Background Worldwide observations point to a two-stage theory of disease called Toxicant-Induced ... more Background Worldwide observations point to a two-stage theory of disease called Toxicant-Induced Loss of Tolerance (TILT): Stage I, Initiation by an acute high-level or repeated lower-level chemical exposures, followed by Stage II, Triggering of multisystem symptoms by previously tolerated, structurally diverse chemical inhalants, foods/food additives and drugs. Until recently, there was no known biological mechanism that could explain these observations. In 2021 we published a plausible and researchable two-stage biomechanism for TILT involving mast cells: Stage I, Initiation via mast cell sensitization; Stage II, Triggering of mast cell degranulation by previously tolerated exposures, resulting in the release of thousands of mediators, including histamine and a host of inflammatory molecules. The objective of this study was to identify common TILT initiators. Methods A randomized, population-based sample of 10,981 U.S. adults responded to a survey which included items concerning m...
Aim The goal of this investigation was to 1) identify exposure sources in the home, 2) teach occu... more Aim The goal of this investigation was to 1) identify exposure sources in the home, 2) teach occupants how to remove or replace them, and 3) determine whether measured levels and reported symptoms could be reduced by these changes.Background Chemical intolerance (CI) is an international public health and clinical concern, but few resources are available to address patients’ often disabling symptoms. Numerous studies show that levels of indoor air pollutants can be two-to-five (or more) times higher than outdoor levels. Fragranced consumer products, including cleaning supplies, air fresheners, and personal care products are symptom triggers commonly reported by susceptible individuals.Methods A team of professionals trained and led by a physician/industrial hygienist and two certified indoor air quality specialists conducted a series of five structured Environmental House Calls (EHCs) in 37 homes of patients reporting chemical intolerances.Results We report three case studies demonst...
Background Chemical intolerance (CI) is a condition that may result in multisystem symptoms trigg... more Background Chemical intolerance (CI) is a condition that may result in multisystem symptoms triggered by low levels of exposure to xenobiotics such as chemical inhalants, foods, and/or drugs. The population prevalence of self-reported chemical intolerance is estimated to be between 4 and 25% across several countries. Clinicians and researchers require a brief, practical screening tool for identifying chemical intolerance. Objectives We investigated the validity of a three-item screening questionnaire for CI, the Brief Environmental Exposure and Sensitivity Inventory (BREESI). The internationally validated, and widely used 50-item Quick Environmental Exposure and Sensitivity Inventory (QEESI) was used as the reference standard. Methods Five thousand individuals (n = 1000 in each of five countries: the US, Japan, Italy, Mexico, and India) responded to both the QEESI and the BREESI using an online research survey platform. We determined the statistical performance metrics for the BREES...
Primary Health Care Research & Development, 2022
Aim: To determine whether environmental house calls that improved indoor air quality (IAQ) is eff... more Aim: To determine whether environmental house calls that improved indoor air quality (IAQ) is effective in reducing symptoms of chemical intolerance (CI). Background: Prevalence of CI is increasing worldwide. Those affected typically report symptoms such as headaches, fatigue, ‘brain fog’, and gastrointestinal problems – common primary care complaints. Substantial evidence suggests that improving IAQ may be helpful in reducing symptoms associated with CI. Methods: Primary care clinic patients were invited to participate in a series of structured environmental house calls (EHCs). To qualify, participants were assessed for CI with the Quick Environmental Exposure and Sensitivity Inventory. Those with CI volunteered to allow the EHC team to visit their homes to collect air samples for volatile organic compounds (VOCs). Initial and post-intervention IAQ sampling was analyzed by an independent lab to determine VOC levels (ng/L). The team discussed indoor air exposures, their health effec...
Background Chemical Intolerance (CI) is characterized by multi-system symptoms initiated by expos... more Background Chemical Intolerance (CI) is characterized by multi-system symptoms initiated by exposures to environmental toxins. Symptoms include fatigue, headache, mood changes, musculoskeletal pain, gastro-intestinal issues, difficulties with memory/concentration. With mixed results, researchers have used targeted genetic approaches to understand the genetic pathways associated with CI. This study is the first to apply a genome-wide untargeted exploratory approach. Methods A high-density genotyping platform was used to perform a hypothesis-free search for genetic variants associated with CI in a set of 200 participants. Each CI patient was verified using a validated survey. The association between CI and SNPs was obtained using SOLAR (Sequential Oligogenic Linkage Analysis Routines). Gene-Chemical-Disease interactions were determined using the DisGeNET Database. Results Several associated SNPs/genes were identified with either increased or decreased risk of CI. Four chemicals were f...
Keywords: Chemical Intolerance, Drug Intolerance, Food Intolerance, QEESI, BREESI, Multiple Chemi... more Keywords: Chemical Intolerance, Drug Intolerance, Food Intolerance, QEESI, BREESI, Multiple Chemical Sensitivity, Toxicant-induced Loss of Tolerance, Prevalence
Background: Chemical intolerance (CI) is characterized by multisystem symptoms initiated by a one... more Background: Chemical intolerance (CI) is characterized by multisystem symptoms initiated by a one-time high-dose or a persistent low-dose exposure to environmental toxicants. Prior studies have investigated symptom clusters rather than defined comorbid disease clusters. We use a latent class modeling approach to determine the number and type of comorbid disease clusters associated with CI. Methods: Two hundred respondents with and without CI were recruited to complete the Quick Environmental Exposure and Sensitivity Inventory (QEESI), and a 17-item comorbid disease checklist. A logistic regression model was used to predict the odds of comorbid disease conditions between groups. A latent class analysis was used to inspect the pattern of dichotomous item responses from the 17 comorbid diseases. Results: Those with the highest QEESI scores had significantly greater probability of each comorbid disease compared to the lowest scoring individuals (P < 0.0001). Three latent class disease clusters were found. Class 1 (17% of the sample) was characterized by a cluster consisting of irritable bowel syndrome (IBS), arthritis, depression, anxiety, fibromyalgia, and chronic fatigue. The second class (53% of the sample) was characterized by a low probability of any of the co-morbid diseases. The third class (30% of the sample) was characterized only by allergy. Discussion: We have demonstrated that several salient comorbid diseases form a unique statistical cluster among a subset of individuals with CI. Understanding these disease clusters may help physicians and other health care workers to gain a better understanding of individuals with CI. As such, assessing their patients for CI may help identify the salient initiators and triggers of their CI symptoms—therefore guide potential treatment efforts.
Background Worldwide observations point to a two-stage theory of disease called Toxicant-Induced ... more Background Worldwide observations point to a two-stage theory of disease called Toxicant-Induced Loss of Tolerance (TILT): Stage I, Initiation by an acute high-level or repeated lower-level chemical exposures, followed by Stage II, Triggering of multisystem symptoms by previously tolerated, structurally diverse chemical inhalants, foods/food additives and drugs. Until recently, there was no known biological mechanism that could explain these observations. In 2021 we published a plausible and researchable two-stage biomechanism for TILT involving mast cells: Stage I, Initiation via mast cell sensitization; Stage II, Triggering of mast cell degranulation by previously tolerated exposures, resulting in the release of thousands of mediators, including histamine and a host of inflammatory molecules. The objective of this study was to identify common TILT initiators. Methods A randomized, population-based sample of 10,981 U.S. adults responded to a survey which included items concerning m...
Aim The goal of this investigation was to 1) identify exposure sources in the home, 2) teach occu... more Aim The goal of this investigation was to 1) identify exposure sources in the home, 2) teach occupants how to remove or replace them, and 3) determine whether measured levels and reported symptoms could be reduced by these changes.Background Chemical intolerance (CI) is an international public health and clinical concern, but few resources are available to address patients’ often disabling symptoms. Numerous studies show that levels of indoor air pollutants can be two-to-five (or more) times higher than outdoor levels. Fragranced consumer products, including cleaning supplies, air fresheners, and personal care products are symptom triggers commonly reported by susceptible individuals.Methods A team of professionals trained and led by a physician/industrial hygienist and two certified indoor air quality specialists conducted a series of five structured Environmental House Calls (EHCs) in 37 homes of patients reporting chemical intolerances.Results We report three case studies demonst...
Background Chemical intolerance (CI) is a condition that may result in multisystem symptoms trigg... more Background Chemical intolerance (CI) is a condition that may result in multisystem symptoms triggered by low levels of exposure to xenobiotics such as chemical inhalants, foods, and/or drugs. The population prevalence of self-reported chemical intolerance is estimated to be between 4 and 25% across several countries. Clinicians and researchers require a brief, practical screening tool for identifying chemical intolerance. Objectives We investigated the validity of a three-item screening questionnaire for CI, the Brief Environmental Exposure and Sensitivity Inventory (BREESI). The internationally validated, and widely used 50-item Quick Environmental Exposure and Sensitivity Inventory (QEESI) was used as the reference standard. Methods Five thousand individuals (n = 1000 in each of five countries: the US, Japan, Italy, Mexico, and India) responded to both the QEESI and the BREESI using an online research survey platform. We determined the statistical performance metrics for the BREES...
Primary Health Care Research & Development, 2022
Aim: To determine whether environmental house calls that improved indoor air quality (IAQ) is eff... more Aim: To determine whether environmental house calls that improved indoor air quality (IAQ) is effective in reducing symptoms of chemical intolerance (CI). Background: Prevalence of CI is increasing worldwide. Those affected typically report symptoms such as headaches, fatigue, ‘brain fog’, and gastrointestinal problems – common primary care complaints. Substantial evidence suggests that improving IAQ may be helpful in reducing symptoms associated with CI. Methods: Primary care clinic patients were invited to participate in a series of structured environmental house calls (EHCs). To qualify, participants were assessed for CI with the Quick Environmental Exposure and Sensitivity Inventory. Those with CI volunteered to allow the EHC team to visit their homes to collect air samples for volatile organic compounds (VOCs). Initial and post-intervention IAQ sampling was analyzed by an independent lab to determine VOC levels (ng/L). The team discussed indoor air exposures, their health effec...
Background Chemical Intolerance (CI) is characterized by multi-system symptoms initiated by expos... more Background Chemical Intolerance (CI) is characterized by multi-system symptoms initiated by exposures to environmental toxins. Symptoms include fatigue, headache, mood changes, musculoskeletal pain, gastro-intestinal issues, difficulties with memory/concentration. With mixed results, researchers have used targeted genetic approaches to understand the genetic pathways associated with CI. This study is the first to apply a genome-wide untargeted exploratory approach. Methods A high-density genotyping platform was used to perform a hypothesis-free search for genetic variants associated with CI in a set of 200 participants. Each CI patient was verified using a validated survey. The association between CI and SNPs was obtained using SOLAR (Sequential Oligogenic Linkage Analysis Routines). Gene-Chemical-Disease interactions were determined using the DisGeNET Database. Results Several associated SNPs/genes were identified with either increased or decreased risk of CI. Four chemicals were f...
Keywords: Chemical Intolerance, Drug Intolerance, Food Intolerance, QEESI, BREESI, Multiple Chemi... more Keywords: Chemical Intolerance, Drug Intolerance, Food Intolerance, QEESI, BREESI, Multiple Chemical Sensitivity, Toxicant-induced Loss of Tolerance, Prevalence
Background: Chemical intolerance (CI) is characterized by multisystem symptoms initiated by a one... more Background: Chemical intolerance (CI) is characterized by multisystem symptoms initiated by a one-time high-dose or a persistent low-dose exposure to environmental toxicants. Prior studies have investigated symptom clusters rather than defined comorbid disease clusters. We use a latent class modeling approach to determine the number and type of comorbid disease clusters associated with CI. Methods: Two hundred respondents with and without CI were recruited to complete the Quick Environmental Exposure and Sensitivity Inventory (QEESI), and a 17-item comorbid disease checklist. A logistic regression model was used to predict the odds of comorbid disease conditions between groups. A latent class analysis was used to inspect the pattern of dichotomous item responses from the 17 comorbid diseases. Results: Those with the highest QEESI scores had significantly greater probability of each comorbid disease compared to the lowest scoring individuals (P < 0.0001). Three latent class disease clusters were found. Class 1 (17% of the sample) was characterized by a cluster consisting of irritable bowel syndrome (IBS), arthritis, depression, anxiety, fibromyalgia, and chronic fatigue. The second class (53% of the sample) was characterized by a low probability of any of the co-morbid diseases. The third class (30% of the sample) was characterized only by allergy. Discussion: We have demonstrated that several salient comorbid diseases form a unique statistical cluster among a subset of individuals with CI. Understanding these disease clusters may help physicians and other health care workers to gain a better understanding of individuals with CI. As such, assessing their patients for CI may help identify the salient initiators and triggers of their CI symptoms—therefore guide potential treatment efforts.
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