Review of Multiple Chemical Sensitivity: Identifying
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- A Scientific Review of Multiple Chemical Sensitivity: Identifying K ey Research Needs
- PREFACE What this review is about
- 2understanding Multiple chemiCal Sensitivity 11
- 3Mechanisms of Multiple chemical sensitivity 24
- 4diagnosis, treatment and Management of Multiple chemical sensitivity 60
- 5Appendix 1 - a survey of australian clinicians approaches to multiple chemical sensitivity 71
- 6appendix 2 - Views of national governments and Professional MEDICAL Organisations 81
A Scientific Review of Multiple Chemical Sensitivity: Identifying Key Research Needs Report prepared by the National Industrial Chemicals Notification and Assessment Scheme (NICNAS) and the Office of Chemical Safety and Environmental Health (OCSEH)
ISBN 978-0-9807221-4-7 © Commonwealth of Australia 2010
PREFACE What this review is about Multiple Chemical Sensitivity (MCS) is a term used to describe a condition presenting as a complex array of symptoms linked to low level exposure to chemicals. There is uncertainty about the event(s) and the underlying biological mechanisms that lead to symptoms. This uncertainty has hampered the development of a clinical basis for the diagnosis and treatment of individuals with MCS. Those with MCS often face situations where their symptoms may be poorly understood or mis-diagnosed, and may be provided with health care that is less than optimal. Difficulties with the diagnosis of MCS are accompanied by a lack of consensus for its treatment other than avoidance of agents that may trigger symptoms. Significant gaps in understanding MCS, together with community concerns over the presence of chemicals in the environment have led the Australian Department of Health and Ageing (DoHA), through the Office of Chemical Safety and Environmental Health (OCSEH) and the National Industrial Chemicals Notification and Assessment Scheme (NICNAS), to prepare this scientific review of MCS. Scope of the review The aim of this review is to examine current scientific research on MCS and to identify priority areas for further study to inform and engage the clinical and scientific research community. The report therefore examines evidence about:
The report also highlights research efforts and further activities that would enhance diagnosis, treatment and better clinical management practices of MCS in Australia. Conduct of the review The review has two key areas of focus. Firstly, it reviews scientific information to identify biologically plausible hypotheses to explain the underlying mechanisms of MCS. The elucidation of the biological basis for MCS will undoubtedly provide direction for clinical diagnosis and improve treatments options for MCS. If the underlying biological mechanism(s) can be determined for MCS, there is potential to not only better treat symptoms but to effect a significant alleviation of the condition. Secondly, to better support the diagnosis and management of individuals with MCS, the review identifies current diagnosis and treatment practices and gaps in clinical research and medical education in Australia. The review findings point to specific priorities for further scientific and clinical research on MCS. 1Executive SummarY 8 1.1Overview 8 1.2Findings 9 Research into biological mechanisms underpinning MCS 9 Clinical research needs 9
2.1What is Multiple Chemical Sensitivity? 11 2.2What are the symptoms of MCS? 12 2.3What chemicals trigger the symptoms of mcs? 13 2.4Can mcs be clincally defined? 16 2.5does MCS have a disease classification? 18 2.6Do individuals with MCS share common characteristics? 19 2.7Is MCS related to other syndromes or disorders? 22 3Mechanisms of Multiple chemical sensitivity 24 3.1Overview of Possible MCS Mode (s) of Action 25 Immunological dysregulation 25 Respiratory disorder/neurogenic inflammation 27 Limbic kindling/neural sensitisation 31 NMDA receptor activity and elevated nitric oxide and peroxynitrite 35 Toxicant-induced loss of tolerance (TILT) 37 Altered xenobiotic metabolism 38 Behavioural conditioning 41 Psychological/psychiatric factors 44 Other proposed mechanisms 49 3.2Further research for elucidating mode(s) of action 49 Chemical initiators/triggers and biological gradients 50 Challenge studies for determining causation 51 Investigations for key modes of action 54
4.1diagnosis and prevalence of mcs 60 Studies on the prevalence of MCS in Australia 60 Studies on the prevalence of MCS in other countries 61 4.2mcs case definition and prevalence data 63 4.3Treatment facilities 64 4.4Treatment/management strategies 65 4.5Clinical Approaches to MCS in Australia 67 4.6clinical research needs 68 Longitudinal Study 69 Education/Training 69
5.1The survey process 71 Stakeholder contact 71 Questionnaire 73 Interviews 73 Workshop 74 5.2Problems encountered 75 5.3The common ground 76 Initial Presentation 77 Diagnosis 77 Prognosis and Treatment 77 Education 78 5.4Implications for treatment/management 78 Common MCS treatments 78 Recognising and responding to MCS individuals 78 Principles for the management of MCS 79 5.5Suggestions for clinical research 79
6.1US professional organisations 81 American Academy of Environmental Medicine (AAEM) 81 American Academy of Allergy, Asthma and Immunology (AAAAI) 81 American College of Physicians (ACP) 81 American College of Occupational and Environmental Medicine (ACOEM) 82 American Medical Association (AMA) 82 Californian Medical Association (CMA) 82 Association of Occupational and Environmental Clinics (AOEC) 83 National Academy of Sciences – National Research Council (NRC) 83 Other Organisations 83 6.2US Government 83 Agency for Toxic Substances and Disease Registry (ATSDR) 84 Department of Defence (DOD) 84 Department of Veterans Affairs 84 National Institute of Environmental Health Sciences (NIEHS), National Institute of Health 84 Environmental Protection Agency (EPA) 85 Occupational Safety and Health Administration (OSHA) 85 6.3Canadian Government 86 6.4German Government 86 6.5United Kingdom professional organisations 86 Royal College of Physicians and Royal College of Pathologists 86 British Society for Allergy, Environmental and Nutritional Medicine (BSAENM) 86 Institute of Occupational Medicine, Edinburgh 87 6.6New Zealand Government 87 6.7Danish government 88 6.8International program on chemical safety (WHO/ILO/UNEP) 88
ABBREVIATIONS AAAAI American Academy of Allergy, Asthma and Immunology AAEM American Academy of Environmental Medicine ACOEM American College of Occupational and Environmental Medicine ACP American College of Physicians ACTA Australian Chemical Trauma Alliance Inc. AESSRA Allergy and Environmental Sensitivity Support and Research Association Inc AIHW Australian Institute of Health and Welfare AIRA Allergies and Intolerant Reactions Association AMA American Medical Association AOEC Association of Occupational and Environmental Clinics ASCEPT Australian Society of Clinical and Experimental Pharmacology and Toxicology ASCIA Australasian Society of Clinical Immunology and Allergy ASEHA Allergy, Sensitivity and Environmental Health Association Qld Inc ATSDR Agency for Toxic Substances and Disease Registry, Atlanta, Georgia BSAENM British Society for Allergy and Environmental Medicine CFMCS SG Circle of Friends MCS Support Group WA CMA Californian Medical Association CNS Central nervous system CTMCS Community Taskforce on Multiple Chemical Sensitivities- WA DBPC Double-blind placebo controlled DOD Department of Defence, USA DoHA Australian Government Department of Health and Ageing EPA U.S. Environmental Protection Agency FM Fibromyalgia GRCMCS and CI Global Recognition Campaign for Multiple Chemical Sensitivity and Chemical Injury IEI Idiopathic environmental intolerance ILO International Labour Organisation IPCS International Programme on Chemical Safety MCS Australia Multiple Chemical Sensitivity Australia MCS Multiple chemical sensitivity ME/CFS Myalgic encephalopathy/Chronic fatigue syndrome. NCEH National Centre for Environmental Health, Atlanta, Georgia, USA NICNAS National Industrial Chemicals Notification and Assessment Scheme NIEHS National Institute for Environmental Health Sciences NIOSH National Institute for Occupational Safety and Health, Cincinnati, Ohio NRC National Research Council OCSEH Office of Chemical Safety and Environmental Health OSHA Occupational Safety and Health Administration RACP Royal Australasian College of Physicians RPAH Royal Prince Alfred Hospital SATFMCS South Australian Task Force on Multiple Chemical Sensitivity SBS Sick building syndrome TILT Toxicant-induced loss of tolerance TRP Transient receptor potential UNEP United Nations Environmental Programme VOC Volatile organic compound WHO World Health Organization Directory: data -> assets -> word doc word doc -> Northern territory of australia word doc -> Number: caveat in the [Will/Will and Codicil/Estate of] word doc -> List of accessible executive records word doc -> National Industrial Chemicals Notification and Assessment Scheme word doc -> This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth word doc -> Commonwealth of Australia 2002 word doc -> Commonwealth of Australia 2000 word doc -> Priority Existing Chemical word doc -> Rail safety news issue 6 – October 2011 word doc -> Board Endorsed October 2009 amended 13-09-11 with extra units Download 454.32 Kb. Share with your friends:
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