The Brief Environmental Exposure and Sensitivity Inventory (BREESI): an international validation study

Palmer, Raymond F.; Rincon, Rudy; Perales, Roger; Walker, Tatjana; Jaén, Carlos Roberto; Miller, Claudia S.

doi:10.1186/s12302-022-00600-8

Cited by 6 publications

(5 citation statements)

References 37 publications

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“…Designed for busy office practices, the brief environmental exposure and sensitivity inventory (BREESI) is an internationally validated 3-item 1-minute screener for CI. 10,30,31 Our research has shown that 97% of persons answering "Yes" to all three items on the BREESI had high CI scores as assessed by the larger 50-item QEESI. Ninety-five (95%) of those who answered "No" to all of the BREESI items, showed no evidence of CI on the QEESI.…”

Section: Discussionmentioning

confidence: 77%

Clinical assessment and patient education of chemical intolerance

Ravi,

Johnson-Esparza,

Hernandez

et al. 2024

Int J Community Med Public Health

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Chemical intolerance (CI) is characterized by multi-system symptoms initiated by a one-time high dose or persistent low-dose exposure to environmental toxicants. Symptoms of this “medically unexplained illness” often include fatigue, headache, weakness, rash, mood changes, musculoskeletal pain, gastrointestinal, difficulties with memory, concentration, and respiratory problems. A general disease mechanism called toxicant-induced loss of tolerance (TILT) explains the initiation, symptoms, and intolerances to chemicals, foods, and medicines reported worldwide by individuals with this condition. TILT is a 2-stage disease process initiated by a major chemical exposure, or a series of low-level exposures, followed by multisystem symptoms and onset of new intolerances. Despite its prevalence of up to 20%, most primary care physicians are not aware of this disease process and thus have been unable to recognize patients with CI. This case series describes three family medicine clinic patients who had multisystem symptoms that were triggered by chemical exposures, saw multiple specialists with no improvement, who were eventually diagnosed with CI and went through a behaviorally based avoidance education program. This report describes the impact of a coordinated educational intervention for patients with CI. We offer several educational tools for health practitioners to discuss with their patients. These patient stories highlight the importance for physicians to be knowledgeable about CI in order to facilitate symptom reduction and improve the quality of life for these patients.

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Section: Discussionmentioning

confidence: 77%

Clinical assessment and patient education of chemical intolerance

Ravi,

Johnson-Esparza,

Hernandez

et al. 2024

Int J Community Med Public Health

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“…CI was assessed using the Brief Environmental Exposure and Sensitivity Inventory (BREESI) [ 12 , 28 , 29 ]. The BREESI is derived from the Quick Environmental Exposure and Sensitivity Inventory (QEESI) [ 30 , 31 ], a 50-item validated questionnaire designed to identify individuals with CI.…”

Section: Methodsmentioning

confidence: 99%

“…The BREESI has excellent positive and negative predictive validity (97% and 95%, respectively), as well as sensitivity and specificity (90% and 87%, respectively). A sum score of the three items is an accurate screen for CI [ 12 , 28 , 29 ].…”

Section: Methodsmentioning

confidence: 99%

“…To assess the modifying effect of CI between QoL items and generations, the analysis was stratified by those with and without CI. We have previously demonstrated the high probability (95%) of being classified as chemically intolerant for those choosing 2 or 3 BREESI items [ 12 , 28 , 29 ]. In this analysis, the sample was stratified by those choosing 2 or 3 BREESI items (Chemically Intolerant group), and those choosing 0 or 1 (Not Chemically intolerant).…”

Section: Methodsmentioning

confidence: 99%

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Diabetes quality of life, Chemical Intolerance, and generational status in a Latino sample: an RRNeT study

Johnson-Esparza,

Wood,

Cruz

et al. 2024

J Diabetes Metab Disord

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Objectives The impact of diabetes on quality of life (QoL) includes deficits in physical functioning and emotional and mental health. Individuals with diabetes can experience significant distress related to diabetes management and burden. Comorbid conditions can contribute to QoL among individuals with diabetes. Chemical Intolerance (CI) has received minimal attention in the context of diabetes. CI is characterized by multi-systemic symptoms initiated by a one-time high dose or persistent low-dose exposure to environmental toxins. Latinos experience diabetes distress and are exposed to environmental factors at disproportionate rates. This study sought to investigate generational differences in diabetes QoL and CI in a Latino sample across generational status. Methods To assess the modifying effect of CI between QoL and generations, the analysis was stratified by those with and without CI. Results Compared to 2nd generation Latinos, Latino immigrants were more likely to indicate that without diabetes, their life would be better across several QoL domains. Latino immigrants had a lower A1C and BMI than2nd generation Latinos. Additionally, they were less likely to have scores indicative of CI than U.S.-born Latinos. QoL varied by generational status and suggested a greater emphasis on family and social relationships among immigrants than U.S.-born Latinos. There were no differences in health services measures across generations. Conclusions This study highlights generational differences in the impact of diabetes on QoL. It is one of the few studies to seek to understand the impact of CI on QoL in the context of a chronic condition such as type 2 diabetes.

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“…The BREESI was used as a screener for CI and then the QEESI questionnaire for con rming CI status. The BREESI provides 91% sensitivity and 93% speci city in identifying CI individuals when used in combination with the QEESI (Palmer et al, , 2022Miller & Prihoda, 1999a,b). Answering "YES" to one or more BREESI questions quali ed participants to complete the 50-item QEESI.…”

Section: Methodsmentioning

confidence: 99%

Environmental House Calls Can Reduce Symptoms of Chemical Intolerance: A Demonstration of Personalized Exposure Medicine

Perales¹,

Rincon²,

Forster³

et al. 2023

Preprint

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Aim The goal of this investigation was to 1) identify exposure sources in the home, 2) teach occupants how to remove or replace them, and 3) determine whether measured levels and reported symptoms could be reduced by these changes.Background Chemical intolerance (CI) is an international public health and clinical concern, but few resources are available to address patients’ often disabling symptoms. Numerous studies show that levels of indoor air pollutants can be two-to-five (or more) times higher than outdoor levels. Fragranced consumer products, including cleaning supplies, air fresheners, and personal care products are symptom triggers commonly reported by susceptible individuals.Methods A team of professionals trained and led by a physician/industrial hygienist and two certified indoor air quality specialists conducted a series of five structured Environmental House Calls (EHCs) in 37 homes of patients reporting chemical intolerances.Results We report three case studies demonstrating that an appropriately structured home intervention can teach occupants how to reduce indoor air exposures and associated symptoms. Symptom improvement, documented using the QEESI Symptom Star, corresponded with reduction of indoor air volatile organic compounds, most notably fragrances.Discussion We address the long-standing dilemma that worldwide reports of fragrance sensitivity have not previously been confirmed by human or animal challenge studies. Our ancient immune systems’ “first responders,” mast cells, which evolved 500 million years ago, can be sensitized by synthetic organic chemicals whose production and use has grown exponentially since WWII. We propose that these chemicals, which include now-ubiquitous fragrances, trigger mast cell degranulation and inflammatory mediator release in the olfactory-limbic tract, thus altering cerebral blood flow and impairing mood, memory, and concentration (so-called “brain fog”). The time has come to translate these research findings into clinical and public health practice.

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The Brief Environmental Exposure and Sensitivity Inventory (BREESI): an international validation study

Cited by 6 publications

References 37 publications

Clinical assessment and patient education of chemical intolerance

Clinical assessment and patient education of chemical intolerance

Diabetes quality of life, Chemical Intolerance, and generational status in a Latino sample: an RRNeT study

Environmental House Calls Can Reduce Symptoms of Chemical Intolerance: A Demonstration of Personalized Exposure Medicine

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