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

Palmer, Raymond F.; Walker, Tatjana; Kattari, David; Rincon, Rudy; Roger, Perales; Jaen, Calos; Grimes, Carl; Sunblad, Dana R; Miller, Claudia S.

doi:10.20944/preprints202106.0618.v1

Cited by 2 publications

(8 citation statements)

References 13 publications

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“…Based on these results, we suggest that caution be taken when interpreting results from different cultures. This current study is consistent with two previous US studies showing the BREESI to be an efficient and reliable CI screening tool [27,28]. We are hoping that the BREESI will lead healthcare providers across the globe to consider how CI may underlie a wide range of chronic and acute health problems.…”

Section: Discussionsupporting

confidence: 90%

“…In two prior studies, the BREESI demonstrated excellent positive and negative predictive values (97% and 95%, respectively) and good specificity and sensitivity (90% and 87%, respectively) in a clinical sample of 297 primary care patients [27]. Using a US population-based sample of over 10,000 Americans, the BREESI also demonstrated good positive and negative predictive values (83% and 97%, respectively) and good specificity and sensitivity (93% and 91%, respectively) [28].…”

Section: Introductionmentioning

confidence: 85%

“…Notwithstanding, the QEESI has been translated into several languages and is used worldwide. It has emerged as the reference standard for assessing chemical intolerance [28].…”

Section: Limitationsmentioning

confidence: 99%

“…The Quick Environmental Exposure and Sensitivity Inventory (QEESI) is the most widely used clinical and research tool for identifying CI. It has emerged as an international reference standard, used by researchers in over 17 countries with a collective N of ~ 32,000 (see [28] for a list of these studies using the QEESI). Although the 50-item QEESI can be completed in 15-20 min, clinicians and researchers need a rapid, accurate means to screen for CI.…”

Section: Introductionmentioning

confidence: 99%

“…We selected India, Italy, Japan, and Mexico based upon our interest in their environmental trends and published literature (or lack thereof ) on chemical intolerance. Although we investigated the BREESI's performance in the US in our previous study [28], it is also included here for comparison, using the same sampling methodology as the other four countries. This study provides the BREESI's sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios using the QEESI as the reference standard.…”

Section: Introductionmentioning

confidence: 99%

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The Brief Environmental Exposure and Sensitivity Inventory (BREESI): an international validation study

et al. 2022

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Background Chemical intolerance (CI) is a condition that may result in multisystem symptoms triggered by low levels of exposure to xenobiotics such as chemical inhalants, foods, and/or drugs. The population prevalence of self-reported chemical intolerance is estimated to be between 4 and 25% across several countries. Clinicians and researchers require a brief, practical screening tool for identifying chemical intolerance. Objectives We investigated the validity of a three-item screening questionnaire for CI, the Brief Environmental Exposure and Sensitivity Inventory (BREESI). The internationally validated, and widely used 50-item Quick Environmental Exposure and Sensitivity Inventory (QEESI) was used as the reference standard. Methods Five thousand individuals (n = 1000 in each of five countries: the US, Japan, Italy, Mexico, and India) responded to both the QEESI and the BREESI using an online research survey platform. We determined the statistical performance metrics for the BREESI, comparing the number of items chosen on the BREESI with QEESI scores for chemical intolerance. Logistic regression was used to determine the likelihood of chemical intolerance based on endorsing 0, 1, 2, or 3 items on the BREESI. We report the BREESI's 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 than in Japan, the negative predictive value was poor. Notwithstanding, logistic regression curves show that in all of the countries, for each one-unit increase in the number of BREESI items, there is a 4- to 5-fold increase in the odds of CI. Discussion This study confirms the results of two recently published validation papers in the US. The BREESI performs well as a screening tool for chemical intolerance. It is a practical screening tool for researchers, clinicians, and epidemiologists seeking to understand and address this important and prevalent condition.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 85%

“…Notwithstanding, the QEESI has been translated into several languages and is used worldwide. It has emerged as the reference standard for assessing chemical intolerance [28].…”

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Brief Environmental Exposure and Sensitivity Inventory (BREESI): an international validation study

et al. 2022

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Clinical assessment and patient education of chemical intolerance

Ravi,

Johnson-Esparza,

Hernandez

et al. 2024

Int J Community Med Public Health

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Chemical intolerance (CI) is characterized by multi-system symptoms initiated by a one-time high dose or persistent low-dose exposure to environmental toxicants. Symptoms of this “medically unexplained illness” often include fatigue, headache, weakness, rash, mood changes, musculoskeletal pain, gastrointestinal, difficulties with memory, concentration, and respiratory problems. A general disease mechanism called toxicant-induced loss of tolerance (TILT) explains the initiation, symptoms, and intolerances to chemicals, foods, and medicines reported worldwide by individuals with this condition. TILT is a 2-stage disease process initiated by a major chemical exposure, or a series of low-level exposures, followed by multisystem symptoms and onset of new intolerances. Despite its prevalence of up to 20%, most primary care physicians are not aware of this disease process and thus have been unable to recognize patients with CI. This case series describes three family medicine clinic patients who had multisystem symptoms that were triggered by chemical exposures, saw multiple specialists with no improvement, who were eventually diagnosed with CI and went through a behaviorally based avoidance education program. This report describes the impact of a coordinated educational intervention for patients with CI. We offer several educational tools for health practitioners to discuss with their patients. These patient stories highlight the importance for physicians to be knowledgeable about CI in order to facilitate symptom reduction and improve the quality of life for these patients.

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

Abstract: Keywords: Chemical Intolerance, Drug Intolerance, Food Intolerance, QEESI, BREESI, Multiple Chemical Sensitivity, Toxicant-induced Loss of Tolerance, Prevalence

Cited by 2 publications

References 13 publications

The Brief Environmental Exposure and Sensitivity Inventory (BREESI): an international validation study

The Brief Environmental Exposure and Sensitivity Inventory (BREESI): an international validation study

Clinical assessment and patient education of chemical intolerance

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