Síndrome de sensibilidad química múltiple y gestación: cómo actuar / Management of multiple chemical sensitivity syndrome in pregnancy

El síndrome de sensibilidad química múltiple es un trastorno crónico poco conocido que ocasiona múltiples síntomas en diversos aparatos y sistemas del organismo tras la exposición a agentes químicos a muy bajas concentraciones consideradas no perjudiciales para la población. Se trata de un proceso de instauración solapada y progresiva que afecta de forma mayoritaria a mujeres de mediana edad. En 1987 Cullen propone el término de SQM, no siendo hasta 1999 cuando se llega a un consenso para su diagnóstico basado en los criterios de Nethercott, los cuales son publicados por Bartha. En España se reconoce la enfermedad en el año 2014 incluyéndose en el CIE-9-MC con el código 995, dentro del acápite de alergias no especificadas. Una actualización posterior en el año 2016 del CIE-10-MC la clasifica con el código T78.40. Su etiopatogenia a día de hoy es desconocida, por lo que la OMS no la ha reconocido como enfermedad, pero se cree que podrían participar factores genéticos, alergénicos, químicos y anatómicos. Se trata de una enfermedad neurológica, con factores de predisposición claros, que empeora al hacer sobreesfuerzos físicos o ante estresores psicológicos mínimos, así como por exposición a factores químicos y ambientales. Su diagnóstico es fundamentalmente clínico y a día de hoy no tiene un tratamiento específico. Exponemos el caso de una gestante afecta de esta patología, así como las medidas llevadas a cabo de forma multidisciplinar en el manejo del parto y puerperio inmediato

Multiple Chemical Sensitivity Syndrome is a poorly understood chronic disorder that causes multiple symptoms in various body systems and organs following exposure to chemicals at very low concentrations that are not considered to be harmful to the population. It is an overlapping and progressive process that mostly affects middle-aged women. In 1987 Cullen proposed the term MCS, but it was not until 1999 that a consensus was reached for its diagnosis based on Nethercott's criteria, which were published by Bartha. In Spain, the disease was recognized in 2014 and was included in the ICD-9-MC with the code 995, under the heading of Unspecified Allergies. A later update in 2016 of the ICD-10-MC classifies it as code T78.40. Its aetiopathogenesis is currently unknown, thus it has not been recognised by the WHO as a disease, but it is believed that genetic, allergenic, chemical, and anatomical factors may be involved. It is a neurological disease, with clear predisposing factors, which is made worse by physical overexertion or minimal psychological stress, as well as by exposure to chemical and environmental factors. Its diagnosis is fundamentally clinical, and it currently does not have a specific treatment. The case is presented of a pregnant woman affected by this disorder, who was cared for by a multidisciplinary team in the management of the childbirth and immediate puerperium

[Multiple chemical sensitivity is for real]. / Tuoksuherkkyys on todellista.

Diagnosis of multiple chemical sensitivity is based on symptoms described by the patient. Sometimes the symptom is manifested as flushing of the face and as watering of the eyes and nose. Patients with multiple chemical sensitivity do not sense lower concentrations of scents and smells than do healthy persons, but their olfaction does not adapt to the smell. Because the mechanism of the sensitivity is not properly known, a good treatment does not exist. Some patients are alleviated by antihistamines or nasally sprayed corticosteroids or dilute local anesthetics. The best way is to avoid intense smells.

Impact of self-reported multiple chemical sensitivity on everyday life: a qualitative study.

BACKGROUND: Multiple chemical sensitivity (MCS) is a descriptive term covering symptoms attributed to exposure to common airborne chemicals. There are no internationally accepted criteria, but it has been suggested that MCS is a chronic and disabling condition. However, details of the impact of MCS on everyday life are limited. OBJECTIVE: To describe the impact of MCS on everyday life, strategies for managing the condition, and experiences with healthcare management. METHODS: A focus group study was conducted, including two interviews with a sample of six women and six men between 27 and 78 years of age, a duration of MCS of at least 1 year, and with different occupational conditions. RESULTS: MCS may severely influence different aspects of everyday life, including lifestyle, social relations, and occupational conditions. Avoiding common airborne chemicals was the most prevalent coping strategy, which implied creating a chemical-free living space and limiting social activities. Experiences with healthcare management were overall reported as negative in terms of not receiving acknowledgement of the reported symptoms. CONCLUSIONS: MCS may have serious implications for daily functioning. Further research on individual consequences and the social and psychological factors that may be associated with MCS is needed in order to add to our understanding of this condition and to the provision of more satisfactory healthcare.

Mechanisms of increased airway sensitivity to occupational chemicals and odors.

PURPOSE OF REVIEW: Airway symptoms induced by chemicals and odors are common problems that are also reported after contact with substances normally regarded as nontoxic. This article reviews current findings and opinions regarding mechanisms of increased airway sensitivity to occupational chemicals and odors. RECENT FINDINGS: Individuals exposed to organic solvents during work had more nasal irritation and lower threshold to pyridine odor compared with a nonexposed control group. Six percentage of a general population in Sweden had pronounced airway chemical sensitivity and augmented capsaicin cough sensitivity, known to reflect the sensory nerve reactivity of the airways. The cough sensitivity was associated with changed levels of nerve growth factor in nasal lavage and such patients had longstanding symptoms influencing their working capacity. Positron emission tomography activation studies with several different odorants showed in patients with odor-associated symptoms an odorant-related increase in activation of the anterior cingulate cortex and cuneus-precuneus in comparison with a control group. SUMMARY: In subgroups of individuals with airway symptoms induced by chemicals and odors, there seems to be a sustainable physiological mechanism behind the reactions. An increased vulnerability to stress cannot be neglected as a confounding factor in some sensitive individuals.

Air emissions from Wagerup alumina refinery and community symptoms: an environmental case study.

Commissioning of a liquor burner at Wagerup alumina refinery gave rise to complaints of malodor and irritation among employees. Subsequently, community members complained about odor and various health issues. Some employees and community members were diagnosed by general practitioners as having multiple chemical sensitivity. After implementation of emission controls, the situation improved; however, community concerns lingered. This paper describes this experience and summarizes several recent investigations including air dispersion modeling, health risk assessment, ambient air quality monitoring, and complaints analyses. It is concluded that refinery emissions currently present negligible risks of acute or chronic health effects including cancer. Communication of these findings has been generally well received, but modifying the perception of risk among some elements of the community has been difficult. Organizations need to effectively address both technical and perception of risk issues.

Multiple-drug intolerance syndrome: clinical findings and usefulness of challenge tests.

BACKGROUND: Multiple-drug intolerance syndrome (MDIS) is characterized by adverse reactions to several classes of chemically unrelated drugs. OBJECTIVE: To analyze all patients with a history of adverse reactions to at least 3 drugs at the Allergy Unit of Policlinico Gemelli in a 6-year period to better characterize patients with MDIS and to find safe alternative drugs. METHODS: We studied 480 patients (aged >16 years) with a history of adverse reactions to at least 3 unrelated drugs and with negative allergy test results. Patients who had experienced mild adverse reactions that remitted spontaneously underwent challenge tests without any premedication (group A). Patients with a clinical history of moderate reactions received sodium cromolyn, 500 mg, before the challenge (group B). Patients with a clinical history of severe reactions or undergoing parenteral challenges were given an antihistamine 30 minutes before the challenge (group C). RESULTS: In group A, 491 tolerance challenge tests were performed: 414 had negative results and 77 had positive results. In group B, 1,077 tolerance challenge tests were performed: 956 had negative results and 121 had positive results. In group C, 240 tolerance challenge tests were performed: 214 had negative results and 26 had positive results. Comparing the tolerance of alternative drugs in groups A and B, groups A and C, and groups B and C, no significant results were observed (P = .24, .14, and .44, respectively). CONCLUSIONS: Patients with MDIS can tolerate alternative drugs. Premedication with sodium cromolyn or oral H1-antihistamines may be useful in preventing adverse reactions.

Multiple chemical sensitivity in the clinical setting.

Multiple chemical sensitivity (MCS) is a condition in which people experience a broad array of symptoms in reaction to exposure to trace amounts of common chemicals. Symptoms are most often triggered by odors, typically affect many systems, and can range from a runny nose to difficulty breathing and heart palpitations. The cause of this condition is unclear and there is no universal consensus on how to diagnose or treat it. MCS afflicts millions of Americans, although its prevalence is difficult to establish reliably. Theories of causation include both the physical and the psychogenic. This article begins with a case study, describes the current research on MCS, and offers recommendations to guide nurses when treating these patients in the hospital.

Hazards in the radiology department.

OBJECTIVE: This article views, collectively, the problems associated with darkroom disease, multiple chemical sensitivity and latex allergy. Each is discussed individually to establish a case definition. METHOD: Common threads and similarities are identified among the 3 conditions along with potential sources. RESULTS: A model is proposed to change attitudes among radiographers in individual departments to improve workplace safety. CONCLUSION: We propose the use of an established health education/disease prevention model to change the attitudes of radiographers toward chemical threats.

Idiopathic environmental intolerances: overview.

The editor discusses usage of the terms "iidiopathic environmental intolerance," "multiple chemical sensitivity," and "environmental illness." Also addressed are prevalence, theories of etiology, evaluation and treatment, and social and political implications.

Hope in multiple chemical sensitivity: social support and attitude towards healthcare delivery as predictors of hope.

This paper examines hope, as measured by the Herth Hope Scale, and its predictors in a sample of 305 people self-identified with multiple chemical sensitivity. The sample had relatively low levels of hope with scores unrelated to gender, severity or length of illness, income loss as a result of illness, or reported iatrogenic harm. Hope scores were positively correlated with perceived social support, having found personal growth through illness, age, reported level of supportiveness from a partner, an improved course of illness and level of reported safety of the home environment in regard to chemical exposures. Negative correlations were found with attitude toward healthcare delivery, fatigue and reported abuse/ostracism from family members other than partner. Social support, Healthcare Orientation, growth through illness, fatigue and age predicted hope scores accounted for 55% of the variance. Implications and suggestions for future research are discussed.

"Eco-syndrome" ("multiple chemical sensitivity"--MCS).

In the physicians's practice in past decades, an increasing number of patients suffering from polysomatic complaints with a subjective feeling of allergy against environmental noxious agents have been seen. Various names for this condition include "Eco-Syndrome" or "Multiple Chemical Sensitivity" (MCS), "Multiorgan Dysesthesia" or "Idiopathic Environmental Intolerances". The uncertainty in the nomenclature reflects the deficiency in the knowledge of the etiopathophysiology and accordingly the diagnostic and therapeutic procedures. Most patients have completed an odyssey of visiting various specialists including psychiatrists and undergone many kinds of so-called alternative or parascientific procedures. We studied such patients since the early 1980s performing intensive interdisciplinary and allergological investigations. In about two third of the patients psychiatric or psychosomatic disturbances were obvious, but in one third of the patients somatic pathophysiological conditions were regarded as predominant cause of the present complaints. Many patients exhibited various pathophysiological patterns including somatic and psychosomatic alterations. Measurements of indoor air pollutants in the dust or in the air showed in some cases increased values of aromatic hydrocarbones, terpenes etc., without, however, explaining the main complaints. We conclude from our experience that patients presenting with hypersensitivity phenomena related to indoor air pollution are a heterogeneous group. There is no evidence, that "MCS" really exists, often it is diagnosed by the patients themselves. The term "eco-syndrome" describes a "working diagnosis" in order to apply careful interdisciplinary investigations for this heterogeneous group of patients. For the practical management of these patients mutual confidence is a prerequisite for success. The role of indoor air pollutants in triggering unspecific complaints beyond the exclusively toxicological field remains to be elucidated by future studies.

Low-level chemical sensitivity: implications for research and social policy.

There is increasing evidence that human exposure to levels of chemicals once thought to be safe--or presenting insignificant risk--are, in fact, harmful. So-called low-level exposures are now known to be associated with adverse biological effects including cancer, endocrine disruption, and chemical sensitivity. This requires that we change both (1) the way we design research linking chemicals and health, and (2) the solutions we devise to address chemically caused injury. The new and emerging science of low-level exposure to chemicals requires appropriate social policy responses which include regulation of toxic substances, notification of those exposed, and compensation and reasonable accommodation to those affected. Research and social policy need to be focused towards two distinct groups: (1) those individuals who could become chemically intolerant as a result of an initiating exposure, and (2) those individuals who have already become chemically intolerant and are now sensitive to chemicals at low levels.

Developing a pesticide policy for individuals with multiple chemical sensitivity: considerations for institutions.

Institutions are increasingly being asked to accommodate individuals with multiple chemical sensitivity (MCS). Most establishments have chosen to provide such accommodations on a case-by-case basis only. This paper investigates feasible actions that may be taken by institutions to reduce exposure of MCS individuals as well as the general institutional population to pesticides and other substances. Emphasis is placed on procedures that can be instituted on a regular basis and may be combined with case-by-case management for better resolution of problems.

Social support in persons with self-reported sensitivity to chemicals.

Social support was examined in 305 persons with multiple chemical sensitivity using the Personal Resource Questionnaire 85 (PRQ85; Weinert, 1987) and qualitative descriptions of respondents' social interactions. PRQ85 scores were lower than those of healthy populations, but similar to samples with chronic illness. Participants needed but were prevented from receiving support for personal difficulties due to their limited public access, their need for chemical avoidance including fragrances, and others' lack of information and negative attitudes regarding chemical sensitivities. Respondents drew some support and validation from support groups and from romantic relationships. Fatigue level, being in a romantic relationship, contact with a support group on a monthly or more frequent basis, chemical avoidance in the home, gender, and an improved course of illness predicted 19% of the variance for perceived social support. Qualitative data are used to illustrate particular problems of persons in this sample, and suggestions are made for practitioners who encounter this population.

Patients with multiple chemical sensitivities in an occupational health clinic: presentation and follow-up.

Thirty-five people with work-related Multiple Chemical Sensitivities were studied to learn about the onset and progression of illness. The subjects were selected from patients at an occupational health clinic. Individuals were identified as subjects if they fulfilled a seven-point case definition for Multiple Chemical Sensitivities and if onset of symptoms was related to workplace exposures. Three occupational exposures to solvents, poor indoor-air quality, and remodeling were associated with onset of Multiple Chemical Sensitivities in 63% of the subjects. Symptoms indicative of a nervous-system disorder topped the list of the most frequently reported symptoms. Commonalities in exposures and symptoms suggest that Multiple Chemical Sensitivities represents a distinct diagnostic category. Even with an incomplete understanding of etiology, it may be possible to limit the onset of work-related Multiple Chemical Sensitivities.

Practical application of air-quality research incorporated in CMHC's research house.

The Canada Mortgage and Housing Corporation has been looking at ways to improve indoor air quality since 1984 and now hopes to interest house designers and manufacturers in the results of its research. Its flagship project has been the construction of a proto-type research house for environmentally hypersensitive people.

Odor-associated idiopathic anaphylaxis. A case report.

A 44 year old woman is described who appears to have idiopathic anaphylaxis triggered by chemical odors. Her case and a general discussion of anaphylaxis are presented. The known causes of anaphylaxis and a discourse on idiopathic anaphylaxis are given. The treatment of idiopathic anaphylaxis is discussed.