Both genes and the environment shape human health and disease. Although IgE-mediated allergic diseases (atopic diseases) have a genetic component and are more prevalent in individuals with a family history of allergic disease, the observed rapid increases in allergic diseases suggest that environmental factors are the predominant driving forces behind these increases rather than genetic alterations. 1,2 Common atopic diseases include atopic dermatitis, food allergy, allergic rhinitis, and allergic asthma. Human diets and lifestyle have undergone major alterations. The exposome, which is the sum total of all the exposures of an individual in a lifetime, has undergone major shifts in the last few decades, affecting human health and disease. A number of environmental factors have been implicated in the increased prevalence of allergic diseases. Predominant among them are increased exposure to pollutants and decreased exposure to microbes and parasitic infections. Air pollution has increased significantly in the last few decades. The hygiene hypothesis suggests that increased hygiene and lack of exposure to microbes and parasitic infections at an early age prevents the necessary stimulus to train the immune system to develop tolerogenic responses. Lifestyle factors,

Background: Psychosocial factors are supposed to play a central role in the development of allergic diseases. Associations with seasonal and perennial forms of allergies have not been investigated, yet. Objectives: The aim of the study was to investigate the associations of psychosocial factors (social status, depression, generalized anxiety, psychosocial stress, Type-D personality) with seasonal, perennial, and other forms of allergies in adults. Method: The analysis of self-reported data of the KORA FF4 study was performed with SAS 9.4. The sample consisted of 1,782 study participants in the study region of Augsburg (39–88 years, 61 years, 51.1% female). Descriptive bivariate statistics and multinomial logistic regression models were performed. Age, sex, family predisposition, and smoking status were considered possible confounders. Moreover, several sensitivity analyses were carried out to check whether missing values distorted the results. Results: A positive association between generalized anxiety and seasonal allergies was found in the multivariate model. Depression was positively, and anxiety negatively, associated with perennial allergies. No association between the analyzed psychosocial factors and other forms of allergies could be found. Conclusion: The results support the relevance of psychosocial factors in association with allergies. Looking at the psychosocial factors, a separate consideration of seasonal and perennial allergies seems reasonable. Further longitudinal studies should investigate the direction of the associations, the underlying mechanisms, and other psychosocial factors, such as coping mechanisms, in confirmed allergies.

Summary Multiple chemical sensitivity (MCS) is a condition characterized by a subjectively perceived increase in sensitivity to environmental chemicals. Individuals affected report a wide variety of nonspecific complaints, and frequently attribute cutaneous and mucosal symptoms to chemical exposures. Dermatologists should therefore be familiar with this condition. MCS is a diagnosis of exclusion. Other causes for the patients’ symptoms should be ruled out by routine laboratory tests, allergy tests and, if indicated, monitoring for toxic (environmental) substances. The primary job of dermatologists is to rule out skin diseases or hypersensitivities as possible causes of the complaints. Interdisciplinary patient management is essential, especially in severe cases in which those affected have problems coping with everyday life. Relevant specialties in this context include environmental medicine, psychosomatic medicine as well as occupational and social medicine. Cutaneous symptoms are usually addressed with symptomatic treatment using basic skin care products. There are currently no evidence‐based treatment recommendations for MCS. It is crucial that MCS patients be protected from unnecessary treatments and thus from mental, social and financial strain. In addition to medical skills, managing MCS patients requires communicative and psychosocial competence in particular. Physicians involved in the treatment will benefit from training in psychotherapy. Irrespective of the mechanisms that lead to MCS, diagnosis and treatment of this condition require an actively supportive attitude towards these patients, a good doctor‐patient relationship and interdisciplinary cooperation.

Atopic diseases have increased in prevalence over the last few decades and the rapid increases suggest that the predominant driving forces behind these increases are environmental factors rather than genetic alterations. A number of environmental factors have been implicated in the increased prevalence of allergic diseases. Predominant among them are increased exposure to pollutants and decreased exposure to microbes and parasitic infections. The hygiene hypothesis suggests that increased hygiene and lack of exposure to microbes and parasitic infections at an early age prevents the necessary stimulus to train the developing immune system to develop tolerogenic responses. Lifestyle factors, such as increased time spent indoors, use of antibiotics, and consumption of processed foods and decreased exposure to farm animals and pets, limit exposure to environmental allergens, infectious parasitic worms, and microbes. The lack of exposure to these factors is thought to prevent proper education and training of the immune system. Other factors that are also associated with increased risk of allergic diseases are Caesarian birth, birth order, tobacco smoke exposure and psychosomatic factors. Here, we review current knowledge on the environmental factors that have been shown to affect the development of allergic diseases and the recent developments in the field.

ZusammenfassungMultiple Chemikaliensensibilität (MCS) ist eine subjektiv erlebte, erhöhte Empfindlichkeit gegenüber Chemikalien aus der Umwelt. Betroffene reagieren mit vielfältigen, unspezifischen Beschwerden. Symptome an Haut und Schleimhäuten werden von Personen mit MCS häufig auf eine Exposition gegenüber Chemikalien zurückgeführt. Auch Dermatologen sollten sich deshalb mit dieser Gesundheitsstörung auseinandersetzen. Multiple Chemikaliensensibilität ist eine Ausschlussdiagnose. Durch Basisdiagnostik, Allergiediagnostik oder Umweltdiagnostik sollen andere mögliche Ursachen für Symptome ausgeschlossen werden. Die Dermatologie sollte in erster Linie Hauterkrankungen und Allergien als mögliche Ursachen für Beschwerden abklären. Interdisziplinäre Betreuung der Betroffenen ist insbesondere bei schweren Verläufen von Relevanz, beispielsweise, wenn Betroffene in Ihrer Alltagsbewältigung eingeschränkt sind. Wichtige Disziplinen sind dabei unter anderen Umweltmedizin, Psychosomatik, Arbeits-und Sozialmedizin. Hautbeschwerden werden durch die Dermatologie symptomatisch, zum Beispiel mit Hautbasispflege, behandelt. Evidenzbasierte Therapieempfehlungen zur Behandlung von MCS gibt es bislang nicht. Menschen mit MCS sollen vor überflüssigen Behandlungen und damit vor psychischen, sozialen und finanziellen Belastungen geschützt werden. Für den Umgang mit Betroffenen sind neben fachlichen, naturwissenschaftlichen Kompetenzen vor allem auch kommunikative und psychosoziale Kompetenzen relevant. Psychotherapeutische Weiterbildung für behandelnde Personen ist hilfreich. Unabhängig von den Mechanismen, die zu MCS führen, ist eine aktiv unterstützende Grundhaltung behandelnder Personen, eine gute Arzt-Patient-Beziehung sowie interdisziplinäre

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