RT Book, Section A1 Harrison, Robert J. A2 LaDou, Joseph A2 Harrison, Robert J. SR Print(0) ID 1180883326 T1 Multiple Chemical Sensitivity T2 CURRENT Diagnosis & Treatment: Occupational & Environmental Medicine, 6e YR 2021 FD 2021 PB McGraw Hill PP New York, NY SN 9781260143430 LK accessmedicine.mhmedical.com/content.aspx?aid=1180883326 RD 2024/10/05 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.