Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder.

Abstract

Idiopathic environmental intolerance (IEI), also known as multiple chemical sensitivity, is a clinical description for a cluster of symptoms of unknown etiology that have been attributed by patients to multiple environmental exposures when other medical explanations have been excluded. Because allergy has not been clearly demonstrated and current toxicological paradigms for exposure-symptom relationships do not readily accommodate IEI, psychogenic theories have been the focus of a number of investigations. A significantly higher lifetime prevalence of major depression, mood disorders, anxiety disorders, and somatization disorder has been reported among patients with environmental illness compared with that in controls. Symptoms often include anxiety, lightheadedness, impaired mentation, poor coordination, breathlessness (without wheezing), tremor, and abdominal discomfort. Responses to intravenous sodium lactate challenge or single-breath inhalation of 35% carbon dioxide versus a similar breath inhalation of clean air have shown a greater frequency of panic responses in subjects with IEI than in control subjects, although such responses did not occur in all subjects. Preliminary genetic findings suggest an increased frequency of a common genotype with panic disorder patients. The panic responses in a significant proportion of IEI patients opens a therapeutic window of opportunity. Patients in whom panic responses may at least be a contributing factor to their symptoms might be responsive to intervention with psychotherapy to enable their desensitization or deconditioning of responses to odors and other triggers, and/or may be helped by anxiolytic medications, relaxation training, and counseling for stress management.

Vocal cord dysfunction: what do we know?

“…Intubation, certain anaesthetics, GER and various other aetiologies have been implicated in inducing laryngospasm [17,29,44]. Finally, there are functional disorders that must be distinguished from VCD, including spasmodic or muscle tension dysphonia, panic attacks, Munchausen's syndrome [45] and multiple chemical sensitivity (idiopathic environmental intolerance) [46][47][48] and somatoform disorders [49].…”

Case–control study of multiple chemical sensitivity, comparing haematology, biochemistry, vitamins and serum volatile organic compound measures

“…Multiple chemical sensitivity (MCS), also known as idiopathic environmental intolerance [1,2], has been described as medically unexplained [3], disabling multi-organ symptoms triggered by multiple incitants with toxicant-induced loss of tolerance to chemicals [1,4,5], somatization disorder [6,7], irrational fear of chemicals [8] and panic attacks paired with non-noxious stimuli [9,10].…”

Double-blind non-controlled chemical challenge with environmental toxicological assessment in a Multiple Chemical Sensitivity case

“…Following the International classification of headaches disorders [16] only a few chemicals are known to trigger headaches. Migraineurs as well as MCS patients show a sensitization to environmental triggers and chronic anxiety with panic disorders [17][18][19]. The severity of the first attacks in MCS may trigger a "posttraumatic stress disorder" [20].…”