses. Neurotoxic pollutants, and these are the most common in our immediate environment, lead to the above-mentioned unspecific symptoms, which also lead to high scores in psychometric questionnaires. The question of “environmental medicine or psychiatry” has therefore been discussed many times.

Studies show a high psychosomatic comorbidity in long-term MCS patients. However, on average, patients have had their symptoms for more than 8 to 10 years before MCS is detected. So the question is whether the MCS is (partly) caused by mental disorders or whether the severe stress caused by the MCS is the cause of subsequent mental disorders (or both).

Studies with people with the onset of chemical intolerance found only a slight increase in anxiety tendencies in those affected. However, those affected are more likely to have asthma, a hyperresponsive bronchial system and allergies. According to Caress et al., Only 1.4% of those affected had a manifest mental illness before the development of MCS.

Provocation tests carried out under controlled conditions do not allow any distinction based on specific chemical exposure between patients who have been affected by MCS for many years and reference populations. However, this could be demonstrated in healthy volunteers with chemical sensitivity.

Prevalence

Prevalences for hypersensitivity to chemicals have been published for several countries . In most studies, a distinction was made between “chemical intolerance” (CI) with moderate health effects and severe symptoms with daily symptoms and far-reaching health effects (MCS). The data for the prevalence of MCS are between 0.5% and 3.9%.

  • 5% (Germany)
  • 0.9% (Australia)
  • 3.7% (Sweden)
  • 3.8% (Japan)
  • 3.9% (USA)

In the USA in particular, there have been studies to clarify and differentiate from MCS with symptomatically similar diseases such as chronic fatigue syndrome, chronic viral infections, fibromyalgia or other rheumatic diseases, autoimmune diseases, allergies and asthma.

Moderate chemical intolerance occurs in 9 to 33% of the populations examined. The results of three studies are very close together at 15 to 16%. The figures also match the information provided by young people.

diagnosis

General

The environmental medical diagnosis consists of the following three sections:

1. Environmental medical social history

Here, the entire environment of the patient is examined more closely with regard to exposure to harmful substances. This includes the living, working or training environment, tooth materials in the dental sector (including implants and root filling materials), consumption of luxury goods (smoking, alcohol), eating habits, leisure time behavior or sport / physical activity and other factors such as social conditions, income, family or possible stress factors .

2. Exclusion diagnostics

Symptoms that have a cause other than environmental must be examined by appropriate specialists (e.g. internists , neurologists , psychiatrists , cardiologists , ENT doctors , urologists, etc.). Only when environmental factors cannot be excluded as the cause, environmental medical laboratory diagnostics are carried out ; To assess the overall clinical picture, the results of other medical specialties are nevertheless important and necessary.

3. Environmental medical monitoring and laboratory diagnostics

This point is divided into several sub-areas:

  • external exposure: analysis / environmental monitoring ; qualitative and quantitative detection of pollutants in the patient's environment
  • Internal exposure: Analysis / biomonitoring : Detection of foreign substances and pollutants including their metabolites in the patient's body samples (blood, serum, saliva, urine, hair, fatty tissue, etc.)
    Unfortunately, biomonitoring often does not provide any meaningful results. There are mutliple reasons for this:
    • Metabolites are often only detectable a few days after exposure. Therefore, attempts are made to detect chemically modified proteins, which is still possible months after exposure. Longer past exposure can no longer be recorded.
    • Fat-soluble substances can accumulate in high concentrations in adipose tissue and / or brain without being detectable in blood or urine
    • For many pollutants (e.g. around 50% of the pesticides used in agriculture) there are still no analytical methods. Due to the lack of evidence, a mental illness can be incorrectly diagnosed instead of MCS.
    • Even if toxicological limit and guide values ​​are not exceeded, chronic exposure to pollutants can lead to lasting disruptions in functional control loops.
For these reasons - if there is reasonable suspicion of chronic long-term exposure to chemicals - priority should be given to effect monitoring.

Provocation tests

In the provocation tests, patients are exposed to low levels of chemicals and compared with non-sensitized control subjects. Alternatively, you can measure neuropeptides and cytokines that are detectable in the blood as a result of chemical exposure. In affected patients, the blood count is significantly higher than in control persons. For example, in the case of volatile organic compounds, there is an increase in the serum concentration of the inflammation marker substance P , vasoactive intestinal peptide , nerve growth factor and histamine .

However, the procedure for this type of test must be viewed critically from a medical-ethical point of view, as this must add harm to the participants in the examination.

In vitro immunological test systems

Compared to the provocation tests, these test systems have the advantage that the reaction of cells of the immune system can be analyzed without having to expose the patient to the harmful substances himself. There are different types of tests, the immune tolerance test (ITT) and the lymphocyte transformation test (LTT).

In the immune tolerance test, the reaction of a patient's immune cells to various stressors is tested by exposing them to a mixture of pollutants as a marker and an influenza virus antigen as a control and the amount of cytokines Il-2 , IFN-? , Il-10 , TNF-? and IL-1β . MCS patients show a significant increase in IFN-? and / or TNF-?. The ITT is therefore suitable as a basic test for the detection of an immune regulatory disorder. MCS can also be differentiated from CFS: MCS has a high concentration of IFN-? and a low concentration of II-2; in the case of CFS exactly the opposite

The lymphocyte transformation test is recommended for differential diagnosis. If the ITT and LTT show positive results for a certain chemical, a chronic allergic type IV sensitization can be assumed. However, if only the ITT is positive, MCS is a disease.

Stage diagnosis and immune status

By using step diagnosis, MCS can be differentiated from various allergies and infectious diseases by means of clinical-internal and inflammatory parameters. The stages include:

  1. Level: differential blood count , blood cell sedimentation rate , immunoelectrophoresis of serum proteins, quantitative immunoglobulins with IgE and urine status
  2. Level: C-reactive protein (CRP), malondialdehyde , homocysteine , IgG subclasses and TNF-?
  3. Level: LTT, ITT, cytokines , autoantibodies and neopterin
  4. Level: Further tests for more detailed clarification, see: Clinical laboratory diagnostics

Levels 1 and 2 are used to differentiate between acute and chronic inflammation and bacterial or viral infection. If a corresponding infection is suspected, bacteria or virus-specific pathogen detection must be carried out. Level 3 limits the clinical picture of environmental medicine.

The laboratory parameters mentioned above can be determined in the context of an immune status; the investigation can be carried out to different extents. Examples are: immunophenotyping of the T cell subclasses CD4-TH1 and CD4-TH2, ratio of CD4 T helper cells to cytotoxic CD8 T cells or the CD4 / CD8 quotient, number / concentration of NK and B cells, determination of the activation markers on the T lymphocytes ( CD25 , CD29 , CD69 , CD71 , HLA-DR) for knowledge about the activation status of the cellular immune system, determination of the regulatory T cells to recognize an overactive immune system, determination of the cytokine pattern in the serum or IgE determinations to rule out type 1 sensitization.

The following immunological tests are recommended for the immune status: Determination of the ratio of immunologically imprinted CD4 memory cells to naive CD4 helper cells and the CD8 effector cells to native CD8 cell production. In chronic inflammatory multi-system diseases, both quotients increase to 1.5 times the normal value. Furthermore, the proportion of T8 lymphocytes no longer capable of dividing with the surface antigen CD57 should be determined in relation to the total number of T8 lymphocytes. After specific activation, these cells can trigger apoptosis , are signs of chronic activation of the immune system and indicate the end stage of degenerative diseases.

Clinical laboratory diagnostics

There are several markers for MCS and other environmental diseases. In the following, the parameters to be determined are divided into detoxification capacity, stress parameters, parameters for oxidative and nitrosative stress, antioxidative capacity and stress hormone status.

  • Stress hormone status: cortisol day profile (morning peak is absent in chronic multisystem and CFS sufferers), melatonin day and night profile (nocturnal peak is absent in patients), dehydroepiandrosterone

Imaging procedures

Imaging methods are used to determine functional disorders of the brain or functional brain centers. Single photon emission computed tomography (SPECT) and positron emission tomography (PET) are two widely used methods in environmental medicine. Using SPECT it could be shown that exposure to formaldehyde , solvents, pentachlorophenone , organophosphate pesticides and mercury damage dopaminergic D 2 receptors of the basal ganglia . This in turn leads to limitations in procedural memory, motor coordination and fine motor skills.

Psychological testing procedures

Psychological and psychometric test procedures and questionnaires can provide information about disorders of brain functions. An example of this would be the Chemical Odor Sensitivity Scale , also known as the COSS test.

treatment

The most effective treatment method is exposure avoidance. If a sufficient intake of glutathione , vitamin E , vitamin C , α-lipoic acid , riboflavin , pyridoxine , folic acid , coenzyme Q10 , long-chain omega-3 fatty acids , curcumin , vitamin B12 , vitamin D cannot be guaranteed through a balanced diet , antioxidant therapy through substitution should be sought. In the case of amalgam fillings in teeth or similar heavy metal contamination , the source should be removed and chelation therapy (with DMSA , DMPS , Tiopronin , etc.) started.

In general, understanding and supportive treatment is still recommended. Psychological-psychiatric therapeutic approaches are suitable for psychological complications. Patients rated supportive psychotherapeutic treatment as effective if the aim was to teach coping strategies . The use of psychotropic drugs is described as "rather harmful" due to intolerance reactions . For patients, the focus is often on conveying information as an aid to " coping " as well as conveying compatible therapies for concomitant diseases and a compatible diet.

Studies to prove the effectiveness of psychotherapy alone are still pending.

consequences

In the advanced stage, MCS leads to complete inability to work and to a largely complete loss of all quality of life. The course of the disease is chronic and is often associated with intolerance to food and medication. On the one hand, this leads to malnutrition / malnutrition; on the other hand, it may prevent accompanying diseases from being treated properly. This can lead to pain pill abuse and ultimately drug addiction.

Due to lack of understanding, MCS leads to conflicts in the family, among friends or at work, and in the most severe forms to social isolation .

MCS has been recognized as a disability in the USA since 1992 and in Germany since 1996.

history

After polarized discussions in the 1980s and 1990s about whether MCS should be assigned to toxicology or psychosomatics , a multifactorial disorder model prevailed, which takes aspects of both fields into account in a "bio-psycho-social" model. Studies in which the risk factors of MCS were examined in their early form were particularly helpful here. The fully developed MCS entails a large number of problems that distort study results.

To differentiate MCS from psychosomatic disorders, the criteria established by Cullen in 1987 applied until 1993:

  1. The disorder occurs in connection with a documentable environmental exposure, injury or illness,
  2. the symptoms affect more than one organ system,
  3. Symptoms appear as a reaction to predictable (environmental) stimuli and subside again,
  4. Symptoms are caused by exposure to chemicals of different structural classes and toxicological mechanisms of action,
  5. Symptoms are triggered by detectable exposure (albeit at a low level),
  6. Exposures that cause symptoms must be very low, that is, well below the average exposure level known to be harmful to humans
  7. No generally accepted laboratory test of organ function can explain the symptoms [to date, 1987]

Some authors who suspect a psychological genesis of MCS suggested the designation " idiopathic environmental intolerances " (IEI), "idiopathic (i.e. without an identifiable cause), environmental intolerance" . In addition to the symptoms previously associated with MCS, this term encompasses a number of similar health disorders and avoids a definition of the suspected cause that is not justified by the state of scientific knowledge.

literature

  • Hans-Ulrich Hill, Wolfgang Huber , Kurt E. Müller: Multiple Chemical Sensitivity (MCS) . A clinical picture of chronic multisystem diseases (CMI). Environmental medicine, toxicological and socio-political aspects - a look at the current state of research. 3. Edition. Shaker-Verlag, Aachen 2010, ISBN 978-3-8322-9046-7 .
  • NICNAS (Australian Government Department of Health and Aging): A scientific review of multiple chemical sensitivity: Working Draft report, November 2008. (online)
  • A. Bauer, E. Schwarz, C. Mai: Multiple Chemical Sensitivity (MCS): An Update. In: Environment Medicine Society. (2008); 21 (4), pp. 9–15 ( online ; PDF; 25 kB)
  • NA Ashford, CS Miller: Chemical exposures. Low levels and high stakes. 2nd Edition. Van Nostrand Reinhold, New York 1998.
  • SM Caress, AC Steinemann, C. Waddick: Symptomatology and etiology of multiple chemical sensitivities in the southeastern United States. In: Arch Environ Health. (2002); 57, pp. 429-436.
  • S. Reid, M. Hotopf, L. Hull, K. Ismail, C. Unwin, S. Wessely: Multiple Chemical Sensitivity and Chronic Fatigue Syndrome in British Gulf War Veterans. In: Am J Epidemiol. (2001); 153, pp. 604-609.
  • R. Kreutzer, RR Neutra, N. Lashuay: Prevalence of people reporting sensitivities to chemicals in a population based survey. In: Am J Epidemiol. (1999); 150, pp. 1-12.
  • WJ Meggs, KA Dunn, RM Bloch et al .: Prevalence and nature of allergy and chemical sensitivity in a general population. In: Arch Environ Health. (1996); 51, pp. 275-282.
  • AL Davidoff, PM Keyl, W. Meggs: Development of multiple chemical sensitivities in laborers after acute gasoline fume exposure in an underground tunneling operation. In: Arch Environ Health. (1998); 53, pp. 183-189.
  • Statement by the board of the dbu ("German Professional Association of Environmental Medicine") on the MCS multicenter study ( PDF, 80 KB ) of September 4, 2003
  • Martin L. Pall: Explaining "Unexplained Illnesses". Disease Paradigm for Chronic Fatigue Syndrome, Multiple Chemical Sensitivity, Fibromyalgia, Post-Traumatic Stress Disorder, Gulf War Syndrome, and Others. Harrington Park Press / Haworth Press, New York / London 2007, ISBN 978-0-7890-2388-9 .
  • William J. Rea: Chemical Sensitivity. Volume 1-4, Lewis Publishers; Volume 1, ISBN 0-87371-541-1 ; Volume 2, ISBN 0-87371-963-8 ; Volume 3, ISBN 0-87371-964-6 ; Volume 4, ISBN 0-87371-965-4 .
  • Indoor pollution and sick building syndrome. UNI Saarland (PDF, 1.4MB)

Individual evidence

  1. ↑ Letter from DIMDI regarding the classification in Germany
  2. ↑ L. Bartha, W. Baumzweiger, DS Buscher, T. Callender, KA Dahl et al .: Multiple Chemical Sensitivity: A 1999 consensus. In: Arch Environ Health. (1999); 54 (3), pp. 147-149.
  3. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 46 ( dnb.de [accessed July 7, 2019]).
  4. ↑ A brief overview of the lecture by Prof. Dr. Martin Pall: MCS - Toxicological mechanisms of origin and therapeutic approaches
  5. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 46–47 ( dnb.de [accessed July 7, 2019]).
  6. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 16-17 ( dnb.de [accessed July 7, 2019]).
  7. ↑ Thomas Eikmann, Caroline Herr: Multiple Chemical Sensitivity Syndrome (MCS). Hessian Center for Clinical Environmental Medicine, University Hospital Gießen and Marburg ( PDF, 29 KB  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. ).@1@ 2Template: Toter Link / www.helmholtz-muenchen.de  
  8. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 17 ( dnb.de [accessed July 7, 2019]).
  9. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 18 ( dnb.de [accessed July 7, 2019]).
  10. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 19-20 ( dnb.de [accessed July 7, 2019]).
  11. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 3 ( dnb.de [accessed July 7, 2019]).
  12. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 3–4 ( dnb.de [accessed July 7, 2019]).
  13. ↑ Overview in: Ashford and Miller 1998, Maschewsky 1996
  14. ^ A b E. Schwarz, A. Bauer, U. Martens: Allergies, stress and pollutants as risk factors for chemical intolerances and "Multiple Chemical Sensitivity" (MCS). In: Allergo Journal. (2006); 15, pp. 139-140.
  15. ↑ Buchwald and Garrity 1994, Kreutzer et al. 1999.
  16. ^ A b Nicholas Ashford, Claudia Miller: Chemical Exposures. John Wiley & Sons, 1998, ISBN 0-471-29240-0 .
  17. ↑ AL Davidoff, L. Fogarty, PM Keyl: Psychiatric inferences from data on psychologic / psychiatric symptoms in multiple chemical sensitivities syndrome. In: Arch Environ Health. (2000); 55, pp. 165-175.
  18. ^ A. Bauer, E. Schwarz, U. Martens: Patients with multiple chemical intolerances - environmental medicine or psychosomatics? In: Journal of General Medicine (ZFA). (2007); 83, pp. 442-446.
  19. ^ A. Bauer, E. Schwarz, C. Mai: Environmental medicine or Psychiatry? In: International Journal of Hygiene and Environmental Health. (2009); 212, pp. 569-570 doi: 10.1016 / j.ijheh.2008.12.004
  20. ↑ F. Fiedler, C. Maccia, H. Kipen: Evaluation of chemical sensitive patients. In: JOM. (1992); 34, pp. 529-538.
  21. ↑ Zucco G. M. et al .: Discriminating between organic and psychological determinants of multiple chemical sensitivity: A case study. In: Neurocase. 2008; 14 (6), pp. 485-493. PMID 19012169 .
  22. ↑ D. Eis et al .: The German Multicenter Study on Multiple Chemical Sensitivity (MCS). In: Int J Hyg Environ Health. 2008 Oct; 211 (5-6), pp. 658-681. PMID 18502687 .
  23. ↑ C. Hausteiner et al .: Dysfunctional cognitions in idiopathic environmental intolerances (IEI) - an integrative psychiatric perspective. In: Toxicol Lett. 2007 Jun 15; 171 (1-2), pp. 1-9. PMID 17548174 .
  24. ↑ A. Bauer, E. Schwarz: What is the significance of the MCS multicenter study? A statement from the German Professional Association of Environmental Medicine (dbu). In: Environment Medicine Society. (2007); 20 (4), pp. 289-296.
  25. ↑ a b K. Osterberg et al .: Personality, mental distress, and subjective health complaints among persons with environmental annoyance. In: Hum Exp Toxicol . 2007; Mar; 26 (3), pp. 231-241, PMID 17439926 .
  26. ^ SM Caress, AC Steinemann, C. Waddick: Symptomatology and etiology of multiple chemical sensitivities in the southeastern United States. In: Arch Environ Health. (2002); 57, pp. 429-436.
  27. ↑ L. Andersson, A. Johansson, E. Millqvist, S. Nordin, M. Bende: Prevalence and risk factors for Chemical Sensitivity and sensory hyperreactivity in teenagers. In: Int J Hyg Environ Health. 2008, 211, pp. 690-697.
  28. ^ A. Johansson, E. Millqvist, S. Nordin, M. Bende: Relationship between self-reported odor intolerance and sensitivity to inhaled capsaicin: proposed definition of airway sensory hyperreactivity and estimation of its prevalence. In: Chest. (2006); 129, pp. 1623-1628.
  29. ↑ IR Bell, CM Baldwin, LG Russek, GE Schwartz, EE Hardin: Early life stress, negative paternal relationships, and chemical intolerance in middle-aged women: support for a neural sensitization model. In: Journal of women's health. (1998); 7 (9), pp. 1135-1147.
  30. ↑ IR Bell, CS Miller, GE Schwartz, JM Peterson, D. Amend: Neuropsychiatric and somatic characteristics of young adults with and without self-reported chemical odor intolerance and chemical sensitivity. In: Arch Environ Health. (1996); 51, pp. 9-21.
  31. ^ J. Das-Munshi et al .: Multiple chemical sensitivities: A systematic review of provocation studies. In: J Allergy Clin Immunol . 2006; 118, pp. 1257-1264. PMID 17137865 .
  32. ↑ S. Bornschein et al .: Double-blind placebo-controlled provocation study in patients with subjective multiple chemical sensitivity (MCS) and matched control subjects. In: Clin Toxicol . 2008; 46, pp. 443-449. PMID 18568800 .
  33. ↑ C. van Thriel, E. Kiesswetter, M. Schäper et al .: From neurotoxic to chemo-sensory effects: new insights on acute solvent neurotoxicity exemplified by acute effects of 2-ethylhexanol. In: Neurotoxicology . (2007) 28, pp. 347-355.
  34. ^ A. Bauer, E. Schwarz, C. Mai: Multiple Chemical Sensitivity (MCS). An update. In: Environment Medicine Society. (2008); 21 (4), pp. 9-15.
  35. ↑ NICNAS (Australian Governmental Department of Health and Aging): A scientific review of multiple chemical sensitivity: report Working Draft. ( Memento of the original from January 20, 2010 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , November 2008. @1@ 2Template: Webachiv / IABot / www.nicnas.gov.au
  36. ^ L. Andersson et al.: Prevalence and risk factors for Chemical Sensitivity and sensory hyperreactivity in teenagers. In: Int J Hyg Environ Health. 2008; 211, pp. 690-697.
  37. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 252 ( dnb.de [accessed July 7, 2019]).
  38. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 252–253 ( dnb.de [accessed July 7, 2019]).
  39. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 253–256 ( dnb.de [accessed July 7, 2019]).
  40. ↑ a b Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 256 ( dnb.de [accessed July 7, 2019]).
  41. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 256–257 ( dnb.de [accessed July 7, 2019]).
  42. ↑ a b Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 257 ( dnb.de [accessed July 7, 2019]).
  43. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 259 ( dnb.de [accessed July 7, 2019]).
  44. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 259–260 ( dnb.de [accessed July 7, 2019]).
  45. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 261 ( dnb.de [accessed July 7, 2019]).
  46. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 263 ( dnb.de [accessed July 7, 2019]).
  47. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 264–265 ( dnb.de [accessed July 7, 2019]).
  48. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 265–266 ( dnb.de [accessed July 7, 2019]).
  49. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 266–267 ( dnb.de [accessed July 7, 2019]).
  50. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 267 ( dnb.de [accessed July 7, 2019]).
  51. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 268 ( dnb.de [accessed July 7, 2019]).
  52. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 269 ( dnb.de [accessed July 7, 2019]).
  53. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 350 ( dnb.de [accessed July 7, 2019]).
  54. ↑ Hans-Ulrich Hill, Wolfgang Huber, Kurt E. Müller: Multiple Chemical Sensitivity (MCS): a clinical picture of chronic multi-system diseases (CMI); environmental medicine, toxicological and socio-political aspects; a look at the current state of research (=  reports from medicine ). 3., rework. and exp. Edition Shaker, Aachen 2010, ISBN 978-3-8322-9046-7 , pp. 351–363 ( dnb.de [accessed July 7, 2019]).
  55. ↑ Multi-Chemical Sensitivity Syndrome (MCS) and treatment with SANUM products. Retrieved April 15, 2019 .
  56. ↑ Notes on therapy chron. multisystem inflammatory diseases. Retrieved April 15, 2019 .
  57. ↑ E. Schwarz et al .: Long-term follow-up in environmental medicine patients with special consideration of patients with chemical intolerances or multiple chemical sensitivity (MCS). ( Memento from December 3, 2013 in the Internet Archive ) Research report, 2006. (PDF; 542 kB)
  58. ↑ a b M. Nasterlack, T. Kraus, R. Wrbitzky: Multiple Chemical Sensitivity: A presentation of the scientific knowledge of occupational health and environmental medicine . In: Deutsches Ärzteblatt 2002; 99, pp. A 2474-2483, issue 38.
  59. ↑ Joint press release by the Federal Environment Agency and the Federal Institute for Consumer Health Protection and Veterinary Medicine: Causes, diagnosis and therapy of multiple chemical hypersensitivity (MCS) pose problems for science and doctors , February 28, 1996.
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  62. ^ P. Rainville et al .: Representation of acute and persistent pain in the human CNS: potential implications for chemical intolerance. In: Ann New York Acad Sci. (2001); 933, pp. 130-141.
  63. ^ MR Cullen: The worker with multiple chemical sensitivities: an overview. In: Occup Med. 1987; 2, pp. 655-661, PMID 3313760 .
  64. ↑ Definitions of MCS ( English )