RT Book, Section
A1 Harrison, Robert J.
A2 LaDou, Joseph
A2 Harrison, Robert J.
SR Print(0)
ID 1104108954
T1 Multiple Chemical Sensitivity
T2 CURRENT Diagnosis & Treatment:  Occupational & Environmental Medicine, 5e
YR 2013
FD 2013
PB McGraw-Hill Education
PP New York, NY
SN 9780071808156
LK accessmedicine.mhmedical.com/content.aspx?aid=1104108954
RD 2024/04/19
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.