Much of what follows has been referenced from the NICNAS report on Multiple Chemical Sensitivity (MCS) entitled: A Scientific Review of Multiple Chemical Sensitivity: Identifying Key Research Needs. Otherwise information has been obtained from the websites quoted.
People with MCS get a wide array of complex symptoms (vide infra) from low levels (normally non-toxic) of exposure to chemicals. These levels would not cause symptoms in most people. People who suffer from MCS will have multi-system illnesses as a result of exposure a wide variety of environmental chemicals.
MCS is a condition within the sphere of “environmental sensitivities”, a descriptor used in a wider sense to describe a variety of reactions to environmental stressors including chemicals and physical phenomena such as electromagnetic radiation (cf. Electromagnetic Hypersensitivity, EHS) at levels commonly tolerated by the majority of people (Sears, 2007).
Like ME/CFS there are currently no bio-marker(s) used to diagnose MCS, so Multiple Chemical Sensitivities (MCS) was identified in a 1989 multidisciplinary survey of 89 clinicians and researchers, and modified in 1999 (Multiple Chemical Sensitivity: A 1999 Consensus) for MCS define the condition by these criteria (Bartha et al., 1999):
- The condition is chronic;
- Symptoms recur reproducibly (with repeated exposure – of the same chemical);
- Symptoms recur in response to low levels of exposure [lower than previously or commonly tolerated];
- Symptoms occur when exposed to multiple unrelated chemicals;
- Symptoms improve or resolve when trigger chemicals are removed;
- Multiple organ systems are affected (added in 1999).
While a case definition of MCS has not been universally agreed. The 1999 Consensus Criteria are commonly used in research definitions of MCS and these criteria have been cited in Australian surveys.
Like ME/CFS, MCS ranges in severity from mild to very severe.
MCS has also been known by different names in both the scientific literature and by the lay media – these terms are as follows:
- Idiopathic Environmental Intolerance (IEI)
- Environmental Illness
- Chemical Acquired Immune Deficiency Syndrome (Chemical AIDS)
- 20th Century Disease
- Cerebral Allergy
- Chemical Sensitivity or Intolerance
- Environmental Hypersensitivity
- Toxic Encephalopathy
- Toxicant-induced loss of tolerance (TILT)
- Acquired Intolerance to Solvents
- Total Allergy Syndrome
In many cases, specific terms reflect particular views of individuals or groups regarding the underlying pathogenesis/cause of MCS.
Like with ME/CFS, some researchers believe MCS may not be just one single defined disease but as a collective term describing a range of symptoms associated with environmental exposures that may represent more accurately a class of disorders (Ashford, 1999, Lancour, 2005).
People with MCS often face situations where their condition and symptoms are poorly understood, mis-diagnosed or not even believed. They may be provided with health care that is less than optimal or even counterproductive. They often find that there is a stigma attached to their illness, and face discrimination or disbelief in many quarters of society – be it by friends, family, colleagues, employers and so on.
What Are People With MCS Are Sensitive To?
Rather than being sensitive to the odours (although odours are chemicals), people with MCS are sensitive to the chemicals as toxins – not an olfactory response. These include: any quantity of exposure to pesticides, secondhand smoke, car exhaust, alcohol, fresh paint, scented products and perfumes including washing powders, candles, fragrances such as aftershaves, food preservatives, flavour enhancers, aerosols, tap water, cosmetics, personal care products, new carpets, petroleum products, formaldehyde, outdoor pollutants, newspaper ink, cleaning compounds, printing and office products, and other synthetically derived chemicals. Some also become ill from natural products that are highly concentrated such as natural orange cleaners due to high volatile organic compound and pesticide concentration.
In their book “Chemical Exposures: Low Levels and High Stakes” Ashford and Miller (1998) outlined a vast array of chemicals and chemical product types that have been shown, or have the potential, to be “offending substances”; to cause problems for people with MCS. The authors categorized them into the following groups:
- Outdoor Air Pollutants: e.g. pesticides, solvent vapours, fuel and paint vapours, combustion products, tar fumes, diesel and auto exhaust, industrial air pollution;
- Indoor Air Pollutants: Domestic and Workplace Chemicals e.g. industrial and domestic indoor air, especially in “tight” buildings and spaces, combustion products from gas or oil fired heaters, sponge rubber bedding, padding and upholstery, plastics, insecticides, perfumes, paints, deodorisers, cedar closets, cleaning agents, disinfectants, mothballs, newsprint and other printed materials, fabrics in clothing, bedding and window coverings, particleboard, carpeting and carpet padding; odours of virtually any description especially petrochemical odours but also natural odours from woods or cooking foods;
- Foods, Food additives and Contaminants: e.g. corn and corn sugar, pesticide residues, fumigants, fungicides, sulphur treatments, artificial colours, sweeteners, preservatives, ripening chemicals such as ethylene oxide, protective waxes, packaging materials;
- Water Contaminants and Additives: ingested but also those encountered whilst showering and bathing;
- Drugs and Consumer Products: e.g. aspirin, barbiturates, sulphonamides, diluents, excipients such as cornstarch or lactose, flavouring agents, coatings, preservatives, mineral oils, petroleum jelly, ointments, lotions, laxatives, synthetic vitamins, adhesive tape, cosmetics, perfumes, shampoos, personal hygiene products, denture adhesives, bath salts and oils, waterbeds, synthetic fabrics, felt tipped pens, polishes, cleaners, chlorinated swimming pools, skin alcohol, radio contrast dyes, contact lenses, plasticisers leaching from medical devices.
Two studies conducted in South Australia in 2002 and 2004 (Fitzgerald, 2008) in which respondents were asked which chemical classes were of most concern, found that those self-identifying as chemically hypersensitive named perfumes as of most concern (82.5%), with tobacco smoke, new building or renovation, pesticides and herbicides, petrochemicals, vehicle smoke, and other chemicals in decreasing order of concern.
What Are The Symptoms Of MCS?
Symptoms can range from minor annoyances (headache, runny nose) to life-threatening reactions (seizures, anaphalaxis). They vary greatly for each patient regarding frequency, intensity, inhalation or dermal exposure. Symptoms are multi-system, have many overlaps with ME/CFS and FM, can be very debilitating and can include: Fatigue (chronic), feeling of weakness, hyperactivity, restlessness ;nausea, vomiting, diarrhea, constipation, bloating, intestinal aches/pains; anxiety, irritability, depression; variable blurred vision; headaches, dizziness, insomnia, sleepiness; irregular, skipped, rapid, or slow heart beats, chest pain, high/low blood pressure; asthma; poor memory, comprehension, concentration or physical coordination, confusion; arthritic pain in joint/s, stiffness, muscle pain, muscular exercise intolerance; sinus problems, hay fever; acne, hives, rash, bruising easily, hair loss, flushing, hot flashes, excessive sweating; anaphylaxis, asthma, chronic cough, gagging, sore throat, hoarseness, voice loss; frequent urination, frequent ‘Urinary Tract Infections’, Aching testis/ovaries; Weight problems (under/overweight), water retention; and inflamed lymph glands, frequent unknown illness or infection.
Who Gets MCS, And What Is The Prevalence Of MCS?
Out of the general population, who is most likely to develop MCS? In the literature to date, the majority of MCS patients are female, between the ages of 30-50.
Initially industrial workers were the first to be described as having MCS-like illnesses in medical clinics (Cullen, 1987). This suggested that at least initially, that MCS might be linked to occupational, intense high-level chemical exposures. Interestingly, several studies over the decades have found that of those reporting MCS-like illnesses, only a quarter and less (some studies 27%, others 5%) have been workers from chemical-intense industries such as the chemical industries, manufacturing and construction. This suggested, paradoxically, that lower level chemical exposures were more associated with MCS.
However, these workers are more likely to be male “blue collar” workers than the typical demographic seen in MCS patients. There was also the problem identified, referred to as the “healthy worker effect” – that individuals with sensitivities to chemicals might be avoiding chemical intensive industries in the first place.
A later study found (Ross, 1992), of 200 patients who were diagnosed with MCS at a clinic in Dallas in the US, less than 5 % were industrial, labour or trade workers. By far the largest percentage (25%) were homemakers – women in their 30s and 40s. This would seem to suggest that there is some link between domestic chemical use and some diagnoses of MCS.
In 2005 in South Australia there was a Parliamentary Inquiry into MCS. They heard many submissions linking occupational exposures to symptoms of MCS, eg occupations as diverse as those in the health care industry, aviation industry, farmers, mechanics, and aluminium workers (at Alcoa in Wagerup SA). These submissions suggest links between occupational chemical exposures and MCS in Australia. However, epidemiological studies have not yet been undertaken.
Perhaps where the male to female ratio is different is in military personnel, because all militaries of the world are male dominated. Amongst British Gulf War veterans, MCS was strongly associated with exposure to pesticides (Reid et al., 2001). In studies by Bell et al., (1998) and Kipen et al., (1999) approximately 30-36% US Gulf War veterans reported themselves to be unusually sensitive to certain chemicals.
In a sample of Gulf War military personnel from Iowa, 2% were medically diagnosed with MCS. In a study by Black et al. in 2000, it was found deployed military personnel were nearly twice as likely as non-deployed military personnel to report symptoms suggestive of MCS.
A recent systematic review (Thomas et al., 2006) of multi-symptom conditions in war veterans noted that Gulf War veterans were more than 3 times more likely than non-Gulf veterans to report MCS or chronic multi-symptom illnesses (eg. ME/CFS or FM). The prevalence of MCS among such individuals is reported to be less than 7%.
It has been suggested that chronic neurological symptoms common in MCS may result from stress and/or genetically impaired metabolism of organophosphates (pesticides) commonly used in these theatres (of war) (Haley et al., 1999).
Prevalence in Australia: In a New South Wales Adult Health Survey in 2002, 2.9% of respondents reported having been medically diagnosed with chemical sensitivity and 24.6% of respondents reported “sensitivity to chemical odours”. In the studies in South Australia in 2002 and 2004 (Fitzgerald, 2008) 0.9% reported a medical diagnosis of MCS with more females than males reporting diagnosis. This is commonly observed in people with MCS, that they are predominately women – not unlike that observed with ME/CFS and FM. There were no differences in reporting between urban and rural environments.
Prevalence in North America: In the US approximately 2.5% of the population have been diagnosed with MCS. According to a 2003 survey, the prevalence of medically diagnosed MCS in Canada was 2.4%, with the rate for females at least twice that for males. Also, along with ME/CFS and FM, the prevalence of MCS was related to socio-economic status, with the likelihood of reports of increased MCS with decreased household incomes, contrary to what has been expected.
Overall, according to currently available data, apart from some people being over-represented as MCS patients, e.g. women, there doesn’t seem to be any one demographic at greater risk of developing MCS.
What Causes MCS, And What Is Its Mechanism?
Many researchers in the field hold the view that MCS occurs in two distinct steps. First is the initiation, that is the trigger – the initial onset exposure. Most MCS patients can trace their onset of symptoms to a major acute chemical exposure or a long-term lower level chronic chemical exposure, such as pesticides, herbicides, petrochemicals etc.
However, other known onset chemicals include glues, synthetics (rubbers, plastics etc), industrial emissions and pollution, fragrances, moulds, preservatives, new furnishings, silicon breast implants, medications, anaesthetics, hair spray, nail polishes, cleaning products, food additives and heavy metals. The second step, or phase, is the sensitisation to a wider array of unrelated (to the trigger) chemicals.
Like ME/CFS, MCS can also occur after viral or other illnesses or after hormonal changes eg. during or after pregnancy. Genetic links to MCS have been shown. People with allergies such as hayfever or asthma appear to be more likely to be sensitive to chemicals.
The mechanism(s) of MCS is/are still the source of much debate in the scientific community. As with ME/CFS, the wide array of symptoms of MCS has led many to doubt it is a single disease with a single etiology/cause and pathogenesis/mechanism.
A review by Chris Winder (UNSW) in 2002 detailed dozens of possible causative mechanisms. An extract from the abstract is as follows:
“The basis of MCS is still to be identified, although a large number of hypersensitivity, immunological, psychological, neurological and toxicological mechanisms have been suggested, including: allergy; autosuggestion; cacosomia; conditioned response; immunological; impairment of biochemical pathways involved in energy production; impairment of neurochemical pathways; illness belief system; limbic kindling; olfactory threshold sensitivity; panic disorder; psychosomatic condition; malingering; neurogenic inflammation; overload of biotransformation pathways (also linked with free radical production); psychological or psychiatric illness; airway reactivity; sensitisation of the neurological system; time dependent sensitisation, toxicant induced loss of tolerance. Most of these theories tend to break down into concepts involving: (1) disruption in immunological/allergy processes; (2) alteration in nervous system function; (3) changes in biochemical or biotransformation capacity; (4) changes in psychological/neurobehavioural function. Research into the possible mechanisms of MCS is far from complete.”
Generally, the debate in the scientific community on mechanisms has traditionally aligned to two diametrically opposed views as to whether MCS symptoms are due to psychosomatic responses to perceived chemical toxicity, or to a physiological/pathological interaction between chemicals and organ systems in the body.
However, some do believe, given the complex nature of the mind and its interplay with physiology, there might be some relationship between one’s psychological condition and the physiological mechanism of MCS (Bock and Birbaumer, 1997; Goudsmit and Howes, 2008).
Some of the possible physiological mechanisms of MCS are as follows:
- Immunological dysregulation: These theories propose that MCS is caused by a chemically induced disturbance of the immune system leading to cell damage, in turn resulting in immunological dysfunction. Within these theories a distinction is made between abnormal disturbances of immune mechanisms and classical allergic responses (Meggs, 1993; Fukuyama, 2008; Labarge and McCaffrey, 2000).
- Respiratory disorder/neurogenic inflammation: This theory suggests that MCS represents an amplification of non-specific immune responses to low-level chemical irritants when they interact with sensory nerves in the airway mucosa. Local inflammatory mediators are released and this leads to altered function of the respiratory system (Bascom, 1992 and 1997).
- Limbic kindling/neural sensitisation: Many symptoms of MCS involve disturbances of the Central Nervous System (CNS). This model suggests that repeated perturbations of the CNS (in particular the limbic system) from a variety of environmental stressors may induce and amplify multiple organ responses to chemical exposures. The limbic system is a group of interconnected brain structures involved in your sense of smell, emotions, learning and memory. The limbic system also participates in the regulation of many cognitive, endocrine and immune functions. Bell and colleagues have postulated that there is a link between smelling chemicals and limbic neural sensitisation that could lead to multi-symptom and multi-organ illnesses such as MCS (Bell et al., 1992; 1997).
- NMDA receptor activity and elevated nitric oxide and peroxynitrite: Martin L. Pall (Professor Emeritus of Biochemistry and Basic Medical Sciences, Washington State University) a notable MCS researcher, hypothesised in the early 2000s (Pall, 2002 & 2003) that the hypersensitivity experienced by people with MCS can be explained by increases in N-methyl-D-aspartate (NMDA) receptor activity coupled with stress-related increases in nitric oxide (NO) and the oxidative product peroxynitrite (ONOO). See his 2009 review for a full description of this theory.
- Toxicant-induced loss of tolerance (TILT): Claudia Miller published a new disease theory in 1997 (Miller, 1997) to explain chemical sensitivities including MCS. This theory suggests that acute or chronic chemical exposures can cause susceptible persons to lose their tolerance to previously tolerated chemicals, drugs and foods. TILT is described as a two step process – initiation from repeated low level or a single high level chemical exposure, and subsequent triggering from everyday common chemical exposures. Once sensitised, low-level exposure to a plethora of substances may trigger symptoms.
- Altered xenobiotic metabolism: This theory is based on genetic differences in the metabolism of chemicals. It holds that people with MCS have a genetically lowered ability to metabolise chemicals.
- Disrupted haem synthesis: Some researchers have suggested that MCS may represent a disturbance in haem synthesis (porphyria), since the clinical manifestation of porphyria can be triggered by chemical exposure and its symptoms have similarities to MCS (Donnay and Ziem, 1995; Ziem and McTammey, 1997). Others question this, and porphyria is normally triggered by chemical exposures above those related to MCS.
- Serum and intra-erythrocyte biochemical changes: Some clinicians have suggested that altered serum biochemistry and haematology may reflect organ dysfunction in MCS.
How Is MCS Diagnosed?
There is not currently a laboratory test to confirm a diagnosis of MCS. No agreed upon biomarker(s) exist for MCS.
The first port of call would be your GP. Because of the lack of any specialists in MCS specifically in Australia you might be referred to an allergy specialist or allergy unit at a hospital.
For those with food chemical sensitivities, following an elimination diet followed by food challenges to determine which food chemicals are problematic. Please see our page on Nutrition and ME/CFS for the section on the Food Intolerance Network and “failsafe shopping list“.
How Is MCS Treated?
The most common management regime for MCS is avoidance of the chemical agents that trigger symptoms. It is possible for people with MCS (and ME/CFS and FM for that matter) to go on a never ending and extraordinarily expensive quest for cause and treatment in the hope of “THE” cure. Established pharmaceutical treatments for MCS do not exist.
In 2003 Gibson and co-workers surveyed 917 self-reported MCS sufferers in the US. They studied the self-perceived efficacies of 101 traditional medical and alternative treatments. On average, participants consulted 12 health care providers and sadly spent over one-third of their annual income on health care costs.
The survey found that 95% of respondents found the most helpful treatment/management strategies were creating living space where toxic chemicals are minimised and avoiding where possible exposure to toxic chemicals.
The Allergy, Sensitivity & Environmental Health Association Qld Inc (ASEHA Qld Inc) which has now closed but their website still has many useful links and resources, have developed a guide to Living with MCS.
Housing And MCS
Finding the right housing as someone with MCS can be a nightmare. MCS can unfortunately lead to very uncertain housing situations and even homelessness. There are many variables one needs to consider when looking for somewhere to live. The following publication may be helpful as it contains advice on things to consider when looking for a place to live: Understanding and Accommodating People with Multiple Chemical Sensitivity in Independent Living by Pamela Reed Gibson, PhD, James Madison University.
ASEHA Qld Inc have developed a guide to Location, Housing Material and Design Guidelines for housing for someone with MCS. They also have a Template Letter Applying For Low Allergy Housing which may apply for private or public (see below) rental housing.
Public Housing: Victoria – From AESSRA Inc.
Apply to the Victorian Government Office for Housing in the usual way by filling in an Application for Public Housing, and fill out a Special Accommodation Requirement form. You will need a letter from a doctor, preferably well respected in the field of allergy and multiple chemical sensitivity. The letter should include the problem chemicals etc, as far as possible.
An advocate is a big help as the person applying usually is not well enough to handle the required negotiations. There will be some degree of choice in sites available, but compromises need to be made in some areas, both with site and building materials. The housing body will appoint a suitably qualified architect to modify the home plan, and a building biologist may help with EMR issues.
Even when using the least toxic options in building materials, the person will have to test each item (after it is aired) to be sure they are OK with it. All workers have to be very clear that they can’t make substitutions, or squirt things with RP40, etc. The first custom Ministry of Housing low toxin house was built about 15 years ago, so the knowledge is there if a person or their advocate can push hard enough to get it.
Key Organisations And Other Websites
The following links contain helpful information, advice and further links to such things as Facebook groups for people with MCS that you might consider joining for ongoing support from those in a similar situation as yourself.
Allergy and Environmental Sensitivity Support and Research Association Inc. (AESSRA Inc. – Australian)
MCS Australia – “Enabling Chemically Sensitive Individuals”
MCS America – “Awareness, Education, Resources, Support”
Fragrance Free Living – by David Twyoniuk and Judy Sterling.
ANRES Australian National Register of Environmental Sensitivities (“We aim to create a national register of those who experience environmental sensitivities so that we can communicate our needs to the decision-makers as a group”)
The Office of Chemical Safety (OCS)—within the Australian Government Department of Health, and the National Industrial Chemicals Notification and Assessment Scheme (NICNAS) prepared a report on Multiple Chemical Sensitivity (MCS) entitled: A Scientific Review of Multiple Chemical Sensitivity: Identifying Key Research Needs.
Sears M.E. (2007) “The medical perspective on environmental sensitivities.” Canadian Human Rights Commission.
South Australian ME/CFS Association Basics on MCS.
The South Australian Task Force on Multiple Chemical Sensitivity “…a community-based group of people living with MCS” – Responding To The Environmental Public Health Crisis Of Chemical Injury – publication: Submission to the House Standing Committee on Legal and Constitutional Affairs Regarding the Draft Disability (Access to Premises – Buildings) Standards.
Donnay A and Ziem G (1995) Comprehensive Protocol for Evaluating Disorders of Porphyrin Metabolism in Chemically Sensitive Patients, MCS referral and Resources, Baltimore.
Guidelines for visiting a person with MCS, from the Allergy, Sensitivity & Environmental Health Association QLD Inc.
A Guide To Living With MCS, from the Allergy, Sensitivity & Environmental Health Association QLD Inc.
Location, Housing Material and Design Guidelines for housing for someone with MCS, from the Allergy, Sensitivity & Environmental Health Association QLD Inc.
Health Information Template – to be provided to the hospital at the start of consultations with them and prior to hospital admission, from the Allergy, Sensitivity & Environmental Health Association QLD Inc.
Understanding and Accommodating People with Multiple Chemical Sensitivity in Independent Living by Pamela Reed Gibson, PhD, James Madison University.
Make your bedroom more liveable when you have MCS, S. Collette (2010), MCSA News, MCS America.
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Khalid, K (2012) ‘Study: Indoor air quality poses possible health threat‘ NewStraitsTimes, October 12.
Mc Coy, Katie (2012) ‘Solving the Smelly Problem of Fragrance- Induced Disabilities’ Foster Pepper PLLC, July 18.
Brown, Lydia (2012) ‘“This job is making me sick”. Strategies for Supporting youth with multiple chemical sensitivities or electromagnetic sensitivity‘. NCWD Youth, August 3.
McKeon, Melissa (2012) ‘Benefit June 23 to aid woman with multiple chemical sensitivity’, TelegramTowns.com, June 20.
[Unknown] (2010) ‘Houses that make you sick: Is your home making you sick?‘, The Age, November 20.
Clementi, Angela (2010) ‘First allergy proof houses to be built‘, swissinfo.ch, October 19.
Jacobs, HS (2010) ‘Buyers with hypersensitivity disorder should raise their concerns early‘, Washington Post Online, September 18.
[Unknown] (2010) ‘Hawaii Proclaimed July 2010 Toxic Injury Awareness and Education Month‘, MCS America, 24th July.
Heller, M (2010) ‘Scents alive! Perfume allergy case settles for $100,000‘, On Point News, July 3rd.
Chemical Sensitivity Network (2009) An Italian law proposal for environmental illnesses and disability, Germany.
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