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The concept that certain individuals suffer a specific illness caused by multiple food and chemical sensitivities is the basis of a medical practice known as "clinical ecology." This concept evolved from the earlier theory of allergic toxemia caused by multiple food sensitivities, described above. In the early 1950s Randolph broadened the idea of allergic toxemia to include sensitivity to environmental chemicals, in addition to foods, as causative agents of this disease, which he called "environmental illness." Later, hypersensitivity to microorganisms, especially Candida albicans, was added to the list of multiple chemical sensitivity.
The term "environmental illness" was used for many years, along with other names such as environmentally induced disease, chemical hypersensitivity syndrome, multiple chemical sensitivities, cerebral allergy, chemically induced immune dysregulation, twentieth century disease, total allergy syndrome, ecologic illness, and food and chemical sensitivities. In recent years, "multiple chemical sensitivities" has been the specified.
Cullen introduced the term "multiple chemical sensitivities" to apply to a subgroup of such patients who have attributed their illness to their workplace, using the following definition: An acquired disorder characterized by recurrent symptoms, referable to multiple organ systems, occurring in response to demonstrable exposure.
In February 2006, a workshop organized by the International Programme on Chemical Safety of the World health Organization recommended a new name, "idiopathic environmental intolerances," because the term multiple chemical sensitivities."
Furthermore, the "relationship between exposures and symptoms is unproven." For these reasons, the term "idiopathic environmental intolerances" (IEI).
IEI is described by clinical ecologists as a condition of multiple symptoms involving numerous areas and systems of the body without accompanying abnormal physical findings or laboratory test results. Many complaints are nonspecific. Additionally, certain defined illnesses such as rheumatoid arthritis, multiple sclerosis, and inflammatory bowel disease, as well as defined psychiatric disorders.
The most common complaints--fatigue, headache, nausea, malaise, pain, mucosal irritation, disorientation, and dizziness--are nonspecific. All these symptoms can occur in diseases with specified pathologic characteristics.
No gross or microscopic evidence of inflammation or other objective signs of a disorder have been associated with IEI.
The list of the specific items believed to cause this condition is virtually unlimited. It includes any naturally occurring food, including drinking water; artificial food additives of all types; almost any synthetic product; specific chemicals such as formaldehyde, phenol, ethanol, ammonia, "hydrocarbons," and "petrochemicals"; and sources of environmental chemicals, particularly cleaning solvents, paints, smoke, gasoline, vehicle exhaust fumes, fumes from office machines, perfumes, synthetic clothing, pesticides, structural plastics, building construction materials, and new carpeting. In many cases, patients complain of difficulty in stores, shopping malls, and public buildings. Although the emphasis is on synthetic chemicals, causes of illness have also included natural gas, electromagnetic radiation, viruses, fungi, yeast, and wood dust.
The items listed here as "causes" are believed to act in a dual role, both in the induction of the disease and in provoking symptoms once disease occurs. A unique feature of environmental illness is the
The diagnostic procedure most commonly used by clinical ecologists is provocation-neutralization, discussed later in this chapter. After provocation-neutralization testing, many of these patients develop
The clinical ecology literature discusses a variety of theories and concepts to explain both the etiology and pathogenesis of environmental illness. Initially Randolphproposed a theory that failure of the human body to adapt to industrial synthetic chemicals produces a condition of hypersensitivity to these
A variety of immunologic mechanisms has been proposed to explain IEI. In general, these theories are made under the presumption that environmental chemicals function as haptens to induce formation of IgG antibodies, IgE antibodies, or specifically sensitized T cells. However, the pattern of illness and the absence of any objective evidence of inflammation or organ dysfunction do not support immunologic hypersensitivity in IEI. Furthermore, there has been no evidence of a quantitative or
The diagnosis of IEI is most often made by the combination of an extensive environmental history and a battery of provocation-neutralization tests. The patient's self-report of symptoms occurring after presumed exposure to environmental odors and fumes or after ingestion of particular foods usually
Data from the clinical ecology literature and from independent review of series of patients with IEI lend no support to the diagnostic usefulness of any of these tests. Levels of serum immunoglobulins and complement components; blood levels of total lymphocytes and various subsets; circulating hormones or other natural body constituents; and quantities of xenobiotics in various body fluids are not consistently abnormal.
Treatment of environmental illness is accomplished according to primarily three modalities: a program of avoidance of environmental chemical exposure, special elimination diets, and neutralization therapy. Drugs are regarded as harmful synthetic chemicals that cause environmental illness. Nevertheless, patients are often instructed to take vitamin and mineral supplements, and some are treated with certain salts, such as sodium bicarbonate, to "neutralize" allergic reactions and with amino acids, intravenously administered gamma-globulin, or oxygen inhalation to relieve symptoms. Patients with a diagnosis of Candida hypersensitivity are usually treated with several drugs to eliminate Candida albicans.
The rationale for the treatment program is twofold: (1) to eliminate or reduce symptoms and (2) to "strengthen" the immune system. Avoidance of multiple environmental chemicals is universally recommended, often requiring a significant change in lifestyle. Many patients remodel their homes to