Skip to main content
PMC home page
Environmental Health Perspectives logoLink to Environmental Health Perspectives
. 2000 Apr;108(4):377–381. doi: 10.1289/ehp.00108377

A 37-year-old mechanic with multiple chemical sensitivities.

H M Kipen 1, N Fiedler 1
PMCID: PMC1638023  PMID: 10753098

Abstract

A 37-year-old heating, ventilation, and air-conditioning mechanic developed respiratory, musculoskeletal, and central nervous system symptoms associated with a variety of odorous environmental chemicals. Organic disease was not evident, but the patient was distressed by these symptoms and was at risk for becoming disabled by them. His symptoms fit broadly into the condition recognized as multiple chemical sensitivity. Multiple chemical sensitivity is a diagnostic term for a group of symptoms without demonstrated organic basis. The symptoms are characteristic of dysfunction in multiple organ systems, they increase and decrease according to exposure to low levels of chemical agents in the patient's environment, and they sometimes occur after a distinct environmental change or insult such as an industrial accident or remodeling. Although traditional medical organizations have not agreed on a definition for this syndrome, it is being increasingly recognized and makes up an increasing percentage of the caseload at occupational and environmental medicine clinics. Although there is often dispute about whether the symptoms have a functional or organic basis, an informed approach to evaluation, diagnosis, and management and a careful assessment of impairment, disability, and work relatedness are necessary. Careful exclusion of organic causes is critical, and this should be followed by a judicious approach to coping with symptoms.

Full text

PDF
377

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barsky A. J., Borus J. F. Functional somatic syndromes. Ann Intern Med. 1999 Jun 1;130(11):910–921. doi: 10.7326/0003-4819-130-11-199906010-00016. [DOI] [PubMed] [Google Scholar]
  2. Bascom R. Multiple chemical sensitivity: a respiratory disorder? Toxicol Ind Health. 1992 Jul-Aug;8(4):221–228. [PubMed] [Google Scholar]
  3. Bell I. R., Schwartz G. E., Baldwin C. M., Hardin E. E., Klimas N. G., Kline J. P., Patarca R., Song Z. Y. Individual differences in neural sensitization and the role of context in illness from low-level environmental chemical exposures. Environ Health Perspect. 1997 Mar;105 (Suppl 2):457–466. doi: 10.1289/ehp.97105s2457. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bolla-Wilson K., Wilson R. J., Bleecker M. L. Conditioning of physical symptoms after neurotoxic exposure. J Occup Med. 1988 Sep;30(9):684–686. [PubMed] [Google Scholar]
  5. Buchwald D., Garrity D. Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities. Arch Intern Med. 1994 Sep 26;154(18):2049–2053. [PubMed] [Google Scholar]
  6. Dager S. R., Holland J. P., Cowley D. S., Dunner D. L. Panic disorder precipitated by exposure to organic solvents in the work place. Am J Psychiatry. 1987 Aug;144(8):1056–1058. doi: 10.1176/ajp.144.8.1056. [DOI] [PubMed] [Google Scholar]
  7. Deale A., Chalder T., Marks I., Wessely S. Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial. Am J Psychiatry. 1997 Mar;154(3):408–414. doi: 10.1176/ajp.154.3.408. [DOI] [PubMed] [Google Scholar]
  8. Doty R. L., Deems D. A., Frye R. E., Pelberg R., Shapiro A. Olfactory sensitivity, nasal resistance, and autonomic function in patients with multiple chemical sensitivities. Arch Otolaryngol Head Neck Surg. 1988 Dec;114(12):1422–1427. doi: 10.1001/archotol.1988.01860240072027. [DOI] [PubMed] [Google Scholar]
  9. Escobar J. I. Overview of somatization: diagnosis, epidemiology, and management. Psychopharmacol Bull. 1996;32(4):589–596. [PubMed] [Google Scholar]
  10. Fiedler N., Kipen H. M., DeLuca J., Kelly-McNeil K., Natelson B. A controlled comparison of multiple chemical sensitivities and chronic fatigue syndrome. Psychosom Med. 1996 Jan-Feb;58(1):38–49. doi: 10.1097/00006842-199601000-00007. [DOI] [PubMed] [Google Scholar]
  11. Fiedler N., Kipen H. Chemical sensitivity: the scientific literature. Environ Health Perspect. 1997 Mar;105 (Suppl 2):409–415. doi: 10.1289/ehp.97105s2409. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Guglielmi R. S., Cox D. J., Spyker D. A. Behavioral treatment of phobic avoidance in multiple chemical sensitivity. J Behav Ther Exp Psychiatry. 1994 Sep;25(3):197–209. doi: 10.1016/0005-7916(94)90020-5. [DOI] [PubMed] [Google Scholar]
  13. Kipen H. M., Fiedler N. Invited commentary: sensitivities to chemicals--context and implications. Am J Epidemiol. 1999 Jul 1;150(1):13–17. doi: 10.1093/oxfordjournals.aje.a009911. [DOI] [PubMed] [Google Scholar]
  14. Kipen H. M., Hallman W., Kang H., Fiedler N., Natelson B. H. Prevalence of chronic fatigue and chemical sensitivities in Gulf Registry Veterans. Arch Environ Health. 1999 Sep-Oct;54(5):313–318. doi: 10.1080/00039899909602493. [DOI] [PubMed] [Google Scholar]
  15. Kipen H. M., Hallman W., Kelly-McNeil K., Fiedler N. Measuring chemical sensitivity prevalence: a questionnaire for population studies. Am J Public Health. 1995 Apr;85(4):574–577. doi: 10.2105/ajph.85.4.574. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kreutzer R., Neutra R. R., Lashuay N. Prevalence of people reporting sensitivities to chemicals in a population-based survey. Am J Epidemiol. 1999 Jul 1;150(1):1–12. doi: 10.1093/oxfordjournals.aje.a009908. [DOI] [PubMed] [Google Scholar]
  17. Lax M. B., Henneberger P. K. Patients with multiple chemical sensitivities in an occupational health clinic: presentation and follow-up. Arch Environ Health. 1995 Nov-Dec;50(6):425–431. doi: 10.1080/00039896.1995.9935978. [DOI] [PubMed] [Google Scholar]
  18. Lehrer P. M. Psychophysiological hypotheses regarding multiple chemical sensitivity syndrome. Environ Health Perspect. 1997 Mar;105 (Suppl 2):479–483. doi: 10.1289/ehp.97105s2479. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Mayberg H. Critique: SPECT studies of multiple chemical sensitivity. Toxicol Ind Health. 1994 Jul-Oct;10(4-5):661–666. [PubMed] [Google Scholar]
  20. Meggs W. J., Cleveland C. H., Jr Rhinolaryngoscopic examination of patients with the multiple chemical sensitivity syndrome. Arch Environ Health. 1993 Jan-Feb;48(1):14–18. doi: 10.1080/00039896.1993.9938388. [DOI] [PubMed] [Google Scholar]
  21. Meggs W. J., Dunn K. A., Bloch R. M., Goodman P. E., Davidoff A. L. Prevalence and nature of allergy and chemical sensitivity in a general population. Arch Environ Health. 1996 Jul-Aug;51(4):275–282. doi: 10.1080/00039896.1996.9936026. [DOI] [PubMed] [Google Scholar]
  22. Meggs W. J. Neurogenic inflammation and sensitivity to environmental chemicals. Environ Health Perspect. 1993 Aug;101(3):234–238. doi: 10.1289/ehp.93101234. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Shusterman D., Balmes J., Cone J. Behavioral sensitization to irritants/odorants after acute overexposures. J Occup Med. 1988 Jul;30(7):565–567. [PubMed] [Google Scholar]
  24. Simon G. E., Daniell W., Stockbridge H., Claypoole K., Rosenstock L. Immunologic, psychological, and neuropsychological factors in multiple chemical sensitivity. A controlled study. Ann Intern Med. 1993 Jul 15;119(2):97–103. doi: 10.7326/0003-4819-119-2-199307150-00001. [DOI] [PubMed] [Google Scholar]
  25. Simon G. E., Katon W. J., Sparks P. J. Allergic to life: psychological factors in environmental illness. Am J Psychiatry. 1990 Jul;147(7):901–906. doi: 10.1176/ajp.147.7.901. [DOI] [PubMed] [Google Scholar]
  26. Smoller J. W., Pollack M. H., Otto M. W., Rosenbaum J. F., Kradin R. L. Panic anxiety, dyspnea, and respiratory disease. Theoretical and clinical considerations. Am J Respir Crit Care Med. 1996 Jul;154(1):6–17. doi: 10.1164/ajrccm.154.1.8680700. [DOI] [PubMed] [Google Scholar]
  27. Sparks P. J., Daniell W., Black D. W., Kipen H. M., Altman L. C., Simon G. E., Terr A. I. Multiple chemical sensitivity syndrome: a clinical perspective. I. Case definition, theories of pathogenesis, and research needs. J Occup Med. 1994 Jul;36(7):718–730. [PubMed] [Google Scholar]
  28. Sparks P. J., Daniell W., Black D. W., Kipen H. M., Altman L. C., Simon G. E., Terr A. I. Multiple chemical sensitivity syndrome: a clinical perspective. II. Evaluation, diagnostic testing, treatment, and social considerations. J Occup Med. 1994 Jul;36(7):731–737. [PubMed] [Google Scholar]
  29. Spurgeon A., Gompertz D., Harrington J. M. Modifiers of non-specific symptoms in occupational and environmental syndromes. Occup Environ Med. 1996 Jun;53(6):361–366. doi: 10.1136/oem.53.6.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Staudenmayer H., Selner J. C., Buhr M. P. Double-blind provocation chamber challenges in 20 patients presenting with "multiple chemical sensitivity". Regul Toxicol Pharmacol. 1993 Aug;18(1):44–53. doi: 10.1006/rtph.1993.1043. [DOI] [PubMed] [Google Scholar]
  31. Terr A. I. Environmental illness. A clinical review of 50 cases. Arch Intern Med. 1986 Jan;146(1):145–149. doi: 10.1001/archinte.146.1.145. [DOI] [PubMed] [Google Scholar]
  32. Van den Bergh O., Stegen K., Van Diest I., Raes C., Stulens P., Eelen P., Veulemans H., Van de Woestijne K. P., Nemery B. Acquisition and extinction of somatic symptoms in response to odours: a Pavlovian paradigm relevant to multiple chemical sensitivity. Occup Environ Med. 1999 May;56(5):295–301. doi: 10.1136/oem.56.5.295. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Environmental Health Perspectives are provided here courtesy of National Institute of Environmental Health Sciences

RESOURCES