TY - CHAP M1 - Book, Section TI - Multiple Chemical Sensitivity A1 - Harrison, Robert J. A2 - LaDou, Joseph A2 - Harrison, Robert J. PY - 2021 T2 - CURRENT Diagnosis & Treatment: Occupational & Environmental Medicine, 6e AB - Clinicians have been challenged by the individual with multiple complaints relating to low-level occupational or environmental exposures. Patients report respiratory, central nervous system, musculoskeletal, gastrointestinal, and systemic symptoms after exposure to common environmental irritants such as perfumes, cigarette smoke, home or office furnishings, household cleaners, and a host of other petrochemical products. Upper respiratory (eg, nasal congestion, dryness, or burning), central nervous system (eg, concentration problems, memory difficulties, insomnia, drowsiness, irritability, and depression), and vegetative (eg, fatigue, headache, arthralgias, and myalgias) symptoms predominate. Symptoms occur with exposures well below thresholds permitted by federal or state regulatory agencies as causing acute adverse effects in humans, resulting in significant impairment, lost work time, complete job loss, or major alterations in social and family functions. Individuals may report symptom onset following acute or chronic low-level occupational or environmental exposures, with persistent symptoms that are triggered by subsequent environmental contaminants. Often patients seek help from multiple health care providers who suggest psychiatric etiologies or treatment, obtain toxicologic or immunologic test batteries, or initiate a variety of empirical treatments. Workers’ compensation or disability claims often are disputed, and employers may have difficulty accepting or accommodating clinician or patient requests for alternative work environments. As a result, frustration, anger, hostility, and suspicion may confront the clinician when significant impairment continues despite lengthy and expensive consultations. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/10/08 UR - accessmedicine.mhmedical.com/content.aspx?aid=1180883326 ER -