Profile of patients with chemical injury & sensitivity

Patients reporting sensitivity to multiple chemicals at levels

usually tolerated by the healthy population were administered

standardized questionnaires to evaluate their symptoms and the

exposures that aggravated these symptoms. Many patients were

referred for medical tests. It is thought that patients with

chemical sensitivity have organ abnormalities involving the

liver, nervous system (brain, including limbic, peripheral,

autonomic), immune system, and porphyrin metabolism, probably

reflecting chemical injury to these systems.

Laboratory

results are not consistent with a psychologic origin of

chemical sensitivity. Substantial overlap between chemical

sensitivity, fibromyalgia, and chronic fatigue syndrome

exists: the latter two conditions often involve chemical

sensitivity and may even be the same disorder. Other disorders

commonly seen in chemical sensitivity patients include

headache (often migraine), chronic fatigue, musculoskeletal

aching, chronic respiratory inflammation (rhinitis, sinusitis,

laryngitis, asthma), attention deficit, and hyperactivity

(affected younger children).

Less common disorders include

tremor, seizures, and mitral valve prolapse. Patients with

these overlapping disorders should be evaluated for chemical

sensitivity and excluded from control groups in future

research. Agents whose exposures are associated with symptoms

and suspected of causing onset of chemical sensitivity with

chronic illness include gasoline, kerosene, natural gas,

pesticides (especially chlordane and chlorpyrifos), solvents,

new carpet and other renovation materials, adhesives/glues,

fiberglass, carbonless copy paper, fabric softener,

formaldehyde and glutaraldehyde, carpet shampoos (lauryl

sulfate) and other cleaning agents, isocyanates, combustion

products (poorly vented gas heaters, overheated batteries),

and medications (dinitrochlorobenzene for warts, intranasally

packed neosynephrine, prolonged antibiotics, and general

anesthesia with petrochemicals). Multiple mechanisms of

chemical injury that magnify response to exposures in

chemically sensitive patients can include neurogenic

inflammation (respiratory, gastrointestinal, genitourinary),

kindling and time-dependent sensitization (neurologic),

impaired porphyrin metabolism (multiple organs), and immune

activation.

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