By * Dr UME
Phenomenon describes for the first time in 1950 by the American allergist, Thern G. Randolph in the middle of work.
For a long time considered as a psychiatric affection, this disease is now included by the WHO in the International Classification of Diseases (ICD-10) under code T 78.4 « other allergy, not specified »
The chemical sensitivity syndrome (MCS) is characterized by a nonspecific symptom complex, highly disabling, often confused with an allergic or psychosomatic reaction, as fatigue, burnout, headache, dizziness, impaired of concentration and memory, depression, irritability, asthma, digestive disorders,...
In the MCS, we find a set of biochemical dysfunction involving the nervous system, immune system, endocrine glands and the intestine, common set with other syndromes emerging in our time. (Merck 1999 - Hooper 2000, 2003 - Donnay 1997) : Chronic fatigue syndrome, fibromyalgia, neurodegenerative disorders, autism, sick building syndrome, food intolerance syndrome...
A new interest for its study appears in the 1990s after the Gulf War, when 100,000 American soldiers mainly complained about nonspecific diseases (GWS) which could be closer to the symptoms described above. Multiple government agencies, medical organizations and researchers, have stressed the strong need for epidemiological and etiological research. (Ashford and Miller 1998) [1]
They say "People are right to want to save themselves from unnecessary exposure. It is better to err with caution (precautionary principle), because it creates more panic, if we don't warns of risks in advance." It may be unscientific, but we must listen and hear the first signs of danger. The absence of proofs is too often raised as a lack of evidence.
Germany, followed by United States and Canada, was the first country to recognize this disease.
Why so much reluctance to recognize this? One of the possible explanations, the cost. Indeed, there are more or less 100,000 substances released into our environment, with about 1,000 new a year. The toxicity of approximately 2000 of these substances, produced over than 1 billion tons per year, should be necessarily studied.
Now, for ¾ of the substances, we are in perfect toxicology ignorance. The conventional toxicological evaluation (extrapolation from animals to humans) of a chemical requires an average of 5 years of studies and costs from 1 to 2 million Euros. A simple economic calculation remains to make ! However, the right for environmental health as defined by WHO "all aspects of human health, including quality of life, which are determined by environmental factors, physical, chemical, biological, psychological and social" is inalienable.[2]
A study by the European Union has shown that every day, each of us is confronted with at least 300 chemicals products potentially toxic. What would be the huge benefit of the prevention !
CLINICAL DIAGNOSTIC CRITERIA summary
In 1999, a group of American experts has defined 6 clinical criteria which can be applied to the diagnosis of chemical sensitivity. (Arch. Environ. Health 1999;54:147)
1. chronic disease
2. reproducible symptoms
3. response to exposure of low doses
4. reaction to multiple chemicals
5. symptoms extending in several organs or systems
6. symptoms diminishing or disappearing when exposure ceases
The differential diagnosis must be established with :
• allergy.
The MCS is a loss of tolerance induced by a chemical poisoning, primarily affecting the central nervous system; the body doesn't resist any more, does not detoxifies more normally.
At the beginning, the sensitivities are often masked by the adaptation of the organism to pollutants (Dr Miller allergist, immunologist).
The disease often occurs after an overexposure to a product, at work or at home and can progress to other emerging diseases: asthma, atopy, autoimmune diseases, cancer,...
• the classic toxic diseases.
1. Pollutants at low doses affect communication networks and regulation of the body (nervous, endocrine, immune) and result in early and long term by purely functional disorders.
2. Multifactorial etiology, and therefore no identifiable biological marker.
3. The type and intensity of the response is variable and not dose-dependent.
4. The disease develops in stages: acute poisoning to a product and then chronic reaction delayed to other products, including food.
Several epidemiological studies estimate that 12 to 15% of the population in industrialized countries is hypersensitive to chemicals, to varying degrees (Journal "Environmental Health Perspectives" of the American Ministry of Health) [4]
According to the same journal, MCS is sometimes so acute, that it led to job loss in 1.8% of the population, so for 5.2 million of Americans. It requires a lifestyle change and rarely accepted by the family circle, the employer and society.
What we do, judiciously, for drug addicts (listen, help, weaning, care), we admit it with difficulty to hypersensitive, to who is accused of trying to find and avoid chemicals or foods that bother them, what would allow them to live an almost normal life.
Much more, often they are reclassified as psychiatric case with all individual and socio-professional consequences that this "diagnosis" implies.
For some "scientific" MCS is "a label given to people who do not feel well for a variety of reasons and who share the common belief that chemical sensitivities are involved. This syndrome exists because the patient believes in its existence and a doctor gave his consent" [5]
The doctors "researchers of other ways" are simply and pejoratively labeled too, ecologists clinicians. However, in this context, they try to find:
• Pesticides
France, with its 35,000 tons / year is the first European consumer. In Wallonia, despite the reduction of pesticide applications, there is no noticeable improvement in the quality of groundwater.
Also note that the approval tests of pesticides concern mainly the study of high doses (lethal doses), that the effect of chronic exposure or a combination of several products is not taken into account. [6]
• Volatile Organic Compounds (VOCs)
That we find everywhere in our daily environment, especially in our home. These are components of vitrified flooring, agglomerated furniture, detergents, perfumes, paints, brominated flame retardants, glues,...
Examples: Formaldehyde, a potent allergen, Toluene, Xylene, neurotoxic, Benzene which replaces the lead in gasoline, carcinogenic, ether glycol, endocrine disruptors.
The classic toxicologic studies gives standards of toxicity for these products. These standards are variable from one country to another, do not take into account individual sensitivities and synergies of compounds.
Example: Formaldehyde WHO sets the limit at 100 mg / m3 for 30 minutes, the sensitive can trigger asthma attacks at 10 mg / m3. The bonded materials, insulation, .. which release noticeably more than 100 mg.
We must also consider the action of mixtures of substances.
Mohammed Abou-Damia, professor of neurobiology and neurotoxicologist, Duke University in the USA, showed that the combination of three organophosphorus individually "safe" for small doses used, becomes extremely harmful and even lethal to the organism.[7]
• Feeding :
Pesticides, heavy metals
2. Physiopathological mechanisms summary
• allergy
The definition of the term allergy is already a considerable debate. There are 4 types of hypersensitivity reaction.
If the allergy of type I to IgE may be added, it is rarely the cause of the syndrome. For cons, the hypersensitivity of Type IV with slower reaction (24 to 72 hours) involves sensitized immune cells, especially T lymphocyte cells of several types (Th0, Th1, Th2, Th3), which release chemical messengers, cytokines, activating other immune cells.
The balance of the chain reaction can be broken and cause direct cellular damage.
• the toxicological effect of low doses
In a global sight, systemic of the organism in interaction with its environment, the low doses act by disrupting the regulation systems, nervous, hormonal and immune, leading to loss of homeostasis of the internal middle and adaptability to the external environment.
• the neurotoxicity
The pesticides, liposoluble and crossing the blood-brain barrier, are neurotoxic by interfering with neurotransmitters, especially acetylcholine. Other substances, in particular food, by intermediate metabolites (opioids of gluten, casein, ... may also intervene in the functioning of the nervous system.
The pro-inflammatory cytokines, produced by the immune system and nerve cells themselves, play a significant role. It has been shown close connections between the brain areas treating olfactory information (rhinencephalon) and those dedicated to the emotions (limbic system)
• metabolism detoxification of the body
The enzymes involved in xenobiotic metabolism include cytochrome P450 (CYP), glutathione S-transferase (GST) and N-acetylcysteine (NAT). These enzymes, produced by the liver, are involved in the detoxification of a variety of environmental substances, foods or drugs.
The activity of these enzymes varies from one individual to another. Deficiencies or exaggerated activities are the result of deficiencies in their expression associated with genetic polymorphisms with absence of expression, partial expression or overexpression. These disturbances cause an inadequate metabolization of xenobiotics and unwanted effects towards these agents. This impaired ability to detoxify can play a huge role in the etiology and exacerbation of many chronic diseases, especially the MCS.
• depression and anxiety
The recent progress in neuroscience and identification of common mechanisms to the nervous and immune systems, revealed common biological pathways involved in various types of stress, psychological, traumatic, toxic or infectious, whose effects may combine and reinforce. [8]
While it is important to not underestimate the depression when it results in complaints that are especially reminiscent of a somatic problem], it is equally important not to label depression and "in the head" all expressions of an organic imbalance, particularly toxic, underlying.[10]
The disease always develops in two stages, an acute poisoning to a product and then a delayed reaction in time to other products of which food.
Clinically, we can find different stages :
- stage 0, exposure tolerated without manifestations
- stage 1, exposure gives multiple complaints (headache, nausea, pruritus, redness,...)
- stage 2, inflammation of one or more organs. The continuous exposure in low doses propagates and prolongs this inflammatory state.
- stage 4, fibrosis and tissue damage, progressively irreversible. All tissues or organs may be affected.
4. The means of objectification summary
Among the objections of opponents to the recognition of MCS as a disease in itself, not psychiatric, we find systematically that there is no identifiable biological marker. This can be understood, if we do not admit that pollutants at low doses affect the communication networks of the body (neuro-endocrine-immunology) and that the origin of the disorder may be multifactorial.
In a global approach, systemic of the MCS, as for other nonspecific chronic infections, often unclassifiable, the diagnosis can be based on a series of toxicological laboratory tests, immunological, genetic : MELISA, TEST LYMPHOCYTE ACTIVATION, BOWEL FUNCTION, GENETIC POLYMORPHISM OF ENZYME, ANTIOXIDANT CAPACITY, GENOTOXICITY TESTS, FOOD INTOLERANCE TEST (IMUPRO 300) Test Infos
5. The therapeutic approaches summary
The multifactorial origin of the syndrome of MCS entails automatically the individualization and personalization of the treatment.
To all, however, a change of the habits of life is required, particularly in terms of food. Once the food responsible is detected, we must ensure the total elimination of it, while replacing it in the diet by well tolerated equivalents.
Diets of severe elimination, if they sometimes bring a temporary solution, are not without danger if they are maintained during long periods (deficiencies in essential nourishing micro-elements). It is thus necessary to pass in a varied food (principle of rotation with cycles of 5 days). It is essential to avoid a monotonous diet to prevent that an intolerance chases away another one.
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