[Diagnosis of multiple chemical sensitivity by chemical compounds exposure tests].

OBJECTIVE: There are no specific signs or symptoms in Multiple Chemical Sensitivity (MCS), so diagnosis of MCS depends on a history, QEESI symptom scores and exclusion of other diseases. A gold standard of diagnosis of MCS is a chemical compound exposure test in which changes of symptoms are used to decide the results positive or negative. We have done chemical compound exposure tests to diagnose MCS in 51 patients. METHODS: Chemical compound exposure tests were done in a special facility (the exposure chamber) in our hospital. Used VOC were formaldehyde or toluene. Maximum exposure concentrations were 0.08 ppm and 0.07 ppm for formaldehyde and toluene, respectively. Forty patients had the tests by a open test manner and 11 patients by a single blinded manner. RESULTS: In the open tests, 18 patients had positive results and 22 patients negative. In 22 patients who had negative results, eleven showed no symptoms by chemical exposures, and other 11 claimed symptoms before VOC went into the chamber. In the single blinded tests, 4 patients had positive results and 7 patients negative. CONCLUSION: The chemical exposure test is the most reliable test to diagnose MCS, so standardization of the methods of the test is necessary.

[The change of exhaled nitric oxide levels in early response after inhaled antigen in antigen-specific provocation test].

BACKGROUND: Inhaled antigen increases exhaled nitric oxide (eNO) in atopic asthmatics. Recent study showed that the increase of eNO levels was observed in late response (8-10 hours after inhaled antigen) but not in early response (1.5 hour after inhaled antigen). But we recognized that in some asthmatics eNO levels were increased during early response induced by antigen. METHODS: Atopic stable subjects with asthma induced by specific antigen (mite 11, housedust 3) were recruited in this study. Through bronchial provocation test with Mite or Housedust antigen, eNO levels were examined. As the control group, 7 atopic asthmatics who were not induced by specific antigen were recruited. RESULTS: In 7 subjects, the levels of eNO were increased during early response after inhaled antigen, and in other 7 subjects the levels of eNO were decreased. There were significant difference in the falling of FEV1 at threshold between the two groups (eNO increased group vs eNO decreased group, 22.1+/-0.87 (%) vs. 44.2+/-6.57 (%), p=0.016). In 6 subjects in control group, the levels of eNO were decreased. CONCLUSION: Inhaled antigen increased the levels of eNO in some asthmatics during early response in bronchial provocation test. The level of eNO has possibility of predicting the sudden decrease of FEV1 in bronchial provocation test.

[The methodological aspects of off-line sampling of exhaled air for nitric oxide measurement in Japanese].

The measurement of exhaled nitric oxide (eNO) is a non-invasive biomarker of bronchial inflammation. Despite the usefulness of eNO measurement, NO analyzers are too expensive for widespread use by general practitioners. In comparison, the off-line (bag collection) method of eNO measurement may be more useful. In Japan, however, there have been few studies about eNO in asthmatics using the off-line method. This study shows methodological aspects of the off-line method. Briefly, with a SIEVERS bag collection kit, we recommend that the flow rate and pressure level of exhaled air should be 70 ml/sec and 10 cm H2O, respectively and that the sampled air should be measured within 12 hours.

The relationship between exhaled nitric oxide measured with an off-line method and airway reversible obstruction in Japanese adults with asthma.

BACKGROUND: Exhaled nitric oxide (eNO) is a useful marker of eosinophilic airway inflammation in asthma patients. There is no study to show the relationship between the eNO measured by using an off-line method and the degree of reversibility of airflow limitation in Japanese asthma patients. We sought to investigate the relationship between the eNO level measured by using an off-line method and the degree of reversibility of bronchial constriction in Japanese asthma patients. METHODS: The study population comprised 97 asthma patients in our outpatient clinic with some patients in both groups who received inhaled corticosteroid treatment. We measured eNO levels, forced expiratory volume in one second (FEV1) before and after treatment, reversible airway obstruction (DeltaFEV1) after inhalation of bronchodilator, and other parameters. RESULTS: eNO was significantly correlated with peripheral blood eosinophil counts in asthma patients (in steroid-naïve asthma patients, r=0.544, p<0.0001; in asthma patients treated with inhaled corticosteroid, r=0.463, p=0.026), and subjects with severe eosinophilia in sputum showed high levels of eNO (mild eosinophilia versus severe, p=0.0152). Among patients with obstructive impairment, eNO levels were correlated with DeltaFEV1 regardless of whether patients received (r=0.527, p=0.0435) or did not receive (r=0.64, p = 0.0056) inhaled corticosteroid. In subjects with normal pulmonary function, there was no significant relationship between eNO and DeltaFEV1 with or without inhaled corticosteroid. CONCLUSIONS: In patients with obstructive impairment, eNO reflects the degree of reversible airflow limitation. In subjects with normal pulmonary function, eNO may facilitate the diagnosis and management of asthma, rather than indicate reversible bronchial obstruction. eNO measurement by off-line methods is applicable as a potential tool for the diagnosis of asthma and management of asthma patients.

[Case of eosinophilic bronchitis and bronchiolitis associated with increased level of serum CEA in asthmatics].

A 50-year-old asthmatic woman showed peripheral blood eosinophilia, significantly increased level of CEA in serum (102.5ng/ml), and atelectasis of the right middle lobe on chest radiograph and CT. The level of CEA subsequently increased further, and then decreased with systemic corticosteroid therapy. Pathological findings of surgically biopsied lung showed eosinophilic broncho-bronchiolitis, without malignant cells. Two years later, chest CT demonstrated various findings such as mucoid impaction, peripheral bronchiectasis and centrilobular nodules, but allergic bronchopulmonary mycosis was not proved. These findings suggest that the eosinophilic bronchiolar inflammation in bronchial asthma caused an increase in serum CEA levels and various findings on chest CT.

[Clinical aspects of patients with MCS - from the standpoint of allergy].

BACKGROUND: "Sick House Syndrome" is thought to be an illness caused by indoor environments such as allergens, bacteria and chemical compounds. But it is not yet an established clinical entity. "Sick House Syndrome" overlaps in part with Multiple Chemical Sensitivity (MCS) whose symptoms are induced by very small amount of volatile chemical compounds. METHODS: We selected possible cases of MCS from patients who visited our specially built facility for"Sick House Syndrome" by tentative criteria as follow: (1)histories of chemical compounds exposure, (2)multi-organ symptoms, (3)exclusion of other disease(s) which may be responsible for symptoms, (4)chronic symptoms. Clinical aspects of the possible cases were examined. RESULTS: Fifty out of about 130 patients were the possible cases of MCS, 38 females and 12 males, aged 15 to 71 years old. Forty two out of 50 patients (84%) had a history and/or a complication of allergic diseases. This rate is much higher than the rate of prevalence of allergic diseases in Japanese population. Allergic rhinitis was the most popular allergic disease in the possible cases. Total IgE values were relatively low, 32 patients (64%) showed the IgE value below 200 IU/ml. No patients showed anti-formaldehyde IgE antibody. Decreased reactivity and decreased sensitivity of histamine release from peripheral blood were observed after challenge tests with chemical compounds. CONCLUSION: Allergic reactions can not be the causative mechanism(s) of the MCS, which is induced by multiple and different chemical compounds. Our results, however, suggest that patients having allergic diseases may be easily suffered from MCS or MCS may strengthen symptoms of allergic diseases.