The Compelling Anomaly of Chemical Intolerance

Abstract

In science, anomalies expose the limitations of existing paradigms and drive the search for new ones. In the late 1800s, physicians observed that certain illnesses spread from sick, feverish individuals to those contacting them, paving the way for the germ theory of disease. The germ theory served as a crude, but elegant formulation that explained dozens of seemingly unrelated illnesses affecting literally every organ system. Today, we are witnessing another medical anomaly—a unique pattern of illness involving chemically exposed groups in more than a dozen countries, who subsequently report multisystem symptoms and new‐onset chemical, food, and drug intolerances. These intolerances may be the hallmark for a new disease process or paradigm, just as fever is a hallmark for infection. The fact that diverse demographic groups, sharing little in common except some initial chemical exposure event, develop these intolerances is a compelling anomaly pointing to a possible new theory of disease, one that has been referred to as “Toxicant‐Induced Loss of Tolerance” (“TILT”). TILT has the potential to explain certain cases of asthma, migraine headaches, and depression, as well as chronic fatigue, fibromyalgia, and “Gulf War syndrome”. It appears to evolve in two stages: (1) initiation, characterized by a profound breakdown in prior, natural tolerance resulting from either acute or chronic exposure to chemicals (pesticides, solvents, indoor air contaminants, etc.), followed by (2) triggering of symptoms by small quantities of previously tolerated chemicals (traffic exhaust, fragrances, gasoline), foods, drugs, and food/drug combinations (alcohol, caffeine). While the underlying dynamic remains an enigma, observations indicating that affected individuals respond to structurally unrelated drugs and experience cravings and withdrawal‐like symptoms, paralleling drug addiction, suggest that multiple neurotransmitter pathways may be involved.

Perceived relation between odors and a negative event determines learning of symptoms in response to chemicals

“…A patient diagnosed with multiple chemical sensitivity (MCS) can report symptoms of neuromuscular, musculoskeletal, gastrointestinal, cardiac, affective, respiratory, or cognitive nature in response to chemical substances whose concentrations are far below established toxic levels (Miller 2001). Often, a (sub-)toxic exposure to one or more chemical substances can be identified in the patient's past.…”

Chemical Intolerance in Primary Care Settings: Prevalence, Comorbidity, and Outcomes

“…Although family histories for alcohol and drug problems are increased in MCS/chemical intolerance, 21 many earlier studies observed increased levels of alcohol intolerance and lower levels of alcohol use in the index cases of chemical intolerance. 12,17,28,[59][60][61][62] At the same time, there is no evidence that treating psychiatric symptoms alone will resolve chemical intolerance. Twin studies of chronic fatigue, a common overlapping diagnosis in chemical intolerance, indicate that psychiatric illness does not fully explain the clinical picture.…”

Abnormalities in cognitive-emotional information processing in idiopathic environmental intolerance and somatoform disorders

“…Theories of IEI have favored either a toxicological mechanism (e.g., Miller, 2001), a primarily psychological mechanism (based on cognitive fear-like reactions and Pavlovian conditioning processes; e.g., Staudenmayer, Binkley, Leznoff, & Phillips, 2003b) or a complex psychophysiological interaction of both (e.g., the olfactory-limbic model: Bell, Miller, & Schwartz, 1992). Little evidence exists for a simple toxicological notion of IEI or an involvement of toxicological factors in more complex psychophysiological models as limbic kindling or sensitization (Staudenmayer et al, 2003a(Staudenmayer et al, , 2003b.…”