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 demonstrating that an appropriately structured home intervention can teach occupants how to reduce indoor air exposures and associated symptoms. Symptom improvement, documented using the QEESI Symptom Star, corresponded with reduction of indoor air volatile organic compounds, most notably fragrances.Discussion We address the long-standing dilemma that worldwide reports of fragrance sensitivity have not previously been confirmed by human or animal challenge studies. Our ancient immune systems’ “first responders,” mast cells, which evolved 500 million years ago, can be sensitized by synthetic organic chemicals whose production and use has grown exponentially since WWII. We propose that these chemicals, which include now-ubiquitous fragrances, trigger mast cell degranulation and inflammatory mediator release in the olfactory-limbic tract, thus altering cerebral blood flow and impairing mood, memory, and concentration (so-called “brain fog”). The time has come to translate these research findings into clinical and public health practice.
Background Chemical intolerance is a condition that may result in multisystem symptoms triggered by low levels of exposure to xenobiotics such as chemicals, foods, and drugs. The prevalence of chemical intolerance is estimated to be between 8% and 33% across several countries. Clinicians and researchers require a brief, practical tool for identifying chemical intolerance. Objectives This 5-country, population-based study investigates the validity of a three-item screening questionnaire, the Brief Environmental Exposure and Sensitivity Inventory (BREESI), against the 50-item Quick Environmental Exposure and Sensitivity Inventory (QEESI). Methods One thousand individuals (n = 1,000) in each of 5 countries, the U.S., Japan, Italy, Mexico, and India responded to both the QEESI and the BREESI on a Qualtrics platform by Dyanata, a survey company that provides recruitment services for researchers. We determined performance metrics for BREESI responses comparing the number of items chosen on the BREESI with QEESI scores for chemical intolerance. We used logistic regression to determine the likelihood of chemical intolerance based on scoring 0, 1, 2 or 3 items on the BREESI. We report BREESI sensitivity and specificity, positive and negative predictive values, and positive and negative likelihood ratios. Results Compared to the QEESI reference standard, the BREESI had excellent sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values for chemical intolerance in all countries except Japan. In Japan, the BREESI had poor sensitivity and a poor negative predictive value. Logistic regression shows that in all countries, with each increase in BREESI items endorsed, there is 4- to 5-fold increase in the odds of CI. Although the samples are relatively small for estimating population prevalence, our results suggest interesting differences and overall high prevalence of chemical intolerance. Applying QEESI criteria, India appears to have very high rates of chemical intolerance—over 50% of those sampled (54.7%, 95% CI = 52–58) followed by Japan (40.3%, 95% CI = 40–77), Italy (34.3%, 95% CI = 32–37), U.S. (31.2%, 95% CI = 28–34) and Mexico (26.0%, 95% CI = 23–29). Discussion This study confirms the results of a two recently published validation papers in the U.S. The BREESI performs well as a screening tool for chemical intolerance. The BREESI is a practical tool for researchers, clinicians, and epidemiologists seeking to understand and address this important and prevalent condition.
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