A First Urological Approach to the Genitourinary Manifestations of Multiple Chemical Sensitivity. Systematic Review.

INTRODUCTION AND OBJECTIVES: Multiple chemical sensitivity (MCS) is a complex disease with multiorgan manifestations, some of which are still poorly understood, such as genitourinary manifestations. The objective of this article is to review these genitourinary manifestations. MATERIAL AND METHODS: A retrospective descriptive study on the genitourinary manifestations described in patients with multiple chemical sensitivity is performed, based on a systematic review of the literature between February 1956 and December 2020, consulting the Medline/PubMed database and the Google search engine. Descriptive statistics of the variables studied were performed with frequency and percentage for qualitative variables and median and range (minimum-maximum value) for quantitative variables. RESULTS: We reviewed the originals or abstracts of 3450 articles on MCS, including 461 on symptoms (13.3%) and selecting 40 (1.1%) that referred to genitourinary pathologies or symptoms and corresponded to 19 reviews, 14 articles on case reports (11 clinical cases and 3 series), 5 books with case reports, 1 consensus document and 1 update. The number of patients with MCS studied in these 40 articles was 4556 of whom 303 presented genitourinary symptoms (6.6%), and corresponded to 277 women (91.4%) and 27 men (8.6%) with a mean age of 39.4 years, range (7-82 years). There were 119 different genitourinary symptoms or pathologies with 170 citations which in frequency were 77 for gynecological symptoms (45.3%) in 28 publications (70%), 62 for urological symptoms (36.5%) in 29 publications (72.5%), 18 for sexological symptoms (10.6%) in 8 publications (20%) and 13 for andrological symptoms (7.6%) in 5 publications (12.5%). CONCLUSIONS: Genitourinary manifestations of MCS are rare and predominantly in women. They constitute a genitourinary syndrome including gynecological, urological, sexological and andrological symptoms. Until today there has been no study of these symptoms in the medical literature.

A First Urological Approach to the Genitourinary Manifestations of Multiple Chemical Sensitivity. Systematic Review

Introduction and Objectives: Multiple chemical sensitivity (MCS) is a complex disease with multiorgan manifestations, some of which are still poorly understood, such as genitourinary manifestations. The objective of this article is to review these genitourinary manifestations. Material and Methods: A retrospective descriptive study on the genitourinary manifestations described in patients with multiple chemical sensitivity is performed, based on a systematic review of the literature between February 1956 and December 2020, consulting the Medline/PubMed database and the Google search engine. Descriptive statistics of the variables studied were performed with frequency and percentage for qualitative variables and median and range (minimum-maximum value) for quantitative variables. Results: We reviewed the originals or abstracts of 3450 articles on MCS, including 461 on symptoms (13.3%) and selecting 40 (1.1%) that referred to genitourinary pathologies or symptoms and corresponded to 19 reviews, 14 articles on case reports (11 clinical cases and 3 series), 5 books with case reports, 1 consensus document and 1 update. The number of patients with MCS studied in these 40 articles was 4556 of whom 303 presented genitourinary symptoms (6.6%), and corresponded to 277 women (91.4%) and 27 men (8.6%) with a mean age of 39.4 years, range (7-82 years). There were 119 different genitourinary symptoms or pathologies with 170 citations which in frequency were 77 for gynecological symptoms (45.3%) in 28 publications (70%), 62 for urological symptoms (36.5%) in 29 publications (72.5%), 18 for sexological symptoms (10.6%) in 8 publications (20%) and 13 for andrological symptoms (7.6%) in 5 publications (12.5%). Conclusions: Genitourinary manifestations of MCS are rare and predominantly in women (AU)

Multiple Chemical Sensitivity in Patients Exposed to Moisture Damage at Work and in General Working-Age Population-The SAMDAW Study.

A considerable proportion of patients having respiratory tract or voice symptoms associated with workplace moisture damage (MD) could have multiple chemical sensitivity (MCS). MCS is characterized by symptoms of different organ systems in association with low-level chemical exposure. The objective of this study was to assess the prevalence of MCS among patients referred to secondary health care because of respiratory or voice symptoms associated with workplace MD compared to the general working-age population. Using three subscales of the QEESI© questionnaire, we assessed MCS in the study patients and 1500 controls in the same district randomly selected from the Finnish Population Information System. Study patients had significantly more often high scores in chemical intolerance (39% vs. 23%, p = 0.001), symptom severity (60% vs. 27%, p < 0.001), and life impact subscales (53% vs. 20%, p < 0.001). Asthma, chronic rhinosinusitis, laryngeal problems, and atopy were not associated with the presence of MCS. MCS is common among patients referred to secondary health care with respiratory tract and/or voice symptoms associated with workplace MD, and it considerably affects their everyday life. MCS should be considered as a possible explanatory factor for MD-associated symptoms.

Italian Expert Consensus on Clinical and Therapeutic Management of Multiple Chemical Sensitivity (MCS).

Multiple chemical sensitivity (MCS) is a multisystem, recurrent, environmental disorder that flares in response to different exposures (i.e., pesticides, solvents, toxic metals and molds) under the threshold limit value (TLV) calculated for age and gender in the general population. MCS is a syndrome characterized by cutaneous, allergic, gastrointestinal, rheumatological, endocrinological, cardiological and neurological signs and symptoms. We performed a systematic review of the literature to summarize the current clinical and therapeutic evidence and then oriented an eDelphi consensus. Four main research domains were identified (diagnosis, treatment, hospitalization and emergency) and discussed by 10 experts and an MCS patient. Thus, the first Italian MCS consensus had the double aim: (a) to improve MCS knowledge among healthcare workers and patients by standardizing the clinical and therapeutic management to MCS patients; and (b) to improve and shed light on MCS misconceptions not supported by evidence-based medicine (EBM).

[Multiple chemical sensitivity and recurrent lower urinary tract symptoms (LUTS). Contribution with an illustrative urological case.] / Sensibilidad química múltiple y síntomas recurrentes del tracto urinario inferior (STUI). Contribución con caso urológico ilustrativo.

INTRODUCTION AND OBJECTIVES: Multiple chemical sensitivity (MCS) is a disease due to a disproportionate systemic response to chemical agents presentin the environment. ts urinary manifestations are rare and poorly understood. We present a case with recurrent lower urinary tract symptoms (LUTS) and review these symptoms in Spanish and foreign publications. CLINICAL CASE: A 30-year-old woman was referred for study of recurrent lower urinary tract symptoms of 17 years of evolution, triggered by food, perfumes, cleaning products, cosmetics and bleach. Repeated analytical, radiological and functional tests were normal. We suspected that she might suffer from MCS and advised a study in Preventive Medicine. The patient consulted an Environmental Medicine Center, and was diagnosed as having gradeIII-IV/IV MCS. CONCLUSIONS: This is the first case of MCS diagnosed from urinary clinical manifestations. Among the causes of LUTS we should also think of MCS.

INTRODUCCIÓN Y OBJETIVOS: La sensibilidad química múltiple (SQM) es una enfermedad debida a una respuesta sistémica desproporcionada a los agentes químicos presentes en el medio ambiente. Sus manifestaciones urinarias son raras y poco conocidas. Presentamos un caso que cursó con síntomas recurrentes del tracto urinario inferior (STUI) y revisamos estos síntomas en publicaciones españolas y extranjeras.CASO CLÍNICO: Mujer de 30 años remitida para estudio de síntomas recurrentes del tracto urinario inferior de 17 años de evolución, desencadenados por alimentos, perfumes, productos de limpieza, cosméticos y lejía. Repetidas pruebas analíticas, radiológicas y funcionales fueron normales. Sospechamos que podía padecer SQM, aconsejando estudio en Medicina Preventiva. La paciente consultó en un Centro de Medicina Ambiental, diagnosticándole SQM grado III-IV/IV.CONCLUSIONES: Éste es el primer caso de SQM diagnosticado a partir de manifestaciones clínicas del tracto urinario inferior. Entre las causas de STUI deberíamos pensar también en la SQM.

[Genitourinary symptoms of multiple chemical sensitivity in spanish publications.] / Los síntomas genitourinarios de la sensibilidad química múltiple en las publicaciones españolas.

INTRODUCTION AND OBJECTIVES:  Multiple chemical sensitivity (MCS) is a multi-symptomatic systemic disease whose genitourinary symptoms are poorly known. The aim of this article is to study these symptoms in Spanish publications. MATERIALS AND METHODS: A retrospective study of descriptive type on the genitourinary symptoms of MCS is carried out in the Spanish publications between the years 2000 and 2019. The search in Medline was performed with MeSH terms "multiple chemical sensitivity Spanish" and in Google with free terms "sensibilidad química multiple España". In the publications found, only those referring to genitourinary symptoms were selected, in which year, authors, type of article (clinical case, review, casuistry), genital symptoms, urinary symptoms, specialty, hospital or centre and city were studied. The results of these variables have been analyzed with descriptive statistics. RESULTS: We found 45 Spanish publications on MCS of which 20 (44,4%) mentioned genitourinary symptoms. The 20 articles corresponded to 7 clinical cases, 6 reviews, 2 case series, 2 updates, 1 book chapter, 1 special article and 1 consensus document. We found 12 publications on female genital symptoms (60%), 12 on urinary symptoms (60%) and 4 on male genital symptoms (20%). The specialties with the highest number of publications were Family Medicine and Psychiatry with 3 (15%) and Neumology, Toxicology and Anesthesia and Resuscitation with 2 (10%). There are publications from 13 hospitals and 7 national centers, health agencies or foundations. The publications corresponded to 10 cities, the 2 with the most publications being Madrid with 6 (30%) and Barcelona with 6 (30%). CONCLUSIONS: The genitourinary symptoms of MCS are mentioned in about half of the Spanish publications. There is a clear predominance of these symptoms in women. This "genitourinary syndrome" should be taken into account in urological and gynecological patients with MCS.

INTRODUCCIÓN Y OBJETIVOS: La sensibilidad química múltiple (SQM) es una enfermedad sistémica plurisintomática cuyos síntomas genitourinarios son poco conocidos. El objetivo de este artículo es estudiar estos síntomas en las publicaciones españolas.MATERIAL Y MÉTODOS: Se realiza un estudio retrospectivo de tipo descriptivo sobre los síntomas genitourinarios de la SQM en las publicaciones españolas entre los años 2000 y 2019. La búsqueda en Medline se realizó con términos MeSH "multiple chemical sensitivity Spanish" y en Google con términos libres "sensibilidad química multiple España". En las publicaciones encontradas se ha seleccionado únicamente aquellas que hacen referencia a síntomas genitourinarios, en las que se ha estudiado año, autores, tipo de artículo (caso clínico, revisión, casuística), síntomas genitales, síntomas urinarios, especialidad, hospital o centro y ciudad. Los resultados de estas variables se han analizado con estadísticas descriptivas.RESULTADOS: Se ha encontrado 45 publicaciones españolas sobre SQM de las que 20 (44,4%) hacen mención a síntomas genitourinarios. Los 20 artículos correspondían a 7 casos clínicos, 6 revisiones, 2 series de casuística, 2 actualizaciones, 1 capitulo de libro,1 articulo especial y 1 documento de consenso. Se encontraron 12 publicaciones sobre síntomas genitales femeninos (60%), 12 sobre síntomas urinarios (60%) y 4 sobre síntomas genitales masculinos (20%). Las especialidades con mayor número de publicaciones correspondían a Medicina de Familia y Psiquiatría con 3 (15%) y Neumología, Toxicología y Anestesia Reanimación con 2 (10%). Hay publicaciones de 13 hospitales y 7 centros nacionales, agencias de salud o fundaciones. Las publicaciones correspondían a 10 ciudades siendo las 2 con más publicaciones Madrid con 6 (30%) y Barcelona con 6 (30%).CONCLUSIONES: Los síntomas genitourinarios de la SQM se mencionan en cerca de la mitad de las publicaciones españolas. Existe un claro predominio de estos síntomas en la mujer. Habría que tener en cuenta este "síndrome genitourinario" en las pacientes urológicas y ginecológicas con SQM.

Los síntomas genitourinarios de la sensibilidad química múltiple en las publicaciones españolas / Genitourinary symptoms of multiple chemical sensitivity in Spanish publications

Introdcción y objetivos: La sensibilidad química múltiple (SQM) es una enfermedadsistémica plurisintomática cuyos síntomas genitourinariosson poco conocidos. El objetivo de este artículo es estudiar estos síntomas en las publicaciones españolas. Material y métodos: Se realiza un estudio retrospectivo de tipo descriptivo sobre los síntomas genitourinarios de la SQM en las publicaciones españolas entrelos años 2000 y 2019. La búsqueda en Medline serealizó con términos MeSH “multiple chemical sensitivity Spanish” y en Google con términos libres “sensibilidad química multiple España”. En las publicacionesencontradas se ha seleccionado únicamente aquellasque hacen referencia a síntomas genitourinarios, en lasque se ha estudiado año, autores, tipo de artículo (casoclínico, revisión, casuística), síntomas genitales, síntomas urinarios, especialidad, hospital o centro y ciudad.Los resultados de estas variables se han analizado conestadísticas descriptivas. Resultados: Se ha encontrado 45 publicacionesespañolas sobre SQM de las que 20 (44,4%) hacenmención a síntomas genitourinarios. Los 20 artículos correspondían a 7 casos clínicos, 6 revisiones, 2 seriesde casuística, 2 actualizaciones, 1 capitulo de libro,1 articulo especial y 1 documento de consenso. Seencontraron 12 publicaciones sobre síntomas genitalesfemeninos (60%), 12 sobre síntomas urinarios (60%) y 4sobre síntomas genitales masculinos (20%). Las especialidades con mayor número de publicaciones correspon-dían a Medicina de Familia y Psiquiatría con 3 (15%) yNeumología, Toxicología y Anestesia Reanimación con2 (10%). Hay publicaciones de 13 hospitales y 7 centros nacionales, agencias de salud o fundaciones. Laspublicaciones correspondían a 10 ciudades siendo las2 con más publicaciones Madrid con 6 (30%) y Barcelona con 6 (30%).CONCLUSIONES: Los síntomas genitourinarios de laSQM se mencionan en cerca de la mitad de las publicaciones españolas...AU)

Intrduction y objetives: Multiple chemical sensitivity (MCS) is a multi-symptomatic systemic disease whose genitourinary symptoms arepoorly known. The aim of this article is to study thesesymptoms in Spanish publications. Material and methods: years 2000 and 2019. The search in Medline was performed with MeSH terms “multiple chemical sensitivitySpanish” and in Google with free terms “sensibilidadquímica multiple España”. In the publications found,only those referring to genitourinary symptoms were selected, in which year, authors, type of article (clinicalcase, review, casuistry), genital symptoms, urinary symptoms, specialty, hospital or centre and city were studied. The results of these variables have been analyzed withdescriptive statistics.Results: We found 45 Spanish publications on MCSof which 20 (44,4%) mentioned genitourinary symptoms. The 20 articles corresponded to 7 clinical cases,6 reviews, 2 case series, 2 updates, 1 book chapter,1 special article and 1 consensus document. We found12 publications on female genital symptoms (60%), 12on urinary symptoms (60%) and 4 on male genital symptoms (20%). The specialties with the highest number ofpublications were Family Medicine and Psychiatry with3 (15%) and Neumology, Toxicology and Anesthesiaand Resuscitation with 2 (10%). There are publicationsfrom 13 hospitals and 7 national centers, health agencies or foundations. The publications corresponded to10 cities, the 2 with the most publications being Madridwith 6 (30%) and Barcelona with 6 (30%).Conclusions: The genitourinary symptoms of MCSare mentioned in about half of the Spanish publications.There is a clear predominance of these symptoms inwomen. This “genitourinary syndrome” should be takeninto account in urological and gynecological patientswith MCS.(AU)

Spatial variation in risk for physician diagnosed environmental sensitivity.

Multiple chemical sensitivity (MCS) is a chronic condition characterized by recurring and severe symptoms triggered by exposures to low levels of toxicants or anthropogenic pollution. This study investigated the spatial structure of MCS incidence and estimated the contribution of socio-economic deprivation to variations in rates of MCS at the community level in Nova Scotia, Canada. Patient data were used to calculate cumulative incidence rate ratios for treated multiple chemical sensitivities. Poisson regression with a spatially autoregressive random effect was employed to assess spatial variation in MCS. Odds of MSC incidence are greatest among patients from the highest socioeconomic category using the most socioeconomically deprived category as reference (OR: 1.94, CI [2.5-95%] 1.45-2.56). No discernable spatial pattern for MCS risk was evident after controlling for known risk factors. This is the first study to investigate spatial variations in cumulative incidence of multiple chemical sensitivities. The socioeconomic status of the community in which patients live has a significant influence on the geographic patterns of MCS. Future research will include a smartphone application to assess positional and temporal information on environmental exposures to further explain MCS prevalence.

Functional brain MRI in patients complaining of electrohypersensitivity after long term exposure to electromagnetic fields.

INTRODUCTION: Ten adult patients with electromagnetic hypersensitivity underwent functional magnetic resonance imaging (fMRI) brain scans. All scans were abnormal with abnormalities which were consistent and similar. It is proposed that fMRI brain scans be used as a diagnostic aid for determining whether or not a patient has electromagnetic hypersensitivity. Over the years we have seen an increasing number of patients who had developed multi system complaints after long term repeated exposure to electromagnetic fields (EMFs). These complaints included headaches, intermittent cognitive and memory problems, intermittent disorientation, and also sensitivity to EMF exposure. Regular laboratory tests were within normal limits in these patients. The patients refused to be exposed to radioactivity. This of course ruled out positron emission tomography (PET) and single-photon emission computed tomography (SPECT) brain scanning. This is why we ordered fMRI brain scans on these patients. We hoped that we could document objective abnormalities in these patients who had often been labeled as psychiatric cases. MATERIALS AND METHODS: Ten patients first underwent a regular magnetic resonance imaging (MRI) brain scan, using a 3 Tesla Siemens Verio MRI open system. A functional MRI study was then performed in the resting state using the following sequences: A three-dimensional, T1-weighted, gradient-echo (MPRAGE) Resting state network. The echo-planar imaging (EPI) sequences for this resting state blood oxygenation level dependent (BOLD) scan were then post processed on a 3D workstation and the independent component analysis was performed separating out the various networks. Arterial spin labeling. Tractography and fractional anisotropy. RESULTS: All ten patients had abnormal functional MRI brain scans. The abnormality was often described as hyper connectivity of the anterior component of the default mode in the medial orbitofrontal area. Other abnormalities were usually found. Regular MRI studies of the brain were mostly unremarkable in these patients. CONCLUSION: We propose that functional MRI studies should become a diagnostic aid when evaluating a patient who claims electrohypersensitivity (EHS) and has otherwise normal studies. Interestingly, the differential diagnosis for the abnormalities seen on the fMRI includes head injury. It turns out that many of our patients indeed had a history of head injury which was then followed sometime later by the development of EHS. Many of our patients also had a history of exposure to potentially neurotoxic chemicals, especially mold. Head injury and neurotoxic chemical exposure may make a patient more vulnerable to develop EHS.