Three questions for identifying chemically intolerant individuals in clinical and epidemiological populations: The Brief Environmental Exposure and Sensitivity Inventory (BREESI)

Abstract

The Quick Environmental Exposure and Sensitivity Inventory (QEESI) is a validated questionnaire used worldwide to assess intolerances to chemicals, foods, and drugs, and has emerged as the gold standard for assessing chemical intolerance (CI). Despite a reported prevalence of 8-33%, epidemiological studies and routine primary care clinics rarely assess CI. To help address this gap, we developed the Brief Environmental Exposure and Sensitivity Inventory (BREESI)-a 3-item CI screening tool. We tested the BREESI's potential to predict whether an individual is likely to be classified as chemically intolerant if administered the 50-item QEESI. We recruited 293 participants from a university-based primary care clinic and through online participation. The statistical sensitivity, specificity, and positive and negative predictive values of the BREESI were calculated against the validated QEESI. Ninety percent (90%) of participants answering "yes" to all three items on the BREESI fit the QEESI criteria for being very suggestive of CI based upon their chemical intolerance and symptom scores (positive predictive value = 90%). For participants endorsing two items, 93% were classified as either very suggestive (39%) or suggestive (54%) of CI (positive predictive value = 87%). Of those endorsing only one item, 13% were classified as very suggestive of CI, and 70% as suggestive. Of those answering "No" to all of the BREESI items, 95% were classified as not suggestive of CI (i.e., negative predictive value = 95%). The BREESI is a versatile screening tool for assessing potential CI useful for clinical and epidemiological applications, based upon individuals' past adverse responses in a variety of settings. Just as health care professionals routinely inquire about latex allergy to prevent adverse reactions, the BREESI provides an essential screen for CI. Together, the BREESI and QEESI provide new diagnostic tools that may help predict and prevent future adverse reactions to chemicals, foods, and drugs.

Toxicant-induced loss of tolerance for chemicals, foods, and drugs: assessing patterns of exposure behind a global phenomenon

“…Additional file 1: Figure S1 presents the so-called "Symptom Star, " which is an illustrative example of the type of visual results that the QEESI, once completed, can offer to help patients and physicians understand and diagnose TILT. In addition to the QEESI, the Brief Environmental Exposure and Sensitivity Inventory (BREESI) has been developed as a much shorter 3-item screener for chemical intolerance with excellent predictive validity [105]. The purpose of the BREESI is to serve as a more useful tool for a quick assessment for TILT-ideal for personal or doctor office assessments and epidemiological studies.…”

Validation of a Brief Screening Instrument for Chemical Intolerance in a Large U.S. National Sample

“…Complete references, along with the URLs for each citation, are provided in the Supplementary Material file. Although the 50-item QEESI can be completed in less than 15 min, clinicians and researchers need a more rapid way to screen for CI, in part because of clinical time constraints and respondent burden [14]. In response, we developed the "Brief Environmental Exposure and Sensitivity Inventory" (BREESI), comprised of three questions derived from the QEESI.…”

Validation of a Brief Screening Instrument for Chemical Intolerance in a large U.S. National Sample

“…Although the 50-item QEESI can be completed in less than 15 minutes, clinicians and researchers need a more rapid way to screen for CI, in part because of clinical time constraints and respondent burden [14]. In response, we developed the "Brief Environmental Exposure and Sensitivity Inventory" (BREESI), comprised of three questions derived from the QEESI.…”

“…In response, we developed the "Brief Environmental Exposure and Sensitivity Inventory" (BREESI), comprised of three questions derived from the QEESI. We previously published the BREESI's validity metrics for a sample of 293 primary care patients [14]. In that clinical sample, the BREESI showed excellent positive and negative predictive values (97% and 95% respectively) and good specificity and sensitivity (90% and 87% respectively) as compared with QEESI defined results.…”