Multiple Chemical Sensitivity (MCS)
MCS is a collection of nonspecific symptomatology affecting multiple organ systems reportedly secondary to multiple differing exposures without any chemical related compounds and without any objective or consistent etiology or pathology. Laboratory studies have not demonstrated any consistent abnormalities among patients in experimental studies nor have epidemiological studies indicated any common characteristics. Several patients in these studies were diagnosed as having underlying treatable psychiatric disorders.
Conventional treatment has emerged as being effective for these groups and individuals with far reaching symptomatology to unrelated chemical compounds. In some cases psychiatric treatment has been proven to be effective.
Symptoms associated with Multiple Chemical Sensitivity are far ranging, highly variable by individual and typically cross a wide variety of chemical compounds and structures. It is a disorder characterized by recurrent symptoms in individuals complaining of symptomatology on exposure to widely different chemical compounds at levels far below the threshold of any demonstrable effects on the general population.
These symptoms span several organ systems. Neurological symptoms include headaches, confusion, memory loss, irritability, mood swings and inability to concentrate. Neurological symptoms include skin irritation, feeling of itching, tingling and nonspecific paresthesias. These symptoms also include generalized joint swelling, muscle and joint pain. This condition is often associated with another controversial clinical entity called fibromyalgia. Genitourinary symptoms include vaginal burning, urinary and dyspareunia as well as painful urination. The rest of the symptoms could include complaints such as wheezing, sneezing, rhino rhea, sore throat, cough and shortness of breath. Gastrointestinal symptoms sometimes are reported to include constipation and diarrhea among others. Patients also complain of intolerance to certain foods.
With minor variation most scientists that study this reported entity will find MCS patients to have subjective complaints virtually involving every body system without any consistency between patients and exposure levels to a variety of different chemicals that have not been known to be associated with any untoward effects.
Tyrone Randolf first described Multiple Chemical Sensitivity in the 1940s. These set of symptoms were first known as an environmental illness and acquired several different names throughout the years. Several alternative nomenclatures and names for Multiple Chemical Sensitivity include total environmental hypersensitivity, total allergy syndrome, environmental illness, and acquired intolerance to solvents, environmental toxemia, chemical hypersensitivity, chemical immune dysfunction and immune environmental disorder. There are several different theories and hypotheses regarding this particular set of symptoms.
The American Counsel on Science and Health in 1989 published a partial list of a variety of substances, which supposedly are related to Multiple Chemical Sensitivity. These substances include different foods, carpet, cigarette smoke, cologne, nickel, pollution, perfumes, natural gas, shampoos, lead, petroleum, pesticides and cleaners including preservatives, deodorants, various solvents and even a long list of others.
The psychiatric community has studied MCS. Staudemeyer and Solner concluded that the symptoms were psychosomatic that lead to so-called Environmental Illness (EI). Typically MCS patients reject the concept that their symptoms are part psychologically or emotionally based in etiology and also generally refuse psychiatric treatment and evaluation.
Several organizations have studied Multiple Chemical Sensitivity. The California Medical Association concluded that, “clinical ecologists have not identified specific processes caused by exposure to low level environmental stressors and there is no convincing evidence to support that hypothesis clinical ecology is scientifically based”. The physicians indicated that the existence of environmental illness as presented in clinical ecology theory must be questioned for the lack of clinical definition. The American Academy of Allergy and Immunology stated that, “the theoretical basis for ecological illness in the present context is not accepted nor is there satisfactory evidence to support the actual existence of an immune system dysfunction.” The AMA issued a document of clinical ecology stating that, “MCS should not be considered a recognized clinical syndrome.” All of these groups contend that diagnosis of Multiple Chemical Sensitivity lacks objective findings, lacks consistency, lacks reproducibility and do not meet the criteria for this being a physiological illness originating from any particular exposure.
Several individuals report to have theories of what causes MCS, even though almost all mainstream medical bodies do not accept this condition. Different concepts discussed over the years include what is called toxic dynamic, immunological or psychogenic origin.
The toxic dynamic chemical theory contends that exposure initiates a response. Subsequent exposure lowers the threshold for future responses. It is almost thought to be a generalized chemical allergy, however, no conclusive double or single blind trials have been done that are consistent with any clinical course of events. This concept is largely theoretical and without any proof to support it.
The immunological theory somehow purports that exposure to different chemicals cause damage to the T cells and the antibody producing white cells. There is no clinical evidence at all to indicate any abnormal function of any T cells. Similarly testing for IGG, IGM and IG antibodies also show no abnormalities. In short, there have been no alterations in the immune systems that are reproducible or even measurable in individuals with MCS.
The most commonly accepted theory is that of psychogenic illness. Dr. Ter notes that a diagnosis of psychiatric illness is common in patients with MCS. His studies suggest that Multiple Chemical Sensitivity is undiagnosed mental illness. Often individuals with this symptom have anxiety and panic disorders.
In short, Multiple Chemical Sensitivity is proposed to be a single clinical entity by clinical ecologists. There is no consistent pathological mechanism that has ever been demonstrated. There are no reported abnormal physical findings, laboratory abnormalities that are consistent with any pathology or any persistent clinical course that has been identified with this diagnosis. There are individuals with MCS that display psychiatric disorders.
In short, based upon the present status of the condition noted as MCS, there is no pathological, definable, clinical disease that should merit impairment. The Fourth and Fifth Editions of the AMA Guides to the Evaluation of Permanent Impairment states that an impairment must be clearly accepted as criteria before being accepted as an impairment. Clearly MCS does not and the AMA does not accept it. Several leading medical organizations including the American Academy of Allergy, American Society of Physicians, California Medical Association and the American Medical Association among several others, all concur that these reported symptoms do not meet the criteria for any disease state.
References are available upon request.