What is Multiple Chemical Sensitivity (MCS)?

General Information

Multiple Chemical Sensitivities (MCS) was identified in a 1989 multidisciplinary survey of 89 clinicians and researchers, and modified in 1999. Top consensus criteria (Multiple chemical sensitivity: a 1999 consensus, 1999) for MCS define the condition as:

1. A chronic condition.

2. Symptoms recur reproducibly.

3. Symptoms recur in response to low levels of chemical exposure.

4. Symptoms occur when exposed to multiple unrelated chemicals.

5. Symptoms improve or resolve when trigger chemicals are removed.

6. Multiple organ systems are affected.

Products that MCS patients react to include any quantity of exposures to pesticides, secondhand smoke, alcohol, fresh paint, scented products and perfumes, candles, fragrances, food preservatives, flavor 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 react to natural products that are highly concentrated such as natural orange cleaners due to high volatile organic compound and pesticide concentration. Symptoms can range from minor annoyances to life-threatening reactions.

Etiology (Causation)

MCS is often misconstrued as an allergy, though IgE (immunoglobulin E) is generally not a factor. Allergies may co-occur with MCS as with any population, however MCS is not an allergy itself.

One of the first studies on MCS focused on possible long term potentiation in the hippocampus and neural sensitization as a central mechanism (Pall, 2003). Later studies examined the role of the inflammatory process and found that brain inflammation was correlated with symptoms of MCS (Pall, 2003). In 1999, Meggs proposed that MCS is caused by low molecular weight chemicals that bind to chemoreceptors on sensory nerve C-fibers leading to the release of inflammatory mediators (Meggs, 1999). Many observable and empirical, scientific facts can help identify MCS including SPECT scans and chemical encephalopathy, vitamin deficiencies, mineral deficiencies, excess amino acid deficiency, and disturbed lipid and carbohydrate metabolism (Rea et al, 2006; Ziem, 2001; Callendar et al, 1995; Heuser et al, 1994).

McKeown-Eyssen et al (2004) studied 203 MCS sufferers and 162 controls and found that blood tests revealed that genetic differences relating to the body's detoxification processes were present more often in those with MCS than those without. Data showed that five genetic polymorphisms have a statistically significant role in determining MCS prevalence ( McKeown-Eyssen et al 2004). Each of these genes encode proteins that metabolize chemicals previously implicated in MCS, notably the organophosphorus pesticides (PON1 and PON2 genes) and the organic solvents (CYP2D, NAT1 and NAT2 genes) ( McKeown-Eyssen et al 2004). People with a ''high'' expression of two specific genes (CYP2D6 and NAT2) were 18 times more likely to have MCS than those without ( McKeown-Eyssen et al 2004). It was concluded that "a genetic predisposition for MCS may involve altered biotransformation of environmental chemicals" ( McKeown-Eyssen et al 2004). Haley found similar, confirmatory results with the PON1 gene in studies of the Gulf War syndrome veterans.

A new study by Schnakenberg et al (2007) confirmed the genetic variation previously found by McKeown-Eyssen and Haley. A total of 521 unrelated individuals participated in the study. Genetic variants of four genes were analyzed: NAT2, GSTM1, GSTT1, and GSTP1. The researchers concluded that individuals who are NAT2 slow acetylators and those with homozygously deleted GSTM1 and GSTT1 genes are significantly more likely to develop chemical sensitivity (Schnackenberg et al, 2007). According to the study, the glutathione S-transferases act to inactivate chemicals, so people without these GSTM1 and GSTT1 genes are less able to metabolize environmental chemicals because "glutathione S-transferases play an important role in the detoxification of chemicals" (Schnackenberg et al, 2007). The deletion of another gene, the GSTP1 gene, leaves individuals more susceptible to developing these diseases, as lack of these genes means a loss of protection from oxidative stress (Schnackenberg, et al, 2007).

The NO/ONOO- cycle is implicated by Pall as being a plausible etiology for Multiple Chemical Sensitivities (MCS), Fibromyalgia (FM), Chronic Fatigue Syndrome (CFS), Post-Traumatic Stress Disorder (PTSD), and Gulf War Syndrome. Peroxynitrite (ONOO-) is oxidized from nitric oxide. Excess peroxynitrite depletes energy stores, which is perceived to cause extreme fatigue (Pall, ND). Of more interest to those who suffer from MCS is the fact that peroxynitrite breaks down the blood brain barrier and excess levels allow greater access to the brain (Pall, ND). This greatly increases the effects of chemicals on the brain. Essentially a non-MCS person has a barrier that protects the brain from damage from low-level chemical exposure, however a person who suffers from MCS has little or no barrier making the brain subject to increased damage and reactivity with minute exposures most people do not react to. The key effect of nitric oxide (NO) is that it inhibits cytochrome P-450 activity and slows degradation of hydrophobic organic chemicals (Pall, ND). This means that excess nitric oxide slows down the body’s natural detoxification processes leaving MCS patients subject to the effects of chemical exposure longer than non-sufferers. Between a reduced blood-brain barrier and increased time to naturally detoxify the body, MCS patients are subject to permanent and long-term brain and nervous system damage which includes toxic encephalopathy.

“The only etiologic mechanism proposed for each of these is a vicious cycle mechanism involving elevated levels of nitric oxide and its oxidant product, peroxynitrite. This cycle may be initiated by a variety of diverse short-term stressors, including viral organic solvent exposure, and exposure to three classes of pesticides, organophosphorus/carbamate pesticides, organochlorine pesticides and pyrethroid pesticides). Each of these short-term stressors are known to be able to trigger responses that lead to increases in nitric oxide levels. Indeed, other initiating short-term stressors, including a protozoan infection, carbon monoxide exposure, thimerosal exposure and ciguatoxin exposure are also known or thought to act to increase nitric oxide levels, as well” (Pall, 2006).

Prevalence

Callender, TJ, et al. (1995). Evaluation of chronic neurological sequelae after acute pesticide exposure using SPECT brain scans. Journal Toxicology & Environmental Health. 41:275-284.

Caress, S., & Steinemann, A. (2003). A Review of a Two-Phase Population Study of Multiple Chemical Sensitivity. Environmental Medicine. 111, 1490 - 1497.

Davidoff, L. (1989). Multiple Chemical Sensitivities (MCS). The Amicus Journal. Winter.

Ferrie, H. (October 2003). Multiple Chemical Sensitivity: Government and Medical Science Finally Recognize Crippling Effects of MCS. Vitality, Retrieved May 17, 2006, from http://www.vitalitymagazine.com/node/112

Gibson, P. (2005). Understanding & Accommodating People with Multiple Chemical Sensitivity in Everyday Living. Independent Living Research Utilization.

Haley, RW, Billecke, S, & La Du, BN (1999). Association of low PON1 type Q (type A) arylesterase activity with neurologic symptom complexes in Gulf War veterans. Toxicology and Applied Pharmacology 157(3):227-33.

Heuser, G, et al. (1994). Neurospect findings in patients exposed to neurotoxic chemicals. Toxicology & Industrial Health. 10:561-571.

McKeown-Eyssen, G, Baines, C, Cole, D, Riley, N, Tyndale, R, Marshall, L, & Jazmaji, V (2004). Case-control study of genotypes in multiple chemical sensitivity: CYP2D6, NAT1, NAT2, PON1, PON2 and MTHFR]. International Journal of Epidemiology 33, 1-8.

Meggs WJ, Dunn KA, Bloch RM, Goodman PE, Davidoff AL (1996). Prevalence and nature of allergy and chemical sensitivity in the general population. Archives of Environmental Health. Jul-Aug;51(4):275-82.

Meggs, WJ (1999). Mechanisms of allergy and chemical sensitivity. Toxicology and Industrial Health. 15:3-4, 331-338.

Multiple chemical sensitivity: a 1999 consensus. Arch Environ Health. 1999 May-Jun;54(3):147-9.

Pall, M. (ND). Multiple Chemical Sensitivity: The End of Controversy. Washington State University School of Molecular Biosciences, Retrieved May 18, 2006, from: http://molecular.biosciences.wsu.edu/faculty/pall/pall_mcs.htm

Pall, M (2006). The NO/ONOO- Cycle as the Cause of Fibromyalgia and Related Illnesses: Etiology, Explanation and Effective Therapy. Washington State University School of Molecular Biosciences.

Pall, M (2003). Elevated nitric oxide/peroxynitrite theory of multiple chemical sensitivity: central role of N-methyl-D-aspartate receptors in the sensitivity mechanism. Environmental Health Perspectives. 111:12, 1461-1464.

Pall, M. (2001). Multiple Chemical Sensitivity - The End of Controversy. Washington State University, School of Molecular Biosciences, Retrieved May 17, 2006, from http://molecular.biosciences.wsu.edu/faculty/pall/pall_mcs.htm

Schnackenberg,E. et al (2007). A cross-sectional study of self-reported chemical-related sensitivity is association with gene variations of drug-metabolizing enzymes. Environmental Health.

Ziem, G (2001). Medical Evaluation and Treatment of Patients with Chemical Injury and Sensitivity. National Institute of Environmental Health Sciences.

The prevalence of MCS, based on sample populations, provides an estimate of 16% of the population and 33% of Gulf War Veterans who experience chemical hypersensitivity (Gibson, 2005; Meggs et al, 1996).

Treatment

References

Age of Onset (Caress et al, 2003)

< 20………………………..32.4%

21 – 35…………………….35.2%

36 – 50…………………….14.8%

> 50………………………...7.9%

Don’t Know.………………..9.7%

Gender (Caress et al, 2003)

Males………………………40%

Females…………………….60%

Education Level (Caress et al, 2003)

Did not Complete High School……….10.1%

High School Graduate………………...24.7%

Some College………………………….25.7%

College Graduate……………………...31.5%

Professional/Graduate School………….7.9%

This site is for informational purposes and is not intended to replace the examination, diagnosis and treatment of a licensed physician and no such claims are inferred. MCS America will not be responsible for misuse of this information or the misuse of any information provided by it’s member organizations. Articles, citations, links and information are not necessarily the opinion of MCS America and printing does not constitute MCS America’s endorsement.

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Disclaimer

Most qualified physicians recommend one or more of the following basic treatments for MCS (Zeim, 2001):

Chemical Avoidance

Chemical Free Housing

Nutrient Therapy

Sauna Therapy & Detoxification

Chemical Avoidance

Chemical avoidance has been scientifically proven to be the most effective treatment for MCS. Avoidance simply means eliminating exposures to chemicals which cause negative reactions. This reduces the body burden of chemicals in the tissues and hepatic detoxification pathways. Failing to avoid exposures to chemicals which do not produce a reaction could cause sensitization to additional chemicals which were previously tolerated.

Chemical avoidance starts with the often hidden chemical cocktail in personal care products.

Personal Care Products to Avoid

· Perfume and Cologne

· All Fragranced Products - including soaps, shampoo, conditioner, and bath products

· Fragranced Lotions

· Shaving Cream

· Aftershave

· Deodorants and Anti-Perspirants

· Hair Spray

· Hair Gel and Mousse

· Hair Color

· Fragranced Shampoo and Conditioner

· Nail Polish and Remover

· Make-up

· Anti-Bacterial Hand Wipes or Hand Sanitizer

· Other Toiletries

Personal Care Products to Use Instead

· Scent - use essential oils if tolerated or eliminate perfume

· Fragrance Free Products - soaps, shampoo, conditioner, and bath products

· Lotion - use unscented versions or natural oils such as jojoba, coconut, and olive oil

· Shaving Cream - soap

· Aftershave - witch hazel or hydrogen peroxide

· Deodorant - peroxide, natural salt crystal, baking soda, unscented versions

· Hair Styling - aloe vera gel, lemon juice

· Hair Color - natural variations, peroxide to bleach, all natural henna for color

· Shampoo / Conditioner unscented variations, baking soda, vinegar, citric acid, oils

· Nail Polish and Remover - safer variations from the health food store or go au natural

· Make-up - unscented, natural variations or go au natural

Chemical Free Housing

The indoor environment is generally more polluted than the outdoor environment due to the extensive amounts of cleaners, fragrances, petrochemicals, solvents, and volatile organic compounds found in building materials and furnishing. Therefore, a chemical free home is most important for symptom reduction, functional improvements, and an increased ability to withstand exposures from unavoidable sources in the general environment.

Domestic Household Products to Avoid

· All Fragranced Products

· Fragranced Laundry Detergents

· Fabric Softener and Dryer Sheet (fragranced or not)

· Air Fresheners

· Window Cleaning Solution

· All Purpose Cleaners, Sprays, and Aerosols

· Scouring Powder

· Fragranced and/or Anti-Bacterial Vacuum Bags and Trash Bags

· Disinfectants

· Fragranced Trash Bags

· Commercial or Industrial Chemicals

· Concentrated Products

· Solvents

· Scented Candles and Incense

· Pesticides

· Herbicides

· Fertilizers

Domestic Household Products to Use Instead

· Laundry - borax, baking soda, or fragrance free laundry detergent

· Fabric Softener - white vinegar in wash or peroxide, tennis shoe, tennis ball in the dryer

· Air Fresheners - white vinegar, open windows, adequate ventilation, fresh herbs, and tea

· Windows - white vinegar

· All Purpose Cleaning - white vinegar

· Scouring Powder - baking soda or borax

· Disinfectant - peroxide followed by white vinegar

· Fragrance Free Products

· Bugs - borax, diatomaceous earth

· Weeds - salt/vinegar or hand pull weeds

Nutrient Therapy

Most qualified physicians offer one or more forms of nutrient and antioxidant therapy. Patients with MCS often suffer from malabsorption, either unable to absorb sufficient nutrients from the foods they eat or requiring higher levels of nutrients utilized in the detoxification process. Increasing the levels of certain nutrients often reduces symptom severity. Increasing antioxidants provides a protective effect. There are many products and protocols available, the most notable ones being created by Dr. Grace Ziem and Dr. Martin Pall.

Martin Pall asserts that MCS is initially triggered by volatile organic solvent exposure, organophosphorus/carbamate pesticide exposure, organochlorine pesticide exposure, and/or pyrethroid pesticide exposure. These initiating triggers act to increase the levels of nitric oxide (NO) in the body. Nitric oxide then acts through its oxidant product, peroxynitrite (ONOO-), to maintain a vicious cycle mechanism which is responsible for the resulting chronic illness (MCS). This cycle is called the NO/ONOO- Cycle (pronounced “no oh no”). In Summary,

· Short term triggers initiate MCS by raising nitric oxide synthesis and consequent levels of nitric oxide and its oxidant product peroxynitrite.

· Initiation is converted into a chronic illness through the action of a vicious cycle mechanism in which chronic elevation of nitric oxide and peroxynitrite and is produced and maintained.

· Symptoms of MCS are generated by elevated levels of nitric oxide and elevated levels of peroxynitrite or inflammatory cytokines, oxidative stress and elevated NMDA and vanilloid receptor activity. This is called “up-regulation”.

· Treatment should focus on down-regulating NO/ONOO- cycle biochemistry.

Pall first developed a nutritional protocol for down-regulating the NO/ONOO– cycle with Dr. Grace Ziem and later developed his own variation.

The NO/ONOO- Cycle is also known as the 10th Paradigm in Medicine.

The following agents have been predicted to be useful to down-regulate the NO/ONOO- cycle and reduce symptoms:

Nebulized Inhaled Reduced Glutathione (RX Only)

Nebulized Inhaled Hyroxocobalamin (RX Only)

Mixed Natural Tocopherols

Buffered Vitamin C

Magnesium as Malate

Four Different Flavonoid Sources:

Ginkgo Biloba Extract, Cranberry Extract, Silymarin, & Bilberry Extract

Selenium as Selenium-Grown Yeast

Coenzyme Q10

Folic Acid

Carotenoids Including Lycopene, Lutein and Alpha-carotene

Alpha-Lipoic acid

Zinc (modest dose)

Manganese (low dose)

Copper (low dose)

Vitamin B6 in the Form of Pyridoxal Phosphate

Riboflavin 5’-Phosphate (FMN)

Betaine (Trimethylglycine)

Green Tea Extract

Acetyl L-Carnitine

Sauna Therapy & Detoxification

There are numerous methods of detoxification which may prove helpful. Testing should be conducted by a qualified provider to rule out or treat heavy metal and pesticide intoxication. Chelation therapy may be considered in cases of documented heavy metal toxicity. Fasting should only be undertaken with medical supervision as the mobilization of chemicals stored in body fat during fasting may cause a worsening of symptoms.

One of the safest methods of overall detoxification recommended by qualified physicians is a sauna. Dr. William Rea offers a sauna room for treatment at his clinic, the Environmental Health Center, in Dallas.

A sauna is a heated, insulated room used for cleansing and detoxification. Saunas eliminate environmental chemicals that are stored in fat cells by heating the body to mobilize chemicals from fat stores which are then eliminated via sweat. The sauna should be one that is not treated with toxic chemicals, such as Heavenly Heat brand (nfi).

Basic instructions:

· Set the heat to 165-180^oF (traditional rock sauna) or 100-130^oF (FIR - far infrared sauna)

· Take a shower before beginning.

· Enter the sauna and sit on a towel or mat on the bench. As you gain experience, you will learn what temperature works best for you and may adjust accordingly.

· Throw water on the stones of the heater for a more intense heat and to add moisture to the air (traditional sauna).

· Rinse off in the shower every few minutes when you feel the need to cool down and return for another round if desired.

· After the last round, shower to cool down and remove sweat / toxics.

· Drink plenty of water before, during, and after sauna’ing.

· Frequent sauna users may look into tri-salts to replace lost salts and minerals.

Additional Information and Resources for MCS Treatment, including a description of allergies vs. MCS and treatments for allergies, see MCS Medical Treatment.

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Conditions:

Multiple Chemical Sensitivity (MCS)

Fibromyalgia (FM)

Chronic Fatigue Syndrome (CFS)

Gulf War Syndrome

Electrosensitivity

Autism