Report on Environmental Hypersensitivity
in response to the
Report of the Advisory Committee
to the Minister of Health,
Province of Nova Scotia, January 5, 1998

Submitted by : 
Dr. Patricia Beresford, BA, MD

 I am writing as a member of the Langley Committee set up to review Environmental Hypersensitivity/Multiple Chemical Sensitivity.  I am not willing to sign the Report as written, and I wish to present my reasons for declining support of this submission:

 On the positive side, I am very pleased that the Committee is reviewing the vast and mounting literature on Multiple Chemical Sensitivity, has recognized the existence of MCS as an entity, and also acknowledges to some extent, the devastation it creates in the lives of those who suffer from this affliction.

 My concerns are many:  I disagree with fundamental issues.  I believe that the definition and the nature of the illness presented are non-representative.  I believe that the conclusions about the Camp Hill experience are not appropriate.  I believe that the Report fails to adequately represent the scope and risks of EI/MCS in Nova Scotia, in Canada, and internationally.  The paper ignores any progress that has been made in Nova Scotia in the last ten years and, for the most part, has based its Clinical data on a survey carried out over ten years ago.  The Report also fails to address any of the issues related to the effects of this illness on children.  The conclusions shown on “treatment recommendations” fail to address the existing urgency to treat thousands of sick people, in Nova Scotia, the rest of Maritime Provinces, and beyond.  As well, the Report ignores data in the literature regarding recognized deficiency states and fails to support the appropriateness of nutritional therapies in treating this and other illnesses.

 In order to address these concerns, I will first step back to give an overview of the problem of EIS and MCS as I see it.  The Report fails to outline the statistics pertinent to Nova Scotia in 1997.  It refers only to fifty persons participating in a survey in 1986, and to the approximately 684 Camp Hill patients who were affected.

 Only a very small number of the Camp Hill patients have been seen in the N.S. Environmental Clinic over the ten years since the previous report was written.  The N.S. Environmental Clinic, over the last 7 years, has seen 884 patients and has 1140 patients on the waiting list.  These patients have been referred by twenty-five percent of all practising physicians in Nova Scotia.  It is now predicted that more than half of these patients will never be seen in the Clinic, and many of the rest will wait for years to be seen.  Only the most urgent patients are seen within months, for anaphylaxis, severe malnutrition, serious neurological symptoms, suicidal risks, and children seriously symptomatic.  Of the numbers already seen, approximately forty have been under the age of twenty.  These statistics exclude the numerous and repeated attempts at referrals from out-of-province (the Maritime Provinces more than others), for which no statistics have been kept because the Clinic has no mandate to serve patients out of province.  It must be remembered that virtually all of the patients referred have seen numerous physicians in various specialties, and that multiple traditional therapies have failed to help them.  What other illness has to wait 4-5 years, or never, to be treated!

These statistics also do not include the number of patients seen privately by physicians working with EI/MCS patients:  Dr. Bruce Elliott, Dr. J.P. Beresford, Dr. Hilda Fox, Dr. John Heisler, Dr. Wm. LaValley, and others.

 Beyond Nova Scotia, to further explore the extent of this illness, I quote Dr. Mark Cullen, in our interview with him; “I don’t think you can practice medicine without it (MCS)...  There are a lot of them”.  He quotes a study conducted in Iowa using a narrow definition of MCS.  The incidence of MCS was 8.6% in the regular army who did not serve in the Gulf War, and 2.5% - 3% in the National Guard who did not serve.  A paper prepared by Meggs, Dunn, Bloch, Goodman, and Davidoff, which did a survey on allergies and MCS found that 4.1% of the general population surveyed suffered almost daily occurrences of symptoms from chemical sensitivity.  If extrapolated to the U.S. population, this would include 10.9 million individuals.  Thus they concluded that initiatives to fund research on chemical sensitivity were greatly needed.  With respect to other medical conditions such as TB or AIDs, for example, percentages as high as these very low and narrow estimates for EIS/MCS would constitute an epidemic and command our greatest attention toward correct diagnosis, treatment and prevention.

 In the United States recognition of the illness is reflected in the amount of attention given this phenomenon.  During the last eight years, there have been two reports sponsored by state agencies.  Ashford and Miller, 1989, and Bascom, 1989; two books written for health professionals and researchers:  Cullen, 1987, and Ashford and Miller, 1991; and the federal government has sponsored three meetings on chemical sensitivity with publications:  Association of Occupational and Environmental Clinics, 1992; National Research Council, 1992; Agency for Toxic Substances and Disease Registry, 1994.  In October 1996, a conference entitled Protecting Children from Environmental Hazards was sponsored by the College of Health and Human Development, School of Nursing, Pennsylvania State University in conjunction with the Pennsylvania Public Health Association and the Pennsylvania Office of Rural Health.  The planners recognized the increased risk to children of environmental health issues:  air pollution, indoor air quality, pesticides, lead, tobacco smoke, etc.  The focus was on developing preventive measures.

 In the US, EI/MCS has been recognized by numerous Federal Authorities including:  US Agency for Toxic Substances and Disease Registry; US Army Medical Evaluation Board; US Congress; US Consumer Product Safety Commission; US Environmental Protection Agency; American Lung Association; American Medical Association (e.g. see its published booklet - Indoor Air Pollution an Introduction for Health Professionals); US Dept. of Education; and the National Institute of Environmental Health Agency, the National Library of Medicine, and the Social Security Administration, all under the US Dept. of Health and Human Services; US Dept. of Housing and Urban Development; US Dept. of Justice; US Dept. of Veterans Affairs; US EPA Office of Air and Radiation, and Office of Research and Development; US Equal Employment Opportunity Commission; Interagency Work Group on Chemical Sensitivity; the President’s Committee on Employment of People with Disabilities.  In the US, EIS/MCS has also been recognized by 16 state authorities, 9 local authorities, 21 federal and state courts, and by 19 independent organizations and institutions.

 In Canada, Canada Mortgage and Housing Corporation (CMHC) recognized the illness in preparing its publication:  “The Clean Air Guide:  How to Identify and Correct Indoor Air Problems in Your Home”.  As well, CMHC conducted a “Survey of the Medical Impact on Environmental Hypersensitive People of a Change in Habitat” (Steven R. Banon, BC, 1990).  Health and Welfare Canada sponsored an international workshop on environmental sensitivities in 1990 in Ottawa with very strong recommendations, including research priorities.

 The problem of patients suffering from EIS/MCS has been recognized in England, and two Clinics for treatment, The Breakspear Hospital in Herfordshire, England, and a Clinic run by Dr. D.J. Maberly in Northern England.  Dr. Jean Monro of the Breakspear Hospital recently reviewed data collected on their 12,000 patients over the last 17 years.  We do not have statistics on other countries, but our lack of information should not be interpreted to mean that EIS/MCS does not exist elsewhere.

 Clinically, EIS/MCS patients have presented at various levels of disability from mild to severe.  There are also several typical manifestations:

1) Patients who have had primarily chemical sensitivity who are developing worsening fatigue and sensitivities to other incitants as their illness progresses, including additional chemicals, foods and inhalants.
2) Patients who present with severe problems of multiple sensitivities to foods, chemicals and inhalants, and polysystem involvement generally classified as environmental hypersensitivity.
3) The patient who develops a syndrome of chronic fatigue, usually following a viral infection, who then begins to develop increased sensitivities to foods, chemicals and inhalants.

There appears to be a continuum:  The less attention given to reducing the “toxic” load to these individuals, the sicker they become.  The concept of “maintaining employment”, as stated in this paper, in a work environment with continued exposure to the same chemical load, clinically may lead to progression of the illness.  CMHC, in their work, recognized the importance of avoiding symptom-triggers.

Furthermore, it is important to recognize that both adults and children have acquired EIS/MCS.  These syndromes are thought to be a response, not just to the workplace, but to other significant environments:  new homes, recent renovations, schools, pesticides in the environment (farm areas, e.g. the Annapolis Valley), other toxic environmental exposure (e.g. Sydney Tar Ponds, fungal exposures in multiple buildings), carpeting, plastics, particle boards, adhesives, paints and other finishes, other building materials which continue to off-gas, and so on, which are not acknowledged in the Report.

 The Committee had its greatest difficulties coming to a consensus regarding a working definition of this illness.

 Some members of the Committee felt that symptoms experienced by patients that are “diagnosable conditions” such as asthma, depression, migraines, irritable bowel, must be excluded as part of the illness, even though many patients report these conditions occurring in response to low-level chemical exposure.  Claudia Miller, in her paper “Chemical Sensitivity; Symptom, Syndrome or Mechanism for Disease?” outlines the nature of multiple chemical sensitivity and sets the stage for criticism of the definition established by the Langley Committee:

 “Chemical sensitivity appears to entail two steps”
1)  Induction, and (2) triggering.  The inducing or initiating exposure may involve any of a wide variety of substances, including pesticides, solvents, indoor air contaminants, drugs, etc.  It may be acute as in a chemical spill, intermittent as in many industrial exposures, or chronic as in a sick building.  Loss of tolerance appears to occur as a consequence of this initial exposure.  Subsequently extremely low levels of chemicals, levels that do not bother most people and were never a problem for that individual before, trigger symptoms.  In addition, alcoholic beverages, caffeine, nicotine, various foods and drugs may trigger symptoms.  Clinically, this “loss of tolerance” is neither vague nor ill defined.  This loss of tolerance is reported to spread to an increasing number of substances as the problem progresses.  When MCS patients are re-exposed to these specific substances, they say they experience a discreet constellation of symptoms.  While the symptoms that are triggered by a given agent are highly individual, they are reportedly reproducible for a particular patient following a particular exposure, e.g. headache with diesel exhaust, mental confusion with a certain fragrance, nausea with cashews,...  Thus, loss of specific tolerance is a focused, well-defined construct... these responses occur not only to drugs, but also apparently to combustion products, fragrances, solvents and even foods...  The range of illnesses attributed to chemical sensitivity is enormous and involves any and all organ systems.”

Very importantly for our purposes, I believe, she goes on to compare MCS to infectious diseases and immunological conditions stating that “analogously, both also can affect virtually any organ system.”

...”close inspection reveals intriguing parallels between chemical sensitivity and the germ and immune theories of disease...Chemical sensitivity has many of the earmarks of an emerging category of disease... chemical sensitivity is a theory of disease that could unite disparate Clinical observations and that may enable practitioners to predict patient responses under conditions of exposure and avoidance.”

She goes on to say:
“Some have proposed that the same mechanisms that are operative in chemical sensitivity might underlie conditions like fatigue, depression, headaches, and asthma.  If one compares the frequency of these particular conditions among groups of ill Gulf Veterans and MCS patients to the frequency of these same conditions among controls (matched for age, sex and education), 5 to 15 times as many Gulf Veterans and MCS patients report severe fatigue, depression, headaches, shortness of breath, asthma or wheezing, as controls”.

 The Langley “working definition” is extremely limiting in the symptoms listed and their timing:  “at least six months duration, ...fatigue, sensitivity to odours and confusion”, and a further list of 10 symptoms which were based on a survey done over ten years ago on a very small sample of 50 patients whom, I believe, are not representative of the over eight hundred patients who have now been seen.  Dr. Miller suggests that
 “...restricting thinking about chemical sensitivity to any immutable set of symptoms or number of organ systems could prematurely constrict the field of view”.

 Further, the definition limits the onset of symptoms to “the workplace and shopping malls”, which, as previously reviewed, is incorrect.

 The Langley definition goes on to state that “various inhaled or injected substances are used in the diagnosis, but reactions to these do not exclude the diagnosis nor do positive reactions necessarily substantiate the diagnosis.”  On the contrary, if, under properly designed testing, in a controlled environment, symptoms are incited by low level substance exposure, and then resolved by clearance of the substance, then this, by definition, establishes the diagnosis of chemical sensitivity.  Numerous researchers have now carried out these trials.

 A more universally accepted definition of multiple chemical sensitivity is that presented by Mark Cullen:
“Multiple Chemical Sensitivity can be defined as an acquired disorder characterized by recurrent symptoms, referable to multiple organ systems, occurring in response to demonstrable exposure to many chemically unrelated compounds at doses far below those established in the general population to cause harmful effects.  No single widely accepted test of physiologic function can be shown to correlate with symptoms.”

This definition would be a better alternative to use, although not ideal.  This definition can also be applied to the Chronic Fatigue Syndrome patient who experiences “the spreading phenomenon” leading to multiple sensitivities.

 Another major problem with the Langley definition is the omission of the critical factor that the triggering exposures, in the syndrome, “multiple chemical sensitivity” are to chemicals or other substance, i.e. drugs, at doses far below those established in the general population to cause harmful effects.  Specialists in the field universally accept this factor.

 This omission regarding “low-level exposures” allows the authors of the Langley Report to make, what I consider, erroneous conclusions concerning the Camp Hill experience.  When discussing the issue of whether the Camp Hill illnesses can be attributed to exposure to chemicals in the hospital environment, the authors have concluded that they are “not prepared to accept this explanation as a reasonable interpretation of the facts as we know them”.  They state that many chemical substances were measured and then concentration was determined...while these readings are episodic...they span a significant period of time.  The committee felt that the degree of disability observed and illnesses reported at CHMC were out of proportion to the values obtained through these many measurements.

 In fact, reviewing the summary of Camp Hill written about testing done at various times over the years at the Camp Hill site identified measurements of over 20 volatile organic compounds, three alphiphatic amines, DEAE (extra corrosive inhibitors), phenol, formaldehyde, ethylene dibromide, sodium hydroxide, sulphur dioxide and “white powder dust consisting of amines”.  Testing of the OR at the Camp Hill site identified glutcaraldehyde vapours (CIDEX), and asbestos.  Throughout these investigations, there appeared to be little correlation made between clinical problems experienced with specific staff, and their particular exposures, and there was no follow-up.  Clinically, in fact, through my own contact with patients affected in the OR area at the Camp Hill building, and in areas where exposure to the amines occurred, I know that staff were seriously affected and continue to be off work.  Although this is the case, the Camp Hill review states  “Symptoms apparently cleared, and the subsequent Worksafe Inc. investigations did not address this subject”, and “no further comments were made”.  In one area, although “the powder” was confirmed to be a source of amines when wet, there was no follow up with staff.  At least one patient from this area suffered and continues to suffer from significant respiratory symptoms as well as typical MCS symptomatology.

 The Camp Hill review indicates the sporadic nature of the studies undertaken, a number of areas and concerns that were not followed up on, and poorly documented data.  However, the information that is summarized is enough to verify that there were, in fact, on the order of thirty potential incitants in the form of vaporized chemicals, as well as all of the other substances reviewed, present at low levels, that could have triggered typical pictures of multiple chemical sensitivity.  Fifty percent of the staff became ill!  The fact that these substances were potentially mixing throughout the building increases the risk of severe response.  The authors of The Report appear to be evaluating this situation from a “toxicology analysis” rather than from the sensitivity perspective, meaning that patients typically become sensitized by substances at very low levels, often well below that which is considered to be toxic, and possibly at the threshold of measurability, in parts per billion, or parts per trillion.

 The authors go on to state that, having rejected chemicals as a possible cause of the symptoms experienced by workers, some other factor(s) should be sought.  The factor the authors identified was “the stress on the staff”...”as possible mitigating and promulgating events”.

 Unfortunately, there was a striking lack of information reviewed by the Langley committee on the overall clinical findings in the Camp Hill victims.  This shortcoming was partially due to the fact that this information has yet to be fully compiled, and at this point, it may never happen.  However, 684 persons were reported as having symptoms, and 66% of these people went off work, 119 workers remain off work, and some others work part-time.  There is a striking resemblance with respect to symptoms and odour intolerance experienced by the Camp Hill workers to those described in the literature on multiple and diverse groups around the world.  Can all these persons be suffering from stress?  Why would doctors, nurses, physiotherapists, dieticians, office workers, and kitchen workers all risk loss of their careers, and all say that they were experiencing multiple symptomatology including progressive sensitivities to multiple chemicals, foods and inhalants, and severe fatigue if this were not the case?

 The authors of the Langley Report state that patients do not present objective evidence of illness.  On the contrary, in my experience with these patients, and that of many others, this is just not true.  During the progress of the Camp Hill site experience, one or two particular individual physicians were selected in each of a number of specialities to assess Camp Hill Complex patients, including dermatology, neurology, urology, respirology, hematology, rheumatology, endocrinology, and psychology.  Review of the multiplicity of symptoms collected by these specialists, for the most part, has not been compiled.  Dr. Barrie Ross, dermatologist, and Dr. Nancy Morrison, Respirologist, did review their findings.  Dr. Jeannette McGlone reviewed her findings on neurocognitive testing.  Summaries of findings recorded by the other specialists must be reviewed.  Some of the objective findings noted by the physicians of the Environmental Clinic include various hematological abnormalities (decreased WBC, decreased platelets), high blood chemical levels, a seemingly high incidence of thyroid disease, skin lesions, reactive airway disease, frequent blood abnormalities including mineral deficiencies, interstitial cystitis, and neurocognitive abnormalities.

 Scientifically, it would appear to be critical to search exhaustively for a biological cause for what was experienced by the Camp Hill workers.
 Further discussion on Camp Hill will follow in the section on Research, and on Recommendations.

 An excellent presentation was made to The Committee by Karen Robins, Chairperson of CASLE, Citizens for A Safe Learning Environment, which is affiliated with the Allergy and Environmental Health Association of Nova Scotia, AEHA-NS.  Despite the tremendous amount of information provided, the Langley Report makes no mention of children as an important high-risk group.

 Data on the risks to children has been accumulating for many years.  Prior to the 1986 Langley Report, Bruce Small, an Ontario architect had published a volume including 144 pages and more than 300 references to research and abstracts on Environmental Risks to Children.

 In 1986 the World Health Organization published a paper entitled Environmental Criteria 59, Principles for Evaluation Health Risks from Chemicals during Infancy and Early Childhood:  The Need for a Special Approach.  In this paper is an outline of the reasons why children are more vulnerable to toxins than adults and this included the following:
- Larger body surface area in relation to weight:
- Higher metabolic rate and oxygen consumption and intake of air percent of body weight;
- Different body composition;
- Greater energy and fluid requirements per unit of body weight;
- Special dietary needs;
- Rapid growth during which chemicals may affect growth or become incorporated into tissues;
- Functionally immature organs and body systems.

According to medical researches at the University of California at Irvine, “the health risk from air pollution is as much as 6x greater, for children than for adults”.  (underline added)

One concern is that present air quality standards are based upon research predominantly done on healthy adult males.  Safe levels for children, the old, for women, the unborn fetus, as well as the infirm and variously disabled, are not determined.

Children’s complaints in school settings often go unrecognized or unheard.  The child has no control over air quality.  Often poor diets and low vitamin and mineral levels as well as genetic predisposition to sensitivities enhance the effects.

A US publication, Tools for School, IAQ Co-ordinator’s Guide, reports that comparative risk studies performed by the EPA and its Science Advisory Board have consistently ranked indoor air pollution among the top five environmental risks to public health.  Good indoor air quality can help schools reach their primary goal of providing sound education.  Failure to respond promptly and effectively to IAQ problems can cause enormous increase in health, and educational costs.

The Cutter Information Corporation “Indoor Air Quality in Schools”, 1996, reports that pollution levels inside homes, offices, shopping malls and schools may equal or exceed those outside.  It states, from EPA studies, that some of the characteristic problems of IAQ specific to schools include:  cheap construction with poor ventilation systems:  add-on spaces not necessarily working in conjunction with original design; energy conservation measures leading to increased pollution; occupant density -- schools may house four times as many occupants per square foot as office buildings; portable buildings; multiple air systems, pollutant sources (art and science supplies, industrial arts areas, poor maintenance, copying machines, etc.) and tight budgets leading to maintenance cut-backs.

A report on Environmental Quality of Schools to the New York State Board of Regents, from the State University of New York, 1994, raised concerns about asbestos, lead, pesticides, radon, electromagnetic fields, and air pollution from new carpeting, copiers, glues, roofing, paints, cleaning agents, insulation, and about other substances including moulds, bacteria and viruses, carbon monoxide, formaldehyde, oxides of nitrogen and sulphur, volatile compounds and lead.  Students and school personnel have experienced mild to serious health problems which interfere with health, activity and ability to learn.  The symptoms of respiratory problems (asthma, bronchitis, and emphysema) can be aggravated by air irritants.  “There is growing evidence that poor IAQ can produce verbal, perceptual, motor, and behavioural disabilities in children as well as hearing impairments, irritability, and delayed physical and neurobehavioral development”  (e.g. lead effects, pesticide effects which are also associated with increased incidence of cancer).

The Halifax District School Board’s 1994 “Blue Book” paper, Indoor Air Quality Assessment done on 47 Halifax School buildings, prepared by its Property Services Department, indicated the following:
- Virtually every school had some classrooms with elevated CO2 levels.
- 24 out of 47 buildings contained unacceptable moulds or fungus.
- 23 contained fungal species that are mycotoxin-producers and that are “unacceptable occupants of indoor air”.  Seven of these included stachytobotyris chartaram (previously identified as Stachybotrys atra).
- 13 contained high levels of “acceptable” moulds and indicated chronically wet environments.
- Only 10 buildings were determined to have minimal fungal contamination, and one of these was vacated and closed permanently due to toxic mould overgrowth approximately 1 1/2 years later.

One of the Halifax Regional School board officials is quoted as saying:  “nobody can tell me things are not affecting the children.  There is an obvious cause-and-effect between people’s health and chemical exposures in schools.  There are well documented incidents that repeatedly prove this.”

 Outside the Halifax Region we were presented with a letter from Jon Van Zoost, MSc, MEd, a teacher in Cornwallis District High School, in Canning, NS, which outlines severe illness which is ongoing, occurring in teachers and students after multiple renovations were done in this school.  He also cites problems in schools in Kings County, in Avonport, Horton, New Minas, Kentville, Coldbrook and Cambridge.

 Although exact statistical breakdown has not yet been done by the N.S. Environmental Clinic, there appear to be a large number of teachers who have acquired EIS/MCS in Nova Scotia, and it is likely that only a fraction of all teachers so affected are known to the Clinic.  As stated earlier, approximately 40 persons under the age of 20 have been seen in the Environmental Clinic, at least a portion of whom have acquired their illness at school.

 Contrary to suggestions made in the Langley Report that multiple chemical sensitivity can be reversible, a study done on a Saskatchewan “sick” school indicates the opposite.  In 1994 teachers and students were becoming ill in the TD Michel School in Big River.  The problem was thought to be due to sewer gas secondary to poor plumbing techniques employed during renovations.  Symptoms included headaches, fatigue, mood swings, abdominal pains, nasal congestion, coughs, sore throats, poor concentration, itchy eyes, and flu-like illness.  After subtracting those whose parents felt their problems “ran in the family”, 63% of children were ill.  Compared to two other schools, this number was highly significant.  The children’s symptoms improved on weekends.  The longer the children and teachers were exposed to the school, the greater the prevalence of illness.  Children who progressed to high school carried their illness with them.  “There was no evidence that symptoms cleared with time”.

 A survey was done by the Building Ecology Research and Service Group in Toronto reviewing children and teachers:  Reports on 4,461 children indicated 6.0% with asthma, 5.4% with food allergies and 6.4% with environmental allergies.  For teachers, the percentages were 35%, 33.3% and 60.7%.  The two consequences identified were (1) the risk of the disease intensifying and, (2) the contribution to learning difficulties.

 The U.S. National Education Association, 1995, reports that in schools where Environmentally safe classrooms are in use, the following consequences were noted:
1) Increased attendance
2) Increased academic ratings
3) Decreased allergies and secondary infections
4) Decreased need for home teaching
5) Decreased need for special classrooms, resource rooms and resource teachers
6) Decreased stress on students, parents, teachers, etc.
7) Decreased school expenditures.

 In Nova Scotia the Deputy Minister of Education set up an Indoor Air Quality Committee “to make recommendations concerning how the government can establish an effective and co-ordinated approach to dealing with concerns about air quality in schools”.  Problems with IAQ have been linked in large part to inadequate maintenance.  Recommendations have been outlined regarding maintenance of ventilation systems, adequate air-intake, water infiltration, carpets, daily cleaning, carpet cleaning, safe cleaners, deodorizers, asbestos removal, painting, finishing of gym floors, etc.  An appropriate complaint mechanism has been set up.  The emphasis is to be on prevention.

 It is critical that these recommendations be carried out in the future.  It is also important that other preventive measures be established for children in their out-of-school environments including construction in the air, water, food, and other environmental exposures.  Children are being affected seriously, and these issues need to be focused upon.


 The Langley Report states that indoor fungal growth in damp housing is associated with allergic symptoms, including asthmatic ones.  They can also cause direct or non-allergic symptoms through irritant effects and tissue injury.  It then goes on to suggest that the risks are overstated.

 Clinically, some of the sickest environmental patients I have seen appear to have developed their illness upon prolonged exposure to moldy homes or workplaces.  Quite typically, the asthma they develop is severe and difficult to treat.  They also typically suffer from profound fatigue and multiple other symptomatology.

 Dr. Harriet Burge, PhD, Associate Professor of Clinical Mycology at Harvard University states that there is good evidence that exposure to fungi can cause allergic disease.  If someone has mold allergy, then almost any mold might be able to trigger symptoms.  If there is actually a moldy odor in any indoor place, that is sufficient indication that mold is present, and that some remediation should be done without regard to the kind of mold present.  She states that the American Conference of Governmental Industrial Hygienists (ACGIH) Guidelines state the importance of this approach.

 I believe that the risk of molds in indoor environments should not be understated.


 No one questions the need for further research into the causation and mechanisms of EIS/MCS, and further treatment methods.  The forty-five page Bibliography included in this Report indicates the vast and growing interest in this field of illness.

 Treatment evaluation has been difficult for several reasons:
A) because of the nature of the illness with multi-system involvement, and because of the multiplicity of sensitivities to foods, chemicals and inhalants, treatment must have a multidimensional focus, employing many approaches at the same time in order to make an impact on the individuals.  Similar approaches have had to be taken in other such multi-system illnesses such as PMS (Premenstrual Syndrome).  This reality makes double-blind, placebo-controlled, one-dimensional research very difficult, if not impossible.

B) because patients have become sensitized to their environment, often including sensitivity to chemically polluted air and foods, much of the focus has to be on extraction or avoidance of these factors.  Drug therapies and the standard “medical model” of “treat and cure” have not proven to be helpful in these illnesses.  Therefore, drug company financing of research and the profit motivation of research is not an option here.  Consequently, progress in the understanding and treatment of EIS/MCS must rely on public and government funding for the most part.

 In our interview with Dr. Rebecca Bascom, Respirologist, who has been studying multiple chemical sensitivity, she was asked the following question:  “Concerning research protocols for MCS, could you please list for the Committee what five aspects of MCS you feel should have priority?”  Her response listed the following two priorities:

1) Clinical trials to improve the quality of life.
 In this regard she identified the importance of the development of an improved “quality of life” instrument being developed by Elizabeth Juniper at McMaster University as a possible future tool.

2) Studies in Epidemiology of the illness.

 I believe that this response from Dr. Bascom reflects the direction that research must take in order to address the previous two points, A and B above.

 Despite the Langley Paper’s position to the contrary, progress has been made in research and documentation of the illness and its therapies.  I will cite a few significant papers that were presented to the Committee:

1) Dr. D.J. Maberly, in his clinic in Airedale, West York, England, demonstrated significant improvement in asthma status over a six month period utilizing the combined therapies of desensitization vaccines for foods, chemicals and inhalants; individually designed rotation diets; and education about reduced exposure to relevant inhalants and chemicals. 1

2) Rea et al, demonstrated reduction of chemical sensitivity be means of combined therapies including heat depuration, physical therapy, rotation diets with organic foods, and nutritional supplementation, in controlled environments. 2

3) Rea et al, demonstrated an overall clinical improvement with magnesium treatment in 45% of patients with chemical sensitivity. 3

4) Numerous studies have been done on booth-testing of chemicals.  4

5) Two important studies were done an SPECT scanning and its potential relevance as a biological marker of chemically induced neurotoxicity, and of virally-related Chronic Fatigue Syndrome.

1 Maberly & Anthony.  Asthma Management in a Clean Environment:  1.  The Effect of challenge with Foods and Chemicals on the Peak Flow Rate.  and
 Maberly & Anthony.  Asthma Management in a Clean Environment:  2.  Progress and Outcome in a Cohort of Patients
2 Rea et al.  Reduction of Chemical Sensitivity by Means of heat Depuration, Physical Therapy and Nutritional Supplementation in a Controlled Environment.
3 Rea et al.  Magnesium Deficiency in Patients with Chemical Sensitivity.
4 Ross & Johnson.  Evidence for Vitamin Deficiencies in Environmentally Sensitive Patients.

a) Fincher et al explored the SPECT scan as a tool in measuring dynamic brain functioning.  This study presented the SPECT findings for 25 healthy control subjects compared to the findings for 25 mixed organic solvent exposure subjects.  The findings indicated significant deficiencies in patterns of tracer uptake in early and late phase between the two groups.  The paper discussed “solvent syndrome” with multiple symptomatology and neuropsyhcological testing which consistently found cognitive defects in memory, learning, visuospatial ability, attention and mental flexibility, and psychomotor speed.  “In cases of “toxic Encephalopathy” where symptoms were accompanied by impaired test performance, ongoing central nervous system effects were present five years later”.  (Edling et al, 1990).  In studies of short term exposure to low levels of organic solvents, cognitive functions improved when the offending agent was removed (Oak, 1988).

 These studies indicate the crucial role of early detection.  This also contradicts statements made in the Langley Report on p. 44, #2, and #4.

 The description of “toxic encephalopathy” and “solvent syndrome” and their associated cognitive impairment profile sound very much like the typical seriously affected Camp Hill victim.  In many of the patients who are still off work, their cognitive impairment is still present after many years.

b) Schwartz et al, 1993, compared SPECT scan images of the brain in patients with Chronic Fatigue Syndrome, AIDS Dementia and Major Unipolar Depression.  This study found that the healthy patients had the fewest defects and the AIDS Dementia had the largest number.  In all groups, defects were located predominantly in the frontal and temporal lobes.  The midcerebral uptake index was found to be significantly lower.  (p<.002) in the patients with Chronic Fatigue Syndrome and Aids Dementia, than in patients with major depression or healthy control subjects.  These findings are connected with the hypothesis that CFS may be due to a chronic viral encephalitis.

 The DePaul University research team, in 1995, collected data on Treatment Efficacy on 305 patients suffering from Multiple Chemical Sensitivity.  Of this group of 305, 40% also reported they had chronic fatigue and immune dysfunction syndrome, and 27.4% stated they were unsure.  In this study, patients rated treatments based on their own personal experience.  The efficacy of treatments was rated from ‘effect unclear’, ‘effect harmful’, to ‘enormous help’.  A full outline is available in appendix 2 of this report.  Of note is that treatments most commonly rated as harmful were the antidepressant drugs Zoloff, Prozac, and Elavil.  The most commonly rated as ‘enormous help’ were “avoiding chemicals which could cause reactions”, “avoiding foods which provoke allergic reactions”, “moving to a less polluted area”, and “creating an environmentally safe living space”.


The Nova Scotia Environmental Medicine Clinic was set up as a pilot project initiated in September, 1990, by the Nova Scotia Department of Health and Fitness in cooperation with the Environmental Health Center at Dallas and Dr. Gerald Ross.  This was a part-time clinic.

1) A review of the operation and a patient satisfaction survey was carried out to evaluate the Clinic in June, 1993.  The survey also reviewed adherence to treatment and self-reported improvement in symptoms.  The survey was based on new patients entering the clinic over a one-year period and a pre- and post-questionnaire was done on a total of 103 patients.

A full report was prepared.  However, some of the highlights were as follows:

- In a two-year period the clinic had a total of 308 active patients.

- Over 50% of respondents saw five or more physicians about their illnesses or had had 16 or more physician visits prior to their first visit in the clinic.

- Treatments in the environmental clinic included oral and IV vitamin and mineral therapy, dietary changes, antigen therapy, and changes to their home environment.

- Pre-questionnaire (on admission to clinic and prior to treatment), 75.7% responded and post-treatment questionnaire, 82.5% responded.

- Most patients, 92.8% indicated that they felt that their symptoms improved slightly or significantly.

- The analysis of results showed a statistically significant difference in the overall symptom score -- ie. for all symptom scores.

- This would suggest that the environmental medicine treatment approaches were contributing to improved health in patients who previously had not responded to traditional therapies from multiple physicians.

2) As a spin-off from the positive feedback from Chronic Fatigue Syndrome (CFS) patients in the Environmental Medicine Clinic, a further therapeutic trial of intravenous vitamin therapy was set up at Camp Hill Hospital in cooperation with the Department of Family Medicine.

 This trial consisted of weekly intravenous vitamin therapy for 19 patients over a period of 18 weeks.  The IVs included vitamin C, magnesium and B-complex, as well as additional supplements where indicated by blood tests.  Patient improvements were recorded.  As well, a number of evaluation instruments were used before, after five weeks, and at the end of the therapeutic trial.  These instruments included the Mental Health Inventory, the Fatigue Impact Scale, the UCLA Loneliness Scale, and the Sickness Impact Scale.

 Patients reported dramatic improvement in rest and sleep patterns, coping behaviours, self-care and care of children, decreased fatigue, and decreased muscoloskeletal pain.  Collection and analysis of the test instruments revealed statistically significant improvements in patient symptoms for three out of the four research instruments utilized (p = .017, p = .02, p = .024).  The UCLA Loneliness Scale showed improvement, but at the p = .108 level.

 It was concluded that a randomized clinical trial examining both vitamin infusions and psychological interventions on functional ability would be appropriate in the future.

 Dr. Jeannette McGlone, PhD, Psychologist and Dr. Wayne MacDonald, PhD, Psychologist, reviewed a group of 39 Camp Hill patients with regards to neuropsychological testing.  The findings of their study were to be kept in confidence.  However, because the incidence and severity of abnormal neuropsychological findings were so high, it was recommended that more rigorous clinical and scientific approach should be developed and funded in order to document the extent of the problem, whether remediation and treatments are effective, and what is the outcome on employability.

3) Camp Hill Evaluation:  In May, 1993, Dr. Gerald Ross, in his role as Director of the Nova Scotia Environmental Medicine Clinic, prepared a paper for the Nova Scotia Department of Health entitled “Report of the Evaluation of Camp Hill Hospital Staff Affected by the ‘Veteran’s Memorial Building Syndrome’”.  This paper outlines the findings of a clinical review of 32 Camp Hill staff members who were thought to have been affected by the Camp Hill Syndrome.  Twenty-six of these patients were seen at the specific request of Camp Hill Hospital.

 The Camp Hill Report summarizes a comprehensive review of these patients, including histories, review of symptoms, administration of Health Status Questionnaires, blood studies, intradermal testing, neurocognitive instruments.

 This paper points out that historically these patients typically reported that they were previously generally well, and then they developed gradual onset of symptoms which became progressively worse.  Early symptoms were inhalant allergies, fatigue progressing to exhaustion, painful skin rashes, headaches, poor concentration and memory, severe mental disorientation at times, arthralgias, abdominal bloating, pain and bowel irritability, and progressive intolerance to low-level odorous chemicals.

 There was a high frequency of the following abnormalities:  CMI testing, elevated sed rate, leukopenia, ANA (anti-nuclear antibodies), and anti-thyroid antibodies.  Skin testing revealed that 100% of patients were sensitive to molds, dust mites, trees, weeds, grasses, wood terps and formaldehyde, 93% were sensitive to phenol (one of the air pollutants found at Camp Hill Hospital).  100% of patients were sensitive to sugar testing.

 On physical exam, 56% of patients were found to have Rhombergism, indicating a problem with balance.  There was a frequent finding of inflamed nasal mucosa, and scattered papular skin rash.

 The administration of the Heal Status Questionnaire revealed significant impairment especially in categories of level of energy/fatigue, and physical and social functioning.

 Cognitive testing using a number of test protocols identified a significant level of neurocognitive impairment.

 Dr. Ross concluded that these Camp Hill patients were developing a typical picture of “chemical sensitivity”.  He quotes Casarett and Dowell’s Toxicology, which defines chemical allergy as

“an immunologically-mediated adverse reaction to a chemical resulting from previous sensitization to that chemical or a structurally similar one.  Once sensitization has occurred, allergic reactions may result from exposure to low doses of chemicals.”

He goes on to state that chemical sensitivity includes:

“non-immune mechanisms involved with the production of symptoms and signs as illustrated by autonomic nervous system instability and dysfunction that has been demonstrated in these patients.  A specific pattern of neurotoxicity is frequently seen on baseline SPECT brain scan imaging with significant deterioration in brain metabolic function after low-level chemical challenge.  This provides physiological corroboration for the subjective neurocognitive complaints that are widely reported by chemically sensitive patients.”

Dr. Ross recommended a series of further investigations that need to be done, and an outline of therapies for these Camp Hill patients and others who continue to be seriously affected.  The investigations recommended include:

1) Blood studies assessing antibodies to the rust-inhibiting amine compounds that were documented to have been distributed throughout the Camp Hill Complex through steam used to humidify the air.

2) Blinded intradermal challenge testing to the amine compound to assess immune response and to assess if the patient symptoms were reproduced during this testing.  This testing could also be done with the other chemicals found to be present in the Camp Hill air.

3) Blood chemical analysis for the amines and other chemicals found in the air.

4) Red Blood Cell Mineral Analysis to assess vitamin and mineral deficiencies, which could relate to difficulties with detoxification ability.

5) Further skin testing for other allergies, since the preliminary findings indicated extensive sensitivity to the things already tested.

6) SPECT scan imaging to assess physiological change in brain function on chemical exposure.

7) Fat tissue biopsy with analysis for toxic chemical contamination including the amine products found at the Camp Hill site.

8) Neurocognitive testing for the remainder of the Camp Hill patients still off work.  These could be compared to normal subjects.

The treatments recommended are according to the protocol of an Environmental Medicine approach to chemical sensitivity as outlined in the attached paper by Dr. Gerald Ross, Toxicology and Industrial Health, 1992.


Discussion of Table 3, Clinical Guidelines, Langley Report.

 Throughout my report, I have made criticisms of many of the points listed here.  However, I must make some further comments.

 Patients with EIS/MCS are sensitive to many foods, chemicals and inhalants.  Treatment must consist of lessening their load by avoiding, as much as possible, those things which make them ill.  But we have also outlined that these patients tend to have a spreading factor, which results in increasing sensitivities.  Again, lessening the load through techniques that help to establish access to clean air, clean water, and organically grown, chemically-free foods, lessens the risk of further sensitization.  This only makes sense.  Steps that are taken include no-scent cleaning products and toiletries, removal of carpets with replacement with hardwood or tile, elimination of mold, air filters to clean the air, organic foods that don’t add more chemicals to the body.

 Unfortunately, such positive steps taken as part of therapy are not covered by most drug plans.  If these patients were instead being prescribed expensive drugs, these would be paid for!  Drug therapy is not generally successfully in these patients.

 A complete evaluation of a patient with EIS/MCS includes the following:

  -Complete history of illness.
  -Functional inquiry (symptom review).
  -Past history.
  -Family history.
  -Employment history.
  -Living conditions.
  -Known allergies.
  -Insect sensitivities.
  -Travel history.
  -Psychological profile.

A complete work-up also includes:

1) Extensive blood work-ups including serum studies, Red Blood Cell Mineral Analysis, and chemical panels measuring chemicals in the blood.  The RBC mineral analysis and chemical studies presently can only be performed on patients who can afford to pay for these or who have drug plan coverage for these.  Red blood cell mineral analyses have indicated many significant mineral deficiencies in patients in the environmental clinic as well as identifying patients with high levels of mercury, lead, arsenic and cadmium.

Another important part of the patient evaluation is a careful dietary history.  Many patients have numerous food intolerances and therefore may avoid critical nutritional intake.  Even when there is seemingly adequate intake, many patients demonstrate signs and symptoms of essential nutrient deficiencies, assumed to be due to malabsorption.

 Dr. Gerald Ross published a review of vitamin deficiencies found in environmentally ill Dallas patients which indicated that 57.8% of patients were deficient in vitamin B-6, 37.7% in vitamin D, 34.9% in B-2, 32.2% in folate, 27.7% in vitamin C, and 26.1% in B-1.

 Dr. Jean Monro, Director of the Breakspear Hospital in England, in a recent conference in California, reported results of various studies she had done on her 12,000 EIS/MCS patients with regard to nutritional status.

 SPECT cell studies indicated deficiencies as follows:  Vitamin B-6, 41%; B-1, 38%; B-2, 26%, B-3, 12%, B-12, 6%, Folate, 44%; Pantothenic acid, 3%, calcium, 62%; zinc, 47%, glutathione, 56%, cysteine, 56%; total antioxidant function, 94%.  Another B-vitamin analysis indicated vit. B-6 deficiency in 83% of patients, and RBC magnesium deficiency in 59% of patients.  In a study of 213 patients, ages 15-68, male:  female 52:161, she found fecal fat levels increased in 90% of patients, indicating low intestinal permeability.

 Shandra (1980), a widely recognized international nutrition expert, has called undernutrition the most frequent cause of immunodeficiency.

 I quote these studies to demonstrate that one important part of therapy in EIS/MCS patients is in the area of nutrition.  In many cases nutritional enhancement with vitamin, mineral supplements, digestive enzymes, amino acids, etc., is appropriate as identified by documented deficiency or intolerance.  Because human enzymatic, metabolic, and detoxification pathways are largely dependent on adequate vitamins, minerals and other essential cofactors, the nutritional status of patients with Multiple Chemical Sensitivity is of obvious importance and concern (Jacoby, 1908).  This is contrary to the Langley Committee Recommendations on p. 44, item #6.  Antioxidant therapy would also appear to be prudent according to Dr. Monro’s findings.  This would include beta carotene, vitamin C, vitamin E, reduced L-glutathione, etc.

 A recent study in Nova Scotia has shown that a very high percentage of individuals do not have sufficient magnesium intake.  Values are in the order of 60-77% of individuals with mg intake below RDA.  Magnesium is an essential cation involved in major metabolic pathways.  It affects energy production, histamine release, over 3000 enzymes, cell membrane permeability, the nervous system, the heart rhythm and so on.  Many patients with chronic fatigue and environmental hypersensitivity have had documented red blood cell deficiencies in magnesium, and have responded very well clinically to intramuscular or intravenous magnesium therapy.

 In summary, The Province of Nova Scotia has over 2000 patients affected by illness suggestive of Environmental Illness, with that number constantly expanding.  Over 800 persons are involved in the Environmental Clinic.  The rest await treatment, or are seeking help from other environmentally trained physicians, or from clinics in other provinces or countries.

 Preliminary reviews and data from the work done in the 7-year practise of Environmental Medicine at the Nova Scotia Environmental Clinic indicated significant improvement and satisfaction from these therapies.

 The Langley Committee did a literature review of academic papers already published.  The group had almost no contact with patients (4 patients only), nor did they do clinical reviews.  Clinical data was based on a 10-year-old survey of patients that I believe does not reflect the present picture.  The Committee chose to ignore data from the Environmental Clinic and input from the Dallas Environmental Health Centre.

 The information regarding molds was again a literature review with no clinical contact.

 The Camp Hill review was based on a paper review, with almost no review of clinical data (4 patients only).  There was a presentation from psychologists, a psychiatrist and a dermatologist.  The other clinicians involved in seeing Camp Hill patients were not involved.  There was no recognition of Dr. Ross’ comprehensive evaluation of 32 Camp Hill patients.

 I feel the Langley Committee has inappropriately drawn absolute conclusions regarding Camp Hill patients, and the ability of molds to affect health.  Because the information available is not yet fully understood or complete, conclusions have been made erroneously.  The Langley definition left out the importance of ‘low-level chemicals’ (recognized by most other groups), and despite multiple chemicals being documented at Camp Hill at low levels, the authors concluded that these had nothing to do with the illness experienced by workers.  Re: molds, there is an implication that because the ‘biomedical data’ hasn’t yet confirmed the health risks of molds, there isn’t a risk.  Yet in clinical experience, severe indoor mold exposure appears to be a factor in some severe and prolonged illness.  The risk in both of these conclusions made by the committee is that by ignoring the potential risk of chemicals and molds, by diminishing the importance of environmental clean-up, more persons will suffer illness needlessly.

 I believe that the Langley Committee has failed to acknowledge the large numbers of Nova Scotians who are severely ill with Environmental Illness, and their clinical needs.  the Langley Report has failed to recommend any treatment that will help patients before the five to ten years of “hard-core research” data collection is completed.  Being “supportive” of patients alone, as recommended in the “9 Point Guidelines” is predictably not going to be helpful to them.  Many patients are at risk of becoming sicker.

 One of the last statements Dr. Mark Cullen made in our interview with him at Yale University was how important it was to establish early treatment of Environmental Illness, because if patients are left too long, they will become chronically ill.  Unfortunately, Dr. Cullen gives no treatment other than offering advice, and he had no specific recommendations.

 Environmental Medicine is practiced by over 400 physicians in the US, and by two very large centres in the world, Dallas, Texas, and Herfordshire, England.  They have seen on the order of 25,000 patients in 23 years, and 12,000 patients, respectively, who have suffered from around the world.  Their expertise in the treatment of Environmental Illness has been ignored by the Langley Committee.  I feel that at this point in time, we must follow their guidelines as we have been for the past seven and a half years.

 In order to address the medical needs of the citizens of our province, immediate steps must be undertaken.  To this end, I would make the following recommendations:


1) That the Dalhousie Environmental Health Centre practice according to the guidelines of the American Academy of Environmental Medicine (see Appendix A), since these practices have already been documented as helping patients (Evaluation of Patient Satisfaction at the N.S. Environmental Medicine Clinic, 1993).  These methods would be further evaluated as treatment is being carried out (clinical trials).

2) That the Dalhousie Environmental Health Centre be established as a treatment and a research centre in order that the needs of affected patients can be met.  At the present time, this is seen as a research centre only.

3) That a review be done surveying the nearly 900 patients already treated in the Environmental Clinic to determine what treatments were most effective in improving their health and function.  This survey could be used as a basis for further research.

4) Blood studies that have been extremely helpful in diagnosing and establishing a basis for treatment of environmentally ill patients should be made available at our hospital labs.  These include the Red Blood Cell Mineral Analysis (which provides a full page analysis of crucial minerals and pathological toxins including lead, arsenic, and mercury), and AcuChem studies, which measure toxic chemicals and pesticides in the blood.  These tests presently have to be ordered through the US and are extremely expensive for the individual patient.  The technology and equipment is available in N.S.  Even being able to reduce the cost by local availability would be helpful to the already overburdened sufferer.

5) The waiting list for the Environmental Health Clinic is over 1200 persons.  The longer they await treatment, the sicker they may potentially become.  Major initiatives must be taken to i) gather these people together in large groups to begin educational sessions to give them the basics of self-help measures.  ii) Strategies need to be established to try to do large-scale clinical trials, perhaps in outlying areas such as Sydney, and The Annapolis Valley, to try to incorporate them into research and treatment immediately.  This would require bringing in additional medical staff trained in environmental medicine to get on top of this ever-increasing number of patients.

6) Treating the environmentally ill requires a multi-disciplinary team of professionals including physicians, nurses, nutritionists, psychologists, social workers, and exercise physiologists.  The present clinic does not have sufficient funds to provide all these critical staff members.  Without this team, a full treatment and rehabilitation service cannot be provided.  Further funding needs to be sought to provide this staff.

7) SPECT scan imaging using the protocols used by those in the Fincher studies should be made available as an extremely important adjunct to the research documenting the cognitive impairment experienced by those Camp Hill victims, other environmentally ill patients, and chronic fatigue patients.

8) Further reviews are required with social services provincially to help establish the special needs of environmentally ill patients, and to secure more help for them.

9) Further intravenous vitamin trials for chronic fatigue patients should be established on a larger scale in follow-up to the trials done at Camp Hill Hospital, and in response to their recommendations.  These trials should be established in a Halifax city-based hospital so as to not over-tax the already over-burdened Environmental Clinic.

10) Funding should be made available to establish a multidisciplinary research program to do a clinical review of Camp Hill Hospital workers, comparing those who remain off sick, those who have been able to return to work, and those who never got sick.  This study should follow the guidelines suggested in Dr. Ross’ evaluation of Camp Hill Hospital Staff.  Since the Camp Hill experience has caused such devastation to so many worker’s lives, it seems critical both for the sake of those affected, and as well in the hope of preventing further such tragedies, that exhaustive research be done to understand the biologic basis of the illness experienced by the workers.

11) Data collected by consulting physicians of multiple specialities who saw Camp Hill patients should be compiled to establish a clearer picture of the clinical manifestations of the Camp Hill illness complex.

12) Publicly funded educational incentives need to be undertaken to help prevent the causes of environmental illness and the consequent ever-increasing numbers of those affected.  This should include discussion of the health risks from pesticides, unmaintained closed air systems, the risks of solvents in cleaning compounds, the need for protection when using toxic compounds, the risks of overgrowth of molds in the home and the workplace, the risks of chemicals and pesticides in foods, etc.

13) It is critical that the recommendations of the Indoor Air Quality Committee of the Dept. of Education be followed upon and instituted as written.  This will maintain a focus on a preventive approach to the health of children.

14) Mechanisms need to be established to force employers to implement environmental change in the workplace where environmental triggers to illness have been established.  This should be in the form of legislation.

15) Financial issues are important to any government.  The potential exists for the Fall River Clinic to become a resource centre of the environmentally ill for other provinces and the Northern US, with potential income from these sources.  A number of additional staff could be hired to provide these services.  The logistical and financial viability of such an approach should be investigated.

Treatment Options in Multiple Chemical Sensitivity
Gerald H. Ross, M.D., CCFP, DIBEM, FAAEM
Environmental Health Center - Dallas
Dallas, Texas
Reprinted from Toxicology and Industrial Health Vol 8, No 4, 1992 pp 87-94

Proceedings of the Multiple Chemical Sensitivity Workshop, Washington, D.C.
September 20-21, 1991

Proceedings of the Association of Occupational and Environmental Clinics
(AOEC)  With support from the Agency for Toxic Sensitivities and Disease Registry.


Environmental Health Center
Dallas, Texas


Multiple chemical sensitivities (MSC), a condition that probably has been present for hundreds of years in various manifestations, is gaining increasing recognition in medicine (Hileman, 1991).  At the same time, the prevalence of classical allergy like asthma and hay fever is growing, and paralleling this is an increase of symptoms that some patients exhibit from exposure to commonly-encountered chemical substances.  A simple definition of MCS is:  a significant intolerance to low-dose components in the patient’s personal environment, which most other people tolerate quite well.

Because of the complex nature of this condition, it is important to keep in mind the concept of total load or the total environment.  This involved the complex interplay of genetic endowment, nutritional status, emotional stress, and exposure to foods, chemicals, microbes, inhalants, and even electromagnetic fields.  How health is expressed is obviously a function of the cumulative effect of these factors on the patient.

Treatment options for MCS center around education, avoidance of allergens (including those in air, food, water), environmental clean-up procedures, rotational diets, enhancement of nutritional status, immunotherapy, immune stimulation, detoxification where appropriate, and addressing the patient’s social and emotional health.  In addition, the emerging awareness remains that electromagnetic fields may play a significant role in certain situations.  (Fitzgerald, 1990).  It is vital to establish a relationship whereby patients feel that physicians take their complaints (though perhaps myriad and long standing) seriously and in an atmosphere of mutual respect and trust.  Within such a context, patients will more readily accept education about things they can do to potentially help themselves.


Surely the basis of treatment for any allergic or sensitivity problem is to avoid the sensitizing agent.  This can be done whether the primary problem is in air, food, water, or physical surroundings, and it may even apply to electromagnetic fields to a certain extent.

Because MCS patients frequently have wide varieties of allergies or sensitivities, they usually benefit from programs that minimize their contact with potentially sensitizing substances.

 Address all correspondence to:  Dr. Gerald H. Ross, Environmental Health Center-Dallas, 8345 Walnut Hill Lane, #205, Dallas, TX 75231.

Glass-bottled spring water is frequently helpful because it is much purer and does not contain the chlorine, flourine, and other contaminants usually found in domestic drinking water supplies.  Unfortunately, water bottled in plastic containers may pick up the phthalates, solvents, or plasticizers used to manufacture the plastic itself (Kailin and Brooks, 1963); for this reason the author recommends water bottled in glass.

One of the largest and best-recognized sources of contact we have with chemical contaminants is our food supply (Davies, 1986), which frequently contains pesticides and other chemical residues potentially harmful to everyone’s health, and especially to persons with chemical sensitivity.  Consequently, MCS patients often do much better clinically by consuming organically grown, less chemically-contaminated food products.

Because of the massive incidence of indoor air pollution, which is often 100 times that of outdoor air (Nero, 1988; NCR, 1981), air-filtration devices that remove both particulate and chemical substances from breathable indoor air usually benefit MCS patients considerably.  In addition, steps to minimize indoor pollution by removing carpeting and combustion products from the home (such as natural gas, heating oil, or wood-burning stoves) usually bring about substantial improvements as well (Barron, 1990); Drerup et al., 1990).

Indoor air pollution is generally lower in homes that have hardwood or tile floors, with natural wood rather than fiber board, plywood, or other pressed-wood products that contain substantial amounts of glues, solvents, and other chemicals (including formaldehyde).  The latter will off-gas and contaminate indoor environments for months or even years (Levin, 1989).  Similarly, synthetic fabrics and other materials made from petroleum will slowly off-gas volatile organic compounds (VOCs) and other chemical substances used in their manufacture, thus adding to the total load of indoor pollution.  These latter substances frequently trigger symptoms and health deterioration in patients with MCS.  An intelligent program of minimizing this kind of exposure usually has substantial therapeutic benefit for these patients.

Shandra (1980), a widely recognized international nutrition expert, has called undernutrition the most frequent cause of immunodeficiency.  Because human enzymatic, metabolic, and detoxification pathways are largely dependant on adequate vitamins, minerals, and other essential co-factors, the nutritional status of patients with MCR is of obvious importance and concern (Jocoby, 1980).  A survey of more than 330 patients at the Environmental Health Center-Dallas showed widespread vitamin deficiencies (including a B6 deficiency in almost 58% of these patients) even in the presence of oral supplementation (Ross et al., 1990).  A rotational diet is one way to minimize exposure to food substances to which the patient may be sensitive, and the diet can be readily designed by competent personnel within the context of nutritional adequacy (Radcliffe, 1987).  A rotational diet does not repeat the same food or beverage item within the rotational cycle, and such diets can be constructed in several ways.  To illustrate a 4-day, monorotational diet (one food per meal):  on Day 1, the patient might consume eggs for breakfast and would not again consume any egg products until the morning of Day 5, thereby minimizing contact with potentially sensitizing foods.  A rotational diet is relatively simple to institute, even before the foods to which the patient is actually sensitive are known.  Such a diet minimizes over-exposure to any foods, and when properly constructed, can provide good nutritional adequacy and wide variety.

Patients with MCS are known to have a higher likelihood of nutritional imbalances (Ross et a., 1989), especially magnesium deficiency (Rea et al., 1987a).  Because many patients with MCS seem to be nutrient deficient despite oral supplementation, intravenous infusions of certain vitamins and minerals (especially vitamin C, B vitamins, magnesium, and trace minerals) can have excellent therapeutic benefits.  The exact mechanism of benefit is not known but may be through enhancing both immune function and detoxication pathways.

The Nova Scotia Environmental Medicine Clinic is currently engaged in a collaborative pilot study with the government of Nova Scotia in Canada on intravenous infusion of nutrients, including magnesium, for patients with chronic fatigue syndrome.  In the author’s experience, these patients also frequently have intracellular magnesium deficits.

Candida Sensitivity.  One aspect of the total-load or the total-environment concept might include the possibility of candida sensitivity or overgrowth (Kroker, 1987).  Although this issue is controversial, many of the author’s patients with MCS have substantial elevations of antibodies against candida and may have had recurring vaginal or oral yeast infections.  An anticandida program involving dietary modification, nutritional support, the replenishment of health gut flora, and possibly an antifungal medication, may prove very beneficial.  Moreover, present knowledge about the potential adverse effects of candida on susceptible individuals appear far from complete.  It seems reasonable to keep an open mind on this topic because the author has seen many patients who benefited from such an approach, within a context of evaluation and lowering the total load.

Intradermal and Sublingual Testing.  A vital question remains:  how to evaluate and confirm chemical sensitivity.  As in all medicine, initial reliance is primarily on history.  Two main types of confirmatory testing, involving intradermal and inhalation challenge, are currently available.  Most patients with a history of MCS have widespread sensitivities to chemicals, foods, and, to a lesser extent, inhalants (Rea and Ross, 1989).  The testing antigens used for intradermal food testing at the Environmental Health Center-Dallas, are prepared from organically grown products, with no preservatives in the vaccines.  This is in distinction to most testing antigens on the commercial market, which have either phenol or glycerine as stabilizers.  Many patients with MCS cannot tolerate antigens that contain these substances for either testing or treatment.  A variety of well-known, skin-testing techniques are available, including scratch or prick testing.  Serial-dilution, end-point titration (SDET) and provocation-neutralization also give reliable data for use in a treatment program (King and King, 1990).

With provocation-neutralization, potential treatment vaccines may be drawn up for foods, chemicals, inhalants, microbial substances (like mixed respiratory vaccine and fluogen), and individual bacteria produced from autogenous vaccines:  the latter are particularly helpful in patients with chronic rhinitis or sinusitis.

Sensitivity to a variety of chemicals may also be tested directly in the same way.  Subsequent immunotherapy treatment with very low-dose, subcutaneous or sublingual vaccines can proceed in conjunction with avoidance of the offending agent (Scadding and Brostoff, 1986).  Testing and treatment are also possible with neutralizing doses to neurotransmitters; like serotonin, dopamine, methacholine and others, which can produce substantial improvement in the patient’s symptomatology.  Intradermal testing involves not only evaluating the skin whealing response but also assessing symptoms and signs that may be produced from the testing itself.  Sublingual testing, which relies almost exclusively on symptoms or signs, can nevertheless be a valuable testing technique.

Inhalation.  One of the most scientifically rigorous evaluations of chemical sensitivity is specific challenge with low-dose chemical exposures.  These take place inside in an enclosed glass and anodized-aluminum booth, under controlled circumstances (Rea et al., 1990).  When done properly, these can help determine whether the patient is sensitive to a variety of chemical substances.  Appropriate dilutions of chemicals are vaporized in the booth to achieve concentrations that are below odor thresholds and that approximate levels found in everyday settings (Rea et al., 1990).  These tests are performed on a double-blind basis, using placebos of water or saline.  The booth is evacuated and washed after each challenge to prevent any potential contamination.  The absence of intake pipes or tubes that direct gas into the booth also prevents potential contamination and subsequent invalidation of subsequent tests at a later date.  Chemical testing performed in such a booth must be done with the patients in the de-adapted state for reliable results (Rea et al., 1990).

The ideal location for this type of low-dose, chemical challenge is a hospital-based, environmental control unit (ECU) (Sprague, 1987) in which the patient is housed in a very clean environment for several days before testing begins.  The principles of total load and de-adaption must be understood and followed with low-dose, inhaled, challenge testing, because incidental outpatient exposures to perfume, traffic exhaust, cigarette smoke, or other substances may trigger delayed responses that will cause inconsistent results.

Transfer Factor.  Another potential treatment for patients with MCS is immune stimulation, especially in view of the frequent occurrence of immunosuppression with this illness.  (Levin and Byers, 1987).  The use of transfer factor may prove very helpful in these cases (Youdim et a., 1991).  Transfer factor is an extract of white blood cells with known immune-stimulating properties.  It is especially helpful in cases of leukopenia or in reduced leukocyte-killing capacity, which may contribute to recurring infections.

Pupilography.  An additional method being developed to evaluate patients with MCS is the assessment of autonomic nervous function by pupilography (Shirakawa et al., 1992).  Hamamatsu Photonics of Japan, in cooperation with the Department of Ophthalmology at Kitasato University, has developed a sophisticated optical device called the binocular iriscorder, that scans the eye surface in the infrared spectrum, and measures the pupilographic response to a specific light stimulus by very precise, computerized measurements.  These are then compared with a standard reference range.

The change in pupil size, velocity of contraction and dilation, recovery time, and other parameters are measured in milliseconds following the light stimulus.  These measurements are usually quite stable in each individual, with a slight diurnal variation.  Patients with MCS have frequent deviations from baseline and exhibit considerable instability of autonomic function, usually in a sympatholytic pattern (Shirakawa et al., 1992).  Many patients, whom the author has tested in blind, intradermal challenges with agents to which the patient is known to be sensitive, show distorted autonomic stability.  Further research with this computerized analysis is pending.

Posturography.  Another technique for evaluating patients with MCS is posturography testing, which essentially evaluates the neurologic integration of the nervous input from the eyes, ears, and peripheral nervous system by computerized methodology.  Frequently, the author finds disorders of balance in patients with chemical sensitivity, and especially patients with histories of significant chemical exposures.  When these patients undergo detoxification programs to enhance metabolism and the elimination of toxic chemical substances from their bodies, substantially improved measurements of these specific, neurologic balance functions usually result.

Adipose and Nerve Tissue.
Toxic chemical substances may be stored for long periods in adipose and nerve tissue; many xenobiotics are direct neurotoxins (Seba et al., 1987).  Indeed, DDT-type compounds and many others are often found in adipose tissue at much higher levels than would be found in blood under steady-state conditions.  Certain individuals appear to have an impaired ability to effectively detoxify some of these exogenous substances.  The chemicals may then build up over long periods following repeated exposures, especially in industrial settings (Seba et al., 1987).  Levels of potentially toxic chemical substances at 10-40 times the population average, or even greater, are not unusual in MCS patients.  With such toxic loads, it is perhaps not surprising that patients are unwell with various neurologic and other symptoms.

Detoxification.  One method that is gaining considerable interest for reducing this total toxic load is a detoxification program using an integrated regiment of graduated exercise:  nutrient replacement; and sauna-chamber, heat-depuration therapy (Schnare et al., 1982).  The heat chamber at the Environmental Health Center-Dallas is built with ceramic tile on all inside surfaces and untreated wooden benches:  it uses relatively low temperatures, in the range of 140°F.  Patients first exercise and then spend time in the sauna to induce profuse perspiration.  Under these conditions, stored xenobiotics appear to mobilize substantially (Schnare et al., 1982) and can then be metabolized, primarily through the liver and the gut, but also through the breath, urine, and perspiration.  The clearance rate of stored xenobiotics from the body may be quite variable, and the author’s experience shows that styrene and chloroform come out most easily.  1.1.1.-Trichloroethane is ubiquitous and seems to be the most difficult to clean (Rea et al., 1987b).  If, however, such a detoxification program proceeds too quickly, the patient may worsen for a time, usually in conjunction with a rise in liver transaminases, which suggests a significant strain on hepatic function.  With caution however, these xenobiotics can be substantially reduced in MCS patients, usually with marked improvement in the patient’s overall chemical sensitivity and general health (Rea et al., 1987b).

Another area of growing interest and potential treatment is the controversial issue of amalgams and their adverse consequences on health.  The television program “60 Minutes” reported on the hazards of silver/mercury tooth fillings and raised many questions about the safety of this heretofore well-accepted dental material.  Although this subject is controversial and consensus is lacking, sensitization to mercury is a real phenomenon.  Removing amalgams is an option that certainly requires investigation, especially for chemically sensitive patients.


The essential features of treatment for chemical sensitivity are:
1) Encouraging the provision of clean air, food, water, and surroundings.

2) Identifying substances to which the patient is sensitive, with subsequent
       a) enhanced avoidance, or
       b) specific immunotherapy to reduce the patient’s reactivity to those substances.

3) Assessing and enhancing the patient’s nutritional status to maximize the body’s ability   to detoxify and to minimize the free-radical production and oxidative stress of xenobiotics.

4) Addressing concurrent problems such as infections, immunosuppression, and other medical conditions in an appropriate fashion.

5) Evaluating the patient’s psychologic status and addressing any social and emotional problems in a compassionate manner.

The author believes that multiple chemical sensitivity is a real condition with documented physiologic abnormalities.  It is not a functional or psychologic illness or a belief system of the patient.  Second, this condition is diagnosable and treatable by various means.  These treatment options not only make common sense but usually result in significant improvement for these unfortunate patients, who deserve the very best efforts of their health care providers.


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