Multiple Chemical Sensitivity and the Workplace: Current Position and Need for an Occupational Health Surveillance Protocol

Abstract

Multiple chemical sensitivity, commonly known as environmental illness, is a chronic disease in which exposure to low levels of chemicals causes correlated symptoms of varying intensity. With the continuous introduction of new substances, people with MCS suffer significant limitations to their living environment and frequently to their workplace. This paper describes the current situation as regards MCS and the critical points in its case definition, which is still not generally agreed upon; this makes it difficult to recognize with certainty, especially, its precise relationship with work. Other problems arise in relation to the occupational physician's role in diagnosing and managing the worker with the disorder, the question of low levels of exposure to chemicals, and the best measures possible to prevent it. A diagnostic “route” is proposed, useful as a reference for the occupational physician who is often called in first to identify cases suspected of having this disease and to manage MCS workers. Work-related problems for people with MCS depend not only on occupational exposure but also on the incompatibility between their illness and their work. More occupational physicians need to be “sensitive” to MCS, so that these workers are recognized promptly, the work is adapted as necessary, and preventive measures are promoted in the workplace.

Prevalence and interannual changes in multiple chemical sensitivity in Japanese workers

“…In the work environment, Watanabe et al [16] identified several at-risk categories of chemicals, especially volatile compounds such as organic solvents. Many compounds used daily in manufacturing processes contained such chemicals, and exposed not only the workers who produced them, but also those in areas such as construction, automotive work, textiles, cleaning, and so on [1]. The impact of environmental sensitivities on workers may range from mild to severe, even making work impossible in some cases [5].…”

“…Multiple chemical sensitivity (MCS) is an acquired chronic disorder in which exposure to low levels of chemicals causes mild to wholly disabling symptoms [1]. Symptoms are usually vague and nonspecific, involving more than one organ system.…”

“…The etiology of MCS, however, remains unclear. It is difficult to estimate its prevalence because it is derived from self-reports, which differ from case rates diagnosed by medical staff-occupational physicians in particular [1]. MCS patients' clinical characteristics are usually evaluated using questionnaires such as the Environmental Exposure and Sensitivity Inventory (EESI), or clinical interviews that rely on the individual's retrospective self-reports [3].…”

Review of the Available Scientific Evidence on Multiple Chemical Sensitivity Syndrome

“…Barnig et al 2013 27 hypothesis review the pathophysiology of MCS and found no differences between healthy and sick people, or medical identification or cognitive development or serum cortisol. Martini et al 2013 28 made an overview of MCS specifying the critical points of the case definition and diagnosis in relation to the workplace. They propose a diagnostic protocol for suspected MCS, including a first phase with detailed interview using several questionnaires, blood and urine analysis, the signs and indications of the patient and spirometry.…”

Toxicant-Induced Loss of Tolerance: A Theory to Account for Multiple Chemical Sensitivity

“…27 The 1999 Consensus Statement on the case definition of MCS suggested using the EESI to screen patients for MCS. 28 A successor to the EESI (also known as the TILT Test) was developed later by Dr. Miller. This successor is the Quick Environmental Exposure and Sensitivity Inventory (QEESI © ).…”