Chemical Hypersensitivity and the Allergic Response

CHEMICAL HYPERSENSITIVITY AND THE ALLERGIC RESPONSE
HTTP://WWW.AEHF.COM/ARTICLES/ARTICLE36.HTML
BY WILLIAM J. REA, M.D.
REPRINTED FROM THE EAR, NOSE, AND THROAT JOURNAL, VOL 67, NO 1, JANUARY 1988.
PUBLISHED BY LITTLE, BROWN AND COMPANY, BOSTON, MA. ALL RIGHTS RESERVED. NO
PART OF THIS REPRINT MAY BE REPRODUCED IN ANY FORM OR BY ANY ELECTRONIC OR
MECHANICAL MEANS, INCLUDING INFORMATION STORAGE AND RETRIEVAL SYSTEMS, WITHOUT THE
PUBLISHER€™S CONSENT.

ABOUT THE AUTHOR . . . . WILLIAM J. REA, MD, FACS, FACA, IS DIRECTOR OF THE
ENVIRONMENTAL HEALTH CENTER€”DALLAS, AND HE IS A PRACTICING CARDIOVASCULAR
SURGEON IN DALLAS, TX.

THE WIDESPREAD CHEMICAL CONTAMINATION OF THE EARTH€™S AIR, FOOD, AND WATER
WITH ITS EFFECTS ON VARIOUS BIOLOGICAL SYSTEMS HAS BEEN DESCRIBED IN NEARLY 5,000
SCIENTIFIC ARTICLES. AT PRESENT, CHEMICAL SENSITIVITY CAN BE DEFINED AS AN
ADVERSE REACTION TO AMBIENT LEVELS OF TOXIC CHEMICALS, WHICH ARE GENERALLY
ACCEPTED AS BEING "SUBTOXIC," IN ENVIRONMENTAL AIR (HOME AND PUBLIC BUILDINGS),
FOOD, AND WATER.1 THE MANIFESTATION OF ADVERSE REACTIONS DEPENDS ON THE TISSUES
OR ORGANS INVOLVED, THE CHEMICAL AND PHARMACOLOGIC NATURE OF THE SUBSTANCES
INVOLVED, THE INDIVIDUAL SUSCEPTIBILITY OF THE EXPOSED PERSON (NUTRITIONAL STATE,
GENETIC MAKE-UP, AND TOXIC LOAD AT THE TIME OF EXPOSURE), THE LENGTH OF TIME,
AMOUNT, AND VARIETY OF OTHER BODY STRESSORS (TOTAL LOAD), AND THE POSSIBLE
SYNERGISM AMONG THESE AT THE TIME OF REACTION.

IT IS OFTEN DIFFICULT, AND AT TIMES IMPOSSIBLE, TO DISTINGUISH BETWEEN
ALLERGIC AND TOXIC RESPONSES, AND CHEMICAL SENSITIVITIES MAY ENCOMPASS BOTH.
CHEMICAL ALLERGIES INVOLVE AN IGE OR IGG RESPONSE, AND ARE A SMALL BUT SIGNIFICANT
PART OF THE OVERALL SPECTRUM OF CHEMICAL SENSITIVITY. AN EXAMPLE IS THE
IGE-MEDIATED TOLUENE DIISOCYANATE ANTIGEN-ANTIBODY REACTION. ANOTHER TYPE HAS BEEN
FOUND IN SURVIVORS OF ACUTE POISONING WHO DEVELOP CHEMICAL SENSITIVITY, BUT IS
USUALLY NOT IGE- OR IGG-MEDIATED. IN TWO LARGE INCIDENCES€”THE GASSING OF TROOPS
DURING WORLD WAR I AND THE CYANIDE ACCIDENT IN BHOPAL, INDIA€”EXPOSED PERSONS
HAVE DEVELOPED CHEMICAL SENSITIVITIES. IN CONTRAST, THE ETIOLOGY OF THOSE WHO
HAVE BECOME CHEMICALLY SENSITIVE FOLLOWING LONG-TERM SUBACUTE TOXIC EXPOSURES
IS OFTEN DIFFICULT TO DISCERN. A SIGNIFICANT NUMBER OF PERSONS ARE INVOLVED,
PERHAPS AS MUCH AS 20% OF THE POPULATION. THE CHEMICALLY SENSITIVE PERSON MAY
DEVELOP REACTIONS QUITE SUDDENLY OR GRADUALLY OVER A PERIOD OF YEARS. THE
CONCENTRATION OF CHEMICALS NEEDED TO TRIGGER A RESPONSE DIMINISHES AND REACTION TO A
MINIMAL AMOUNT OF TOXIC CHEMICAL MAY BE POSSIBLE. THIS PROGRESSION IS
PROBABLY RELATED TO AN OVERLOAD OF THE ENZYME DETOXIFICATION SYSTEMS. CHEMICAL
SENSITIVITY IS USUALLY MANIFESTED IN ONE MAIN ORGAN WITH SECONDARY EFFECTS IN
OTHERS, AND SYMPTOMS ARE USUALLY MULTIPLE. THE END-ORGAN RESPONSES ARE OFTEN IN THE
SMOOTH MUSCLES OF NEURO-CARDIOVASCULAR, GASTROINTESTINAL, UROGENITAL, AND
RESPIRATORY SYSTEMS, AS WELL AS THE SKIN, BUT ANY ORGAN MAY BE INVOLVED.

MUCH OF THE CONTROVERSY ABOUT CHEMICAL SENSITIVITY STEMS FROM THE CLINICIAN€™S
INABILITY TO RECOGNIZE THE OCCURRENCE OF ENVIRONMENTAL OVERLOAD WITH
SUBSEQUENT APPLICATION OF APPROPRIATE CLINICAL DIAGNOSIS AND TREATMENT TO THE
INDIVIDUAL PATIENT.

PATHOPHYSIOLOGY

THE TOTAL BODY LOAD IS THE TOTAL OF ALL INCITANTS TO WHICH THE BODY HAS TO
RESPOND TO MAINTAIN HOMEOSTASIS.1 POLLUTANTS MAY BE BIOLOGICAL (POLLENS, DUSTS,
MOLDS, VIRUSES, BACTERIAS), CHEMICAL (ORGANIC OR INORGANIC), OR PHYSICAL
(HEAT, COLD, ELECTROMAGNETIC RADIATION, LIGHT, RADON, AND POSITIVE AND NEGATIVE
IONS). TO PREVENT DISEASE, THE BODY MUST MANAGE THIS BURDEN THROUGH USE OR
ELIMINATION. IF THE LOAD IS EXCESSIVE, SYMPTOMS MAY OCCUR AS A RESPONSE TO
DISTURBANCE OF THE BODY€™S IMMUNE AND ENZYME DETOXIFICATION SYSTEMS.1

ACUTE TOXILOGIC TOLERANCE (MASKING, ADAPTATION) IS A CHANGE IN THE
HOMEOSTASIS (STEADY RATE) INDUCED BY THE INTERNAL OR EXTERNAL ENVIRONMENT, WITH
ACCOMMODATION OF BODY FUNCTION ADJUSTING TO A NEW SET POINT.2 THIS ADAPTATION OR
MASKING IS AN ACUTE SURVIVAL MECHANISMS IN WHICH THE PERSON APPARENTLY ADJUSTS TO A
CONSTANT ACUTE TOXIC EXPOSURE TO SURVIVE INITIALLY BUT THEN LATER PAYS THE
PRICE WITH A LONG-TERM DECREASE IN EFFICIENT FUNCTIONING AND, PERHAPS,
LONGEVITY. BECAUSE OF THIS PHENOMENON, THE TOTAL BODY LOAD MAY INCREASE WITHOUT THE
PERSON KNOWING. EVEN THOUGH NO CORRELATED SYMPTOMS ARE APPARENT, REPEATED
EXPOSURES CONTINUE TO DAMAGE THE IMMUNE AND ENZYME DETOXIFICATION SYSTEMS, AND THE
EVENTUAL RESULT IS END-ORGAN FAILURE. AVOIDANCE OF THE OFFENDING SUBSTANCE FOR
FOUR DAYS MAY UNMASK ASSOCIATED SYMPTOMS. INITIAL WITHDRAWAL SYMPTOMS MAY EVEN
OCCUR. HOWEVER, SUBSEQUENT RE-EXPOSURE WILL PRODUCE AN IMMEDIATE AND CLEARLY
DEFINABLE REACTION BECAUSE CAUSE AND EFFECT ARE EASILY DISTINGUISHED.

WHEN EXPOSED TO A TOXIC SUBSTANCE, THE BODY INITIALLY DEVELOPS A BIPOLAR
RESPONSE, WITH A STIMULATORY PHASE FOLLOWED BY A DEPRESSIVE PHASE.3 INDUCTION OF
THE DETOXIFICATION SYSTEMS OCCURS. IF THE INCITANT IS VIRULENT, BIOCHEMICALLY
ACTIVE, OR OF SUBSTANTIAL VOLUME OR DURATION, THE DETOXIFICATION SYSTEMS MAY BE
DEPLETED (DEPRESSED) BY OVERSTIMULATION. AT THE SAME TIME, A PERSON MAY
PERCEIVE A STIMULATORY REACTION IN THE BRAIN AND INITIALLY FEEL THAT THE INCITING
SUBSTANCE IS NOT HARMFUL BUT ACTUALLY PLEASURABLE. THEREFORE, THE PERSON MAY
CONTINUE TO SUBJECT HIM OR HERSELF TO MORE EXPOSURES; WITH TIME (MINUTES TO
YEARS), HOWEVER, THE BODY€™S DEFENSES CAN BREAK DOWN AND DEPRESSION-EXHAUSTION
SYMPTOMS DEVELOP. THIS STIMULATION AND THE RESULTANT RESPONSE HAS BEEN OBSERVED
WITH MANY POLLUTANT EXPOSURES, INCLUDING OZONE.

BIOCHEMICAL INDIVIDUALITY ACCOUNTS FOR INDIVIDUAL SUSCEPTIBILITY. EACH PERSON
HAS DIFFERING QUANTITIES OF CARBOHYDRATES, FATS, PROTEINS, ENZYMES, VITAMINS,
MINERALS, AND IMMUNE PARAMETERS WITH WHICH TO RESPOND TO ENVIRONMENTAL
FACTORS. THIS INDIVIDUALITY ALLOWS US TO CLEAR NOXIOUS SUBSTANCES OR TO CONTRIBUTE
TO OUR OWN BODY BURDEN. BIOCHEMICAL INDIVIDUALITY DEPENDS ON AT LEAST THREE
FACTORS: GENETICS, THE STATE OF THE FETUS€™S NUTRITIONAL HEALTH AND TOXIC BODY
BURDEN DURING PREGNANCY, AND THE PERSON€™S TOXIC BODY BURDEN IN LATER LIFE IN
RELATION TO NUTRITIONAL STATE AT THE TIME OF EXPOSURE. FOR EXAMPLE, SOME PERSONS
ARE BORN WITH SIGNIFICANTLY LESS OF A SPECIFIC ENZYME. ALTHOUGH THAT PERSON MAY
BE ABLE TO RESPOND TO AN ENVIRONMENTAL STIMULANT, THIS RESPONSE IS OFTEN
CONSIDERABLY LESS THAN THAT OF THE PERSON WHO WAS BORN WITH 100% OF THE EXPECTED
DETOXIFYING ENZYME AND IMMUNE PARAMETERS.

ENVIRONMENTAL POLLUTION

RECENT STUDIES HAVE SHOWN THAT NEARLY HALF OF THE WORLD€™S POLLUTANTS ARE
GENERATED BY MAN,4 ACCENTUATING THE PROBLEM DESCRIBED BY RANDOLPH5 MORE THAT 30
YEARS AGO. LITERALLY THOUSANDS OF SYNTHETIC CHEMICAL PRODUCTS HERETOFORE
BELIEVED INNOCUOUS HAVE BEEN INCRIMINATED AS AGENTS OF HOMEOSTATIC DYSFUNCTION. WITH
THE FINDINGS THAT SENSITIVITIES OCCUR IN ASSOCIATION WITH PICOMOLAR QUANTITIES
OF CHEMICAL AGENTS HAS COME THE DISCOVERY THAT PROCEDURES SUCH AS SKIN PRICK
OR SCRATCH TESTS OFTEN FAIL TO DEMONSTRATE POSITIVE REACTIONS THAT ARE
CLINICALLY VERIFIABLE BY OTHER MEANS.

RECENT LITERATURE VERIFIES PREVIOUS FINDINGS REGARDING THE HARMFUL EFFECTS OF
CERTAIN CHEMICAL INCITANTS, SUCH AS FORMALDEHYDE, PHENOL, CHLORINE, AND
PETROLEUM ALCOHOL.6 COMMONLY ENCOUNTERED CHEMICALS, SUCH AS GLYCINE,
CHLORPHENOTHANE, TOLUENE, AND TURPENTINE, HAVE BEEN ASSOCIATED WITH THE TRIGGERING OF A
PLETHORA OF VASCULAR ALTERATIONS,7-9 AND SOME FAMILIAR METALS, AMONG THEM NICKEL,
COBALT, CHROMIUM, ALUMINUM, AND MERCURY, HAVE BEEN IMPLICATED.10 OTHER COMMON
ENVIRONMENTAL CHEMICAL INCITANTS INCLUDE XYLENE, BENZOYL PEROXIDE, CARBON
TETRACHLORIDE, SULFATES, AND ISOCYANATES.

WATER POLLUTION

MINERALS, TOXIC ORGANIC AND INORGANIC CHEMICALS, PARTICULATE MATTER, AND
RADIATION PLAY AN IMPORTANT ROLE AS PATHWAYS FOR CHEMICAL CONTAMINANTS ENTERING
THE HUMAN ORGANISM. THE INCIDENCE OF MANY CHRONIC DISEASES (CORONARY DISEASE,
HYPERTENSION, AND STROKE) IS ASSOCIATED WITH VARIOUS WATER CHARACTERISTICS,
INCLUDING PURITY, HARDNESS, AND SOFTNESS.11-13 PROTECTIVE AGENTS FOUND IN HARD
WATER ARE CALCIUM, MAGNESIUM, VANADIUM, LITHIUM, CHROMIUM, AND MANGANESE.

CERTAINLY, ONCE CARDIOVASCULAR PATHOLOGY IS INDUCED, WATERS WITH HIGH SODIUM
CONTENT MAY BE COUNTERPRODUCTIVE. SUSPECTED HARMFUL AGENTS INCLUDE CADMIUM,
LEAD, COPPER, AND ZINC, WHICH TEND TO BE FOUND IN HIGHER CONCENTRATIONS IN SOFT
WATER. NITRATES (FROM FERTILIZER) IN WATER POSE IMMEDIATE THREATS TO CHILDREN
UNDER THREE MONTHS OF AGE BECAUSE OF THE PRODUCTION OF METHEMOGLOBULIN. SULFUR
WILL BE A PROBLEM TO SOME PEOPLE.

CITY WATER TODAY CONTAINS FROM 100 TO 10,000 TIMES AS MANY SYNTHETIC
COMPOUNDS AS NATURAL SPRING WATER. EXAMPLES OF GROSS WATER CONTAMINATION INCLUDE TIMES
BEACH, MISSOURI, WITH DIOXIN-CONTAMINATED OIL USED 20 YEARS AGO, THE LOVE
CANAL AREA OF NIAGARA FALLS, NY, WATERBURY, CT, AND MIDDLEBORO, KY. IN THE US,
SOME 80,000 PITS AND LAGOONS THAT HOLD TOXIC WASTES RANGING FROM CARBON
TETRACHLORIDE TO DISCARDED MUSTARD-GAS BOMBS HAVE BEEN REPORTED.

IN THE EARLY 1980S, CALIFORNIA, NEW YORK, NEW JERSEY, ARIZONA, NOVA SCOTIA,
AND PENNSYLVANIA CONDEMNED DOZENS OF PUBLIC WATER SUPPLY WELLS BECAUSE OF A
TRICHLOROETHYLENE POLLUTION. LEAKING FUEL TANKS CONTAMINATED KANSAS PUBLIC WATER
SUPPLIES IN 1981. OFFICIALS IN NEW MEXICO IDENTIFIED 25 CITIES WHERE
HYDROCARBONS AND SOLVENTS CONTAMINATED THE GROUNDWATER. ANALYSIS OF NEW ORLEANS
DRINKING WATER REVEALED THE PRESENCE OF 13 HALOGENATED HYDROCARBONS.14

FIFTY-FIVE PERCENT OF THE WATER TREATED IN MUNICIPAL PLANTS IS FROM HOMES,
AND THE REMAINDER FROM INDUSTRY (AN IMPORTANT SOURCE OF CONTAMINATION). OVER
HALF OF THE TOTAL VOLUME OF INDUSTRIAL WASTES COMES FROM PAPER, ORGANIC CHEMICAL
MANUFACTURING PLANTS, PETROLEUM COMPANIES, AND STEEL MANUFACTURING PLANTS. THE
MAJOR POLLUTANTS ARE CHEMICAL BYPRODUCTS, OIL, GREASE, AND RADIOACTIVE WASTE.
AGRICULTURAL WASTES INCLUDE LIVESTOCK AND TOXIC CHEMICALS (PESTICIDES,
HERBICIDES, FERTILIZERS) THAT RUN OFF FROM THE FARM LANDS INTO RIVERS, LAKES, AND
GROUNDWATER.15

INORGANIC COMPOUNDS CONTRIBUTING TO POLLUTION INCLUDE ARSENIC, CADMIUM,
CHROMIUM, COPPER, MANGANESE, MERCURY, SILVER, AND SELENIUM. ASBESTOS MAY BE A
SIGNIFICANT FACTOR BECAUSE OVER 200,000 MILES OF ASBESTOS CEMENT PIPES ARE IN USE
IN THE US.16

IN 1965, A SERIOUS PROBLEM RELATED TO DRINKING WATER EXISTED IN APPROXIMATELY
40% OF PATIENTS HOSPITALIZED FOR A DIAGNOSTIC THERAPEUTIC PROGRAM OF
COMPREHENSIVE ENVIRONMENTAL CONTROL; TODAY, THIS FIGURE IS 80%. PATIENTS SUSCEPTIBLE
TO WATER CONTAMINANTS EXHIBIT MULTIPLE SENSITIVITIES. MANY PATIENTS SEEN IN THE
ECU WITH THEIR UNIQUE METABOLIC INDIVIDUALITY ARE EVEN FOUND TO BE INTOLERANT
OF SPECIFIC SPRING WATERS. SOME HAVE DIFFICULTY WITH WATERS CONTAINING HIGH
LEVELS OF SODIUM, CALCIUM, OR BICARBONATES. IF THE REACTIONS TO SPECIFIC WATER
CONTAMINANTS ARE UNDISCOVERED, EVALUATION OF OTHER INCITANTS, INCLUDING FOOD
AND CHEMICAL TESTING, MAY BE INACCURATE. IT IS, THEREFORE, NECESSARY TO FIND
SAFE WATER BEFORE PROCEEDING WITH OTHER TESTING IN SEVERELY SENSITIVE PERSONS.

FOOD CONTAMINANTS

THE STUDY OF FOOD SENSITIVITY IS COMPLICATED BY THE USE OF FOOD ADDITIVES,17
PRESERVATIVES, AND DYES IN THE MANUFACTURING AND PROCESSING OF COMMERCIALLY
AVAILABLE FOOD PRODUCTS. THIS IS FORCING US TO DEFINE MORE CLEARLY THE NATURE OF
THE INCITANTS IN FOODS AND WATER. BELL18 HAS REPORTED URTICARIA,
HYPERACTIVITY, AND IMMUNOLOGIC CHANGES AFTER FOOD-CONTAMINANT EXPOSURE IN SENSITIVE
PERSONS. URTICARIA HAS BEEN DESCRIBED WITH SEVERAL ADDITIVES SUCH AS P
-HYDROXYBENZOIC ACID PROPYLESTER, BENZOIC ACID, SODIUM BENZOATE, AND INDIGO CARMONE.19 A
CASUAL ROLE IN THE PROVOCATION OF VASCULAR ALTERATIONS IS PLAYED BY TARTRAZINE
AZO DYES AND SALICYLATES.20 SODIUM NITRITE AND SODIUM GLUTAMATE HAVE BEEN FOUND
TO TRIGGER MIGRAINE IN SUSCEPTIBLE PATIENTS. SULFUR DIOXIDE AND SODIUM
SALICYLATE CAN PROVOKE ASTHMATIC REACTIONS, AND ASPIRIN ADDITIVES AND ASPIRIN-LIKE
FOOD CONTAMINANT DYES MAY TRIGGER URTICARIA, ANGIOEDEMA, BRONCHOCONSTRICTION,
AND PURPURA. SEVERE GASTROINTESTINAL DISORDERS HAVE BEEN ASSOCIATED WITH
SENSITIVITIES TO ANILINE, COMMONLY FOUND IN RAPESEED OIL.

HOME CONTAMINATION

INDOOR AIR POLLUTION HAS SPAWNED A MULTITUDE OF SENSITIVITIES TO
CHEMICALS.21-24 NUMEROUS HYGIENIC PRODUCTS MAY BE NOXIOUS TO THE CHEMICALLY SUSCEPTIBLE
PERSON, INCLUDING A WIDE VARIETY OF COSMETICS (PARTICULARLY THOSE CONTAINING
GLYCERIN OR PROPYLENE GLYCOL), PERFUMES AND HAIR PRODUCTS, SUCH AS DYES, CREAMS,
SPRAYS, SOAPS, SHAMPOOS, AND CONTACT SOLUTIONS. CHEMICALS IN TEXTILES,
INCLUDING SYNTHETIC ACRYLIC FIBERS, POLYESTER SPIN FINISHES, THE EPOXY RESINS, AND
SYNTHETIC CLOTHING, MAY ACT AS ENVIRONMENTAL ANTIGENS AND ARE WIDESPREAD. MANY
HOUSEHOLD CLEANING PRODUCTS, PARTICULARLY THOSE CONTAINING FORMALDEHYDE,
PHENOLS, AND CHLORINE HAVE BEEN SHOWN TO BE HAZARDOUS FOR MANY. CHEMICALS CONTAINED
IN WOOD PRESERVATIVES (PENTACHLOROPHENOLS) ARE ENVIRONMENTAL INCITANTS CAPABLE
OF TRIGGERING A VARIETY OF SYMPTOMS. OTHERS REPORT PROBLEMS WITH
FORMALDEHYDE-CONTAINING PRESSED BOARD, CARPETS PLYWOOD, AND PETROCHEMICAL CONTAMINANTS.
PESTICIDES AND FOSSIL FUELS (OIL, GAS, AND COAL) ARE THE NUMBER ONE OFFENDERS IN
HOMES.

OCCUPATIONAL CONTAMINATION

BECAUSE MANY WORKERS€™ SYMPTOMS IMPROVED DURING EVENING HOURS AND WEEKENDS,
HERETOFORE "SAFE" OCCUPATIONS MUST BE RE-EVALUATED FOR POTENTIAL HAZARDS.25-27
AUTOMOBILE FACTORY WORKERS EXPOSED TO POLYURETHANE FOAM HAVE BEEN SHOWN TO BE
AT SIGNIFICANT RISK, PARTICULARLY BECAUSE THIS INDUSTRY USES A SIZABLE NUMBER
OF CHEMICALS, SUCH AS CHROME, RUBBER, NICKEL, AND ISOCYANATES IN SPRAY PAINTS,
CAPABLE OF TRIGGERING SENSITIVITIES. OCCUPATION-RELATED RESPIRATORY DISEASES
ARE COMMON AMONG GRAIN ELEVATOR WORKERS AND FARM WORKERS, WHO CAN DEMONSTRATE
SYMPTOMS RANGING FROM RHINITIS TO ASTHMA. ABNORMAL RESPONSES MAY ALSO BE SEEN
IN PERSONS WHO WORK WITH PESTICIDES, HERBICIDES, AND FARM EQUIPMENT, AS WELL AS
IN PERSONS EMPLOYED IN CARPENTRY (CONTACT SENSITIVITIES TO WOODS), PAINTING
(SEVERE RESPIRATORY SYMPTOMS), BRICKLAYING (CHEMICALS SUCH AS COBALT), HAIR
CARE (VARIETY OF HYDROCARBONS), BAKING, PHOTOGRAPHY, AND FILM PROCESSING.

THE LIST OF OCCUPATIONS IN WHICH EXPOSURES TO POTENTIALLY HAZARDOUS CHEMICALS
MAY OCCUR SEEMS ENDLESS. WHAT IS REMARKABLE, HOWEVER, IS THE EXTENT TO WHICH
SEEMINGLY SAFE OCCUPATIONS ARE FRAUGHT WITH RISKS; FOR EXAMPLE, A CHEMICALLY
TRIGGERED REACTION MAY OCCUR IN A CONCERT VIOLINIST BECAUSE OF CONTACT WITH
ROSIN.28 OVER THE PAST THREE YEARS, SOME 60 REPORTS HAVE ASSOCIATED DERMATITIS
WITH CHEMICAL SENSITIVITY IN THE WORK ENVIRONMENT, INCLUDING THE LATEX SURGICAL
GLOVES AND HAND SCRUB SOLUTIONS USED BY SURGEONS. AGAINST THE BACKDROP OF
PRESENT RESEARCH, IT SEEMS CLEAR THAT A VIRTUALLY INFINITE NUMBER OF OCCUPATIONS
CONTAIN DANGERS FOR THE SUSCEPTIBLE PERSON. DATA CLEARLY REVEALS THE NECESSITY
OF ENVIRONMENTAL CONTROL FOR THE EVALUATION AND TREATMENT OF SUCH OCCUPATIONAL
SENSITIVITIES.

MECHANISMS OF SENSITIVITY

OUR UNDERSTANDING OF THE MECHANISMS INVOLVED IN CHEMICAL SENSITIVITY IS
BECOMING CLEARER. POLLUTANT INJURY OF THE LUNGS OR LIVER LEADS TO FREE RADICAL
GENERATION AND SUBSEQUENT DISTURBANCES AT THE CELLULAR, SUBCELLULAR, AND MOLECULAR
LEVELS. THIS REACTION CAN BE EITHER IMMUNOLOGIC OR NONIMMUNOLOGIC THROUGH THE
ENZYME DETOXIFICATION SYSTEMS. THEN, VASCULAR-AUTONOMIC NERVOUS SYSTEM
DYSFUNCTION OCCURS WITH A MYRIAD OF END-ORGAN RESPONSES.29-30  

IMMUNOLOGIC

TYPE I HYPERSENSITIVITY IS USUALLY MEDIATED THROUGH THE IGE MECHANISM ON THE
VESSEL WALL. CLASSIC EXAMPLES ARE ANGIOEDEMA, URTICARIA, AND ANAPHYLAXIS
CAUSED BY SENSITIVITY TO POLLEN, DUST, MOLD, FOOD, OR CHEMICALS, SUCH AS TOLUENE
DIISOCYANATE.31 OF THE PATIENTS SEEN AT THE EHC-DALLAS, 10% SEEM TO FALL WITHIN
THIS CATEGORY.

TYPE II CYTOTOXIC DAMAGE MAY OCCUR WITH DIRECT INJURY TO THE CELL. A CLINICAL
EXAMPLE IS THE PATIENT EXPOSED TO MERCURY.32 TWENTY PERCENT OF THE PATIENTS
SEEN AT THE DALLAS ECU FALL INTO THIS CATEGORY.

TYPE III IMMUNE COMPLEXES OF COMPLEMENT AND GAMMA GLOBULIN MAY DAMAGE THE
VESSEL WALL. A CLINICAL EXAMPLE IS LUPUS VASCULITIS.33-34 NUMEROUS CHEMICALS,
INCLUDING PROCAINAMIDE AND CHLOROTHIAZIDE, ARE KNOWN TO TRIGGER THE AUTOANTIBODY
REACTION OF LUPUS, AND OTHER CHEMICALS HAVE BEEN SHOWN TO TRIGGER THE
AUTOIMMUNE RESPONSE.

TYPE IV CELL-MEDIATED IMMUNITY OCCURS WITH TRIGGERING OF T-LYMPHOCYTE.
NUMEROUS CHEMICALS, SUCH AS PHENOL, PESTICIDES, AND ORGANOHALIDE,35 AS WELL AS SOME
METALS, WILL ALSO ALTER IMMUNE RESPONSES, THUS TRIGGERING LYMPHOKINES GIVING
THE TYPE IV REACTIONS. CLINICAL EXAMPLES36-38 ARE POLYARTERITIS NODOSA,
HYPERSENSITIVITY ANGIITIS, HENOCH-SCHONLEIN PURPURA, AND POSSIBLY WEGENER€™S
GRANULOMATOSIS. A RECENT STUDY DONE AT THE DALLAS ECU ON 104 PROVEN CHEMICALLY
SENSITIVE (70 VASCULAR, 27 ASTHMATIC, AND 7 RHEUMATOID) PERSONS COMPARING THEM WITH 60
NORMAL CONTROLS SHOWED THAT THOSE MANIFESTING A CHEMICAL SENSITIVITY THROUGH
THEIR VASCULAR TREE HAD A STANDARD DEVIATION SUPPRESSION OF GREATER THAN FOUR
OF THE SUPPRESSOR T-CELL POPULATION.27 CLEARLY, THE LARGER PORTION OF OUR
PATIENTS FALL INTO THE TYPE III AND TYPE IV CATEGORIES.

NONIMMUNE ENZYME DETOXIFICATION

NONIMMUNE TRIGGERING OF THE VESSEL WALL MAY OCCUR. COMPLEMENT MAY BE
TRIGGERED DIRECTLY THROUGH THE ALTERNATE PATHWAY BY MOLDS, FOODS, OR TOXIC CHEMICALS.
MEDIATORS SUCH AS KININS AND PROSTAGLANDINS MAY ALSO BE DIRECTLY TRIGGERED.
THESE REACTIONS THEN CAUSE VASCULAR SPASM WITH RESULTANT HYPOXIC RELEASE OF
LYSOZYME, WHICH FURTHER ACCELERATES THE CYCLE WITH MORE SPASM AND HYPOXIA.
EVENTUALLY, END-ORGAN FAILURE WILL OCCUR.

TRIGGERING OF THE ENZYME DETOXIFICATION SYSTEMS ALSO MAY OCCUR IN ANY ORGAN
BUT MORE FREQUENTLY IN THE LIVER AND RESPIRATORY MUCOSA. FOREIGN COMPOUND
BIOTRANSFORMATIONS VARY GREATLY DEPENDING ON GENETIC AND ENVIRONMENTAL FACTORS SUCH
AS AGE, SEX, NUTRITION, HEALTH STATUS, AND THE SIZE OF THE DOSE. FOR EXAMPLE,
PHENOL MAY BE EXCRETED BY THE FOLLOWING PATHWAYS: PHENYGLUCURONIDE (50%),
POTASSIUM PHENYLSULFATE (40%), GUINOL (10%), AND CATECHOL (1%). THE METABOLISM OF
FOREIGN COMPOUNDS USUALLY OCCURS IN THE MICROSOMAL FRACTION (SMOOTH-MUSCLE
RETICULUM) OF LIVER CELLS. A FEW BIOTRANSFORMATIONS ARE NONMICROSOMAL (REDOX
REACTIONS INVOLVING ALCOHOLS, ALDEHYDES, AND KETONES). THE FOUR BASIC
BIOTRANSFORMATION CATEGORIES ARE OXIDATION, REDUCTION, DEGRADATION, AND CONJUGATION.
BECAUSE THE FIRST THREE ARE THE SAME FOR NUTRIENTS, FOOD PROBLEMS ARE IMPORTANT IN
CLEARING AND TREATING CHEMICAL SENSITIVITY. THE FOURTH CATEGORY APPEARS
UNIQUE FOR THE CATABOLISM OF FOREIGN COMPOUNDS USING AMINO ACIDS AND THEIR
DERIVATIVES WITH PEPTIDE BONDS AND CARBOHYDRATES AND THEIR DERIVATIVES WITH GLYCIDE
FOR BONDS. SIMPLER COMPOUNDS LIKE SULFATE AND ACETATE ARE OCCASIONALLY INVOLVED
IN CONJUGATION LINKAGE OF ESTER BONDS. ACTIVATED CONJUGATED COMPOUNDS AND
SPECIFIC ENZYMES ARE OFTEN COUPLED WITH COENZYMES FROM WHICH THEY CAN BE
TRANSFERRED TO THE FOREIGN COMPOUND.30

DIAGNOSIS

THE DIAGNOSIS OF CHEMICAL SENSITIVITY CAN NOW BE MADE WITH A COMBINATION OF
HISTORY; PHYSICAL EXAMINATION; IMMUNE TESTS, INCLUDING IGE, IGG, COMPLEMENTS,
AND T AND B LYMPHOCYTES WITH SUBSETS; BLOOD LEVELS OF PESTICIDES, ORGANIC
COMPOUNDS, AND HEAVY METALS (INTRACELLULAR); AND, OCCASIONALLY, BRAIN FUNCTION
TESTS. CHALLENGE TESTS ARE THE CORNERSTONE OF CONFIRMATORY DIAGNOSIS. THESE MAY BE
ACCOMPLISHED THROUGH ORAL, INHALED, OR INTRADERMAL CHALLENGES. CARE SHOULD BE
TAKEN TO RULE OUT INHALANT PROBLEMS WITH POLLEN, DUST, AND MOLDS. FOOD
SENSITIVITY MUST BE CONSIDERED, BECAUSE IT OCCURS IN APPROXIMATELY 80% OF PERSONS
WITH CHEMICAL SENSITIVITY. WATER-CONTAMINANT SENSITIVITIES MUST ALSO BE
DETERMINED BECAUSE 90% OF PERSONS WITH CHEMICAL SENSITIVITY HAVE WATER-CONTAMINANT
SENSITIVITY. THIS CAN BE CHECKED BY PLACING THE PATIENT ON CHEMICALLY LESS
CONTAMINATED WATER (CHARCOAL-FILTERED, DISTILLED, OR GLASS-BOTTLED SPRING WATER) FOR
FOUR DAYS, WITH RECHALLENGE WITH THE PATIENT€™S USUAL DRINKING WATER.

PATIENTS OFTEN KNOW THE LOCATION AND TIME OF THE ONSET OF SYMPTOMS. THEY MAY
REPORT SENSITIVITY TO THE ODOR OF GASOLINE, PERFUMES, NEW PAINTS, CAR
EXHAUSTS, GAS STOVES, FABRICS, CLOTHING OR CARPETING STORES, CHLORINE AND CLOROX, OR
CIGARETTE SMOKE. OTHER SYMPTOMS CAN RANGE FROM FATIGUE TO CLASSIC END-ORGAN
FAILURES. PHYSICAL FINDINGS FREQUENTLY ARE VASCULAR IN NATURE AND INCLUDE EDEMA,
PETECHIAE, SPONTANEOUS BRUISING, PURPURA, AND PERIPHERAL COLDNESS AND ARTERIAL
SPASM. FREQUENTLY, FLUSHING, ACNE (ADULT), AND A YELLOWNESS OF THE SKIN
WITHOUT JAUNDICE OCCUR. CHRONIC RECURRING SIGNS OF ANY ORGAN SYSTEM WITH CHRONIC
NONSPECIFIC INFLAMMATION, SUCH AS VASOMOTOR RHINITIS, COLITIS, CYSTITIS, AND
VASCULITIS, MAY OCCUR. LABORATORY FINDINGS ARE OFTEN NOT SPECIFIC: SEDIMENTATION
RATES MAY INCREASE OR LIVER ENZYMES MAY BE MILDLY ELEVATED, POSITIVE
C-REACTIVE PROTEINS AND ABNORMAL COMPLEMENT LEVELS CAN BE FOUND, T-CELL LEVELS MAY ALSO
BE DEPRESSED AND BLASTOGENESIS IMPAIRED. FINALLY, A NUMBER OF PATIENTS WILL
BE FOUND TO HAVE ABNORMAL DELAYED HYPERSENSITIVITIES AS ELICITED BY DELAYED
SKIN TESTS. AS MENTIONED BEFORE, PATIENTS WITH T-CELL ABNORMALITIES MAY HAVE A
SUPPRESSOR-CELL POPULATION THAT IS MORE THAN FOUR STANDARD DEVIATIONS LOWER THAN
NORMAL CONTROLS. BLOOD LEVELS OF PESTICIDES ARE NOW AVAILABLE. TABLE 1 LISTS
OUR FINDINGS IN MORE THAN 200 CHEMICALLY SENSITIVE PATIENTS. TABLE 2 LISTS THE
VOLATILE ORGANIC CHEMICALS FOUND IN 114 PATIENTS STUDIED FROM 1983 TO 1986.

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TABLE 1 BLOOD LEVELS OF PESTICIDES FOUND IN 200 CHEMICALLY SENSITIVE
PATIENT
1TIME FROM EXPOSURE TO TESTING, IN DAYS.

TABLE 2 VOLATILE ORGANIC CHEMICALS FOUND IN 114 PATIENTS
1TIME FROM EXPOSURE TO TESTING, IN DAYS.

UNFORTUNATELY, ORGANOPHOSPHATE LEVELS ARE ONLY POSITIVE WITHIN 24 HOURS AFTER
EXPOSURE. BLOOD LEVELS FOR PENTACHLOROPHENOL AND ORGANIC SOLVENTS LIKE HEXANE
AND PENTANE ARE NOW AVAILABLE, AS ARE HERBICIDE LEVELS. GENERAL VOLATILE
ORGANIC HYDROCARBONS, SUCH AS BENZENE, TOLUENE, AND XYLENE, ARE FOUND IN A LARGE
PORTION OF CHEMICALLY SENSITIVE PATIENTS. THEIR PRESENCE INDICATES EITHER
RECENT EXPOSURE OR A BREAKDOWN IN THE ENZYME DETOXIFICATION SYSTEM. METALS,
INCLUDING LEAD AND MERCURY, HAVE BEEN FOUND IN 10% OF THE PATIENTS STUDIED. CHALLENGE
TESTS CAN BE DONE BY THE SUBLINGUAL ROUTE. THE EFFICACY OF THIS AND
INTRADERMAL CHALLENGED OF FOODS HAVE BEEN WELL ESTABLISHED BY NUMEROUS DOUBLE-BLIND
STUDIES. THESE NEED TO BE DONE BECAUSE 80% OF THE CHEMICALLY SENSITIVE PATIENTS
ARE ALSO FOOD SENSITIVE. BLIND INTRADERMAL CHALLENGE FOR CHEMICALS CAN BE DONE
WITH TERPENES, PETROLEUM-DERIVED ETHANOL, GLYCERINE, FORMALDEHYDE, PHENOL,
PERFUME, AND NEWSPRINT. PRODUCTION OF SYMPTOMS ESTABLISHES THE CHEMICAL
SENSITIVITY. MORE THAN 200,000 INTRADERMAL CHALLENGES OF CHEMICALS DONE AT THE
EHC-DALLAS WERE CONSIDERED POSITIVE WHEN THEY MET THE CRITERIA OF REPRODUCTION OF
SIGNS AND SYMPTOMS, WHEAL GROWTH, AND NEGATIVE PLACEBO RESPONSE.

INHALATION CHALLENGE IS ANOTHER MODALITY FOR THE DIAGNOSIS OF CHEMICAL
SENSITIVITY. THIS CAN BE DONE UNDER ENVIRONMENTALLY CONTROLLED CONDITIONS OF MANY
DEGREES. FOR BEST RESULTS, A STAINLESS STEEL GLASS BOOTH IS USED FOR AMBIENT
DOSE CHALLENGE OF ANY TOXIC CHEMICAL. MORE THAT 16,000 AMBIENT DOSE DOUBLE-BLIND
INHALED CHALLENGES OF TOXIC VOLATILE ORGANIC CHEMICALS HAVE BEEN DONE IN OUR
CENTER WITH ACCURATE AND REPRODUCIBLE RESULTS. SIMILAR STUDIES CAN BE DONE IN
THE OFFICE; HOWEVER, UNDER THESE CIRCUMSTANCES CONTROLS ARE MORE DIFFICULT AND
MANY MORE PLACEBO REACTIONS MAY OCCUR BECAUSE ENVIRONMENTALLY CONTROLLED
CONDITIONS ARE MUCH MORE DIFFICULT TO OBTAIN AND PATIENTS ARE OFTEN STUDIED IN THE
MASKED STATE.

VITAMIN AND INTRACELLULAR MINERAL LEVELS ARE NEEDED TO EVALUATE COMPLETELY
THE CHEMICALLY SENSITIVE PERSON. IN OUR CENTER, ANALYSIS OF MORE THAN 300
CHEMICALLY SENSITIVE PATIENTS FROM 1984 TO 1985 HAS SHOWN A NUMBER OF VITAMIN
DEFICIENCIES: B6 (64%), B2 (30%), B1 (29%), FOLIC ACID (27%), VITAMIN C (25%),
VITAMIN D (24%), VITAMIN B3 (19%), AND VITAMIN B12 (3%). FURTHERMORE, OF 190
CHEMICALLY SENSITIVE PATIENTS WITH MINERAL DEFICIENCIES, 88% HAD CHROMIUM
DEFICIENCIES, 35% SULFUR DEFICIENCY, 12% SELENIUM, AND 8% ZINC DEFICIENCY.

TREATMENT

THE CORNERSTONE OF TREATMENT FOR CHEMICAL SENSITIVITY IS AVOIDANCE. THIS WILL
DECREASE TOTAL BODY BURDEN, ALLOWING RECOVERY OF THE DETOXIFICATION SYSTEMS.
CHEMICALLY LESS CONTAMINATED WATER MAY BE USED INCLUDING SPRING, DISTILLED,
AND CHARCOAL-FILTERED WATER, BUT ONLY IN GLASS AND STEEL CONTAINERS. CHEMICALLY
LESS CONTAMINATED FOOD ON A ROTARY DIET SHOULD ALSO BE USED TO REDUCE LOAD AND
KEEP THE PATIENT IN THE NONADAPTIVE STATE. AS MANY SYNTHETIC SUBSTANCES AS
POSSIBLE SHOULD BE REMOVED FROM THE HOME, INCLUDING PETROLEUM-DERIVED HEAT,
ROUTINE INSECTICIDES, SYNTHETIC CARPETS AND MATTRESSES, AND
FORMALDEHYDE-CONTAINING SUBSTANCES, SUCH AS PRESSED BOARD AND PLYWOOD. A CHANGE IN WORK AREAS IS
OFTEN NEEDED. THIS CAN BE DETERMINED BY THE GENERAL VOLATILE ORGANIC HYDROCARBON
BLOOD TESTS. SOMETIMES JOB CHANGES ARE NECESSARY, AND OCCASIONALLY THE MOST
SEVERELY SENSITIVE PATIENTS HAVE TO LEAVE CERTAIN POLLUTED GEOGRAPHIC AREAS.

INJECTION THERAPY FOR INHALANTS, FOODS, AND SOME CHEMICALS SUCH AS TERPENES,
PERFUMES, AND PETROLEUM-DERIVED ETHANOL MAY ALSO HELP ALLEVIATE A
CHEMICALLY-INDUCED HYPERSENSITIVITY. THESE CAN BE DONE DAILY, BUT USUALLY ARE GIVEN EVERY
FOUR TO SEVEN DAYS. A ROTARY DIET IS ALSO ESSENTIAL IN TREATING ANY FOOD
SENSITIVITIES. VITAMIN AND MINERAL SUPPLEMENTATION IS OFTEN NECESSARY TO REPLACE
ANY DEFICIENCIES OCCURRING FROM DIRECT TOXIC DAMAGE, AN INCREASED METABOLISM
REQUIRED FOR DETOXIFICATION, OR COMPETITION WITH DIRECT ABSORPTION.

SUMMARY

CHEMICAL SENSITIVITY€”THE ADVERSE REACTION TO AMBIENT LEVELS OF TOXIC
CHEMICALS GENERALLY ACCEPTED AS BEING SUBTOXIC IN THE AIR, FOOD, AND WATER€”IS NOW
BECOMING A WELL-RECOGNIZED PHENOMENON. WIDESPREAD TOXIC CHEMICAL POLLUTION OF
OUR AIR, FOOD, AND WATER TRIGGER IMMUNE AND ENZYME DETOXIFICATION MECHANISMS.
THIS MAY RESULT IN ADVERSE EFFECTS ON THE NEUROVASCULAR, ENDOCRINE,
GASTROINTESTINAL, RESPIRATORY (INCLUDING EAR, NOSE, AND THROAT), GENITOURINARY,
MSUCULOSKELETAL, AND DERMAL SYSTEMS. LABORATORY PARAMETERS, INCLUDING TOTAL EOSINOPHIL
COUNT, IGE, T&B LYMPHOCYTES, TOTAL SERUM COMPLEMENTS, PESTICIDE AND SOLVENT,
AND GENERAL TOXIC VOLATILE ORGANIC CHEMICAL BLOOD LEVELS, ARE AVAILABLE TO AID
IN DIAGNOSIS AND TREATMENT. THE MOST DEFINITIVE MEANS OF DIAGNOSIS ARE
CHALLENGE TESTS BY INHALATION, ORAL, AND INTRADERMAL EXPOSURES.

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