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“1. There are usually multiple symptoms involving multiple body systems, such as the nervous, respiratory, gastrointestinal, and the musculo-skeletal systems.

2. Typically, symptoms occur after initial exposures which can be identified by the person (such as the chemical off-gassing during the installation of new carpeting), or repeated low-levels of chronic exposures (such as pesticide spraying, working over a dry cleaning shop, or with solvents).

3. Symptoms occur and subside in response to an ever-increasing number of substances and products at lower and lower levels. Reactions are triggered by petrochemicals, combustion sources and by-products and coal tar derivatives.

4. Symptoms are brought on by very low levels of exposures - below the permissable exposure levels for various chemicals established by the government, and usually below exposure levels tolerated by most people.

5. Symptoms are triggered by exposures to a wider range of substances found in the workplace and at home. Solvents (paint, varnishes, adhesives, pesticides, and cleaning solutions) are most frequently implicated. Some other substances include new building materials and furnishings, formaldehyde in new clothes, perfumes and colognes, detergents, air exhaust, books, and copying machines and laser printer toners.

(A compilation from various sources by Nancy Day: Hazards at the Brigham. Revolution, Spring 1995.)

R A Graveling, A Pilkington, J P K George, M P Butler, S N Tannahill. Institute of Occupational Medicine, Edinburgh, UK. 1999.[1]

A critical review of several hundred references on MCS. “Despite extensive literature on the existence of MCS, there is no unequivocal epidemiological evidence; quantitative exposure data are singularly lacking; and qualitative exposure data are, at best, patchy. There is also some evidence to suggest that MCS is sometimes used as an indiscriminate diagnosis for undiagnosed disorders. Despite this, the collated evidence suggests that MCS does exist although its prevalence generally seems to be exaggerated. Many causal mechanisms have been proposed, some suggesting a physical origin - such as MCS reflecting an immunological overload (total body load) - others favouring a psychological basis - such as MCS symptoms being evoked as part of a conditioned response to previous trauma. The available evidence seems most strongly to support a physical mechanism involving senstisation of part of the midbrain known as the limbic system. However, it is increasingly being recognised that the psychological milieu of a person can considerably influence physical illness, either through generating a predisposition to disease or in the subsequent prognosis. Work is needed to establish the prevalence of MCS and to confirm or refute selected causal mechanisms.”

“The concepts of masking and TILT both merit consideration ... it seems there is a range of individual susceptibility to the effects of chemicals... It is plausible that components of unrelated chemicals could share certain carbon links with similar surface activity able to trigger a response in a previously sensitised person.... As yet limbic kindling... is purely hypothetical. It seems to fit most, if not all, the facts concerning MCS and can be supported by knowledge of the neurophysiology of the brain... However this... has to explain why MCS is not more prevalent among groups with higher exposures...”

Perhaps the use of a controversial MCS diagnosis in a work-related injury (eg solvent, glutaral- dehyde or formaldehyde exposure) has kept physicians and patients away from an MCS diagnosis for fear of having the claim for compensation rejected upon psychosomatic/it’s all the the head/they have PMT etc grounds. There is no doubt about the MCS symptoms of some of the glutaraldehyde, formaldehyde, and solvent members of this network. There is also no doubt about the general policy of rejection of MCS claims upon psychological grounds by the ACC of New Zealand, until the recent acceptance in the High Court of three claims for solvent and pesticide exposures resulting in MCSS. (One claim for MCS from exposure to photographic chemicals was accepted by ACC in 1992 (Marriot ACA 249/91). Some MCS claims were accepted in the early 1980s.) Several claims for MCSS in nurses and radiographers are currently at ACC review.

From ACTA UPDATE, April 1999. “One of Australia’s most promising young show horses has tested hyper-sensitive to more than 3 dozen foods and natural stubstances... it is obvious the horse also reacts to numerous synthetic chemicals with reactions which have both behavioural and physical manifestations. Surely not even the most skeptical can accuse an animal of holding “an inappropriate belief system... ”

Dr Claudia Miller, Assistant Professor in Allergy and Immunology at the University of Texas Health Science Centre, San Antonio, and Nicholas Ashford, Professor of Technology and Policy at the MITposits that their new, testable TILT theory of chemically induced disease shows how in certain susceptible persons, a single high level or repeated low-level exposure to chemicals may cause some people to lose their natural tolerance for various chemicals, foods and drugs. Subsequently, ultra-low levels of the same and chemically-unrelated substances trigger symptoms, thus perpetuating illness.

Converging lines of evidence support this theory: (1) The fact that similar multisystem symptoms and new-onset intolerances have been reported by different investigators among different demographic groups following exposure to many different types of chemicals; (2) the internal consistency of these patients’ complaints of intolerances for not only tiny doses of inhaled chemicals but also various foods, caffeine, alcohol, and medications; (3) the degree to which the illness mimics addiction; (4) the identification of an anatomical substate whose malfunction might explain these problems (the limbic system); and (5) recent animal models that replicate key features of TILT.

Ultimately, human challenges conducted in an environmentally-controlled hospital unit may be essential for resolving questions of etiology (psychogenic, toxicogenic) in a definitive manner. A set of postulates for etiological verification is offered.[2]

TILT Website: http://www.med.vc.edu/htdocs/medicine/ceg/oxstress/Leikauf.htm

At the American Chemical Society Symposium, Aug 1998, Barbara Sorg, University of Washington, described attempts to use time-dependent sensitisation to model MCS. Low doses of formaldehyde were administered daily for 7 or 20 days to rats which were, 2 weeks later, tested for response to cocaine. The F-treated rats showed more cocaine reaction (rearing and moving about) than did the controls. She then blocked this activity with tranquiliser injected into the portion of the limbic system of the brain which influences emotional/endocrine etc processes. The results demonstrated how the sensitivity to an endogenous (from outside the body) chemical can be changed. (Our Toxic Times, Dec 1998).

Cynthia Wilson, CIIN, in Our Toxic Times, March 1999, quotes the adage: “An illness for which there are many treatments has no cure”. Several surveys of MCS have shown the only point of agreement is that there is no cure. MCS is progressive. The more you are exposed the more damage can be done. Four categories of treatment: (1). No harm. (2). Benefit unlikely or patient made worse. (3). Treating the illnesses and conditions which appear concurrently. Other medical causes need to be ruled out. The longer an MCS person is on a drug the more likely they are to develop an adverse reaction to it. (4). The treatment universally beneficial and hated: AVOIDANCE. It wrecks havoc on families. Tracking chemical triggers can be long and painful - on average 3 yrs to work out and successfully manage. “No exposure, no symptoms, no need for medication.” Avoidance builds tolerance but sufferers begin to to feel so good many mistake the feeling for being cured. But people in this stage are on very dangerous ground and are devastated when they forget avoidance and get an exposure that may undo years of avoidance.

CFS forms part of the diagnosis in some chemical injuries. Research by the Collaborative Pain Research Unit (including Prof Tim Roberts and Dr Hugh Dunstan, Dept Biological Sciences of the University of Newcastle; Dr Neil McGregor, clinical scientist; Dr Henry Butt, of John Hunter Hospital) and duplicated in Sweden, has (Aug 1997) linked a common bacterial infection, mycoplasma, to CFS. One SNFTAAS member whose doctor is involved in this research writes: “My food absorption and gut function is poor. Consequently I am on digestive enzymes, amino acid supplements, massive doses of vitamin C (1200mg), calcium and vitamin D (not absorbing), acidophilus plus a bowel flora food, all in excessively large doses with no side effects. He also performed a new test for mycoplasma infections using DNA - positive (as were 4 other glutaraldehyde-affected). Consequently, I have been on double strength antibiotics for 8 months with some interesting results. I was told all my symptoms would come back if it was going to work and then I would get better. I had a range of symptoms that I had not even connected to my exposure and, yes, I have not felt this well for a long long time.”

This mycoplasma test is also available at Waikato Hospital, NZ - cost c. $150. The haematologist involved is Kevin Barratt who works with the blood bank.

The Challenge of Chronic illness; A Report on the Recent International CFS Conference, Sydney, 1999. Peter Evans, ACTA. (Report in UPDATE, No 47, April, 1999)

Predominant theme was evidence of the role of bacterial and viral infections in CFS - such as mycoplasma fermentans, rickettsia, chlamydia, and stealth viruses with their experimental treatments. Other research subjects are serum potassium and hormone dysregulation following exercise; biochemical and urinary metabolite abnormalities; the disruption of ion exchange mechanisms across the cell wall (channelopathy) and the presence of an interferon enzyme of low molecular weight, called RNase L which may have potential as a diagnostic marker. Although the treatment of CFS with multiple combinations of antibiotics does have some promise, many of the organisms are not proven pathological or thought necessarily to be a cause of CFS. However the increased presence of mycobacterium and other organisms may be a result of immune dysfunction through a process similar to HIV/AIDS where opportunistic infections contribute to the disease process. A legal warning was given on the potential for litigation relating to institutional negligence in the care of people with CFS. Conference transcripts from Alsion Hunter Memorial Foundation ph (02) 9418 2465.

NOTE: ACTA Update Oct 98: Such a positive response [to antibiotics] may only happen in an atypical subset, as antibiotics can trigger an acute reaction in MCS sufferers. Mycoplasmas, the smallest bacterial organisms with the capacity to invade cells, tissues and blood, are aeons old and were not previously considered human pathogens, however the organism may have mutated.

Hedrick T. The Royal Colleges report on CFS. CFIDS Chronicle, 1997, 10, 1, 8-13. This is an “insidiously biased and potentially harmful” report on Chronic Fatigue Syndrome....with a pervasive psychiatric bias... Neuroimaging studies were largely dismissed....No credibility was given to the ‘reverse causation’ hypothesis that the reactive depression or anxiety may develop because of the experience of having a debilitating illness for which cause and treatment are not known, and that may result in loss of career and lead many patients to have negative health experiences with health professionals. Is a self-reported physical symptom psychiatric or physical? Dr Leonard Jason (Monitor, Nov 1996): “People with CFS can make you a list of all the things they want to do tomorrow, but a person with depression cannot...Also CFS patients tend to suffer from exercise intolerance - they find exercising particularly difficult and tiring - whereas exercise usually makes depressed people feel better”. A 1994 US study found no significant reduction in depression, self-reported stress, or fatigue scores in CFS patients under-going cognitive-behavioural intervention (CBT), whereas positive results were found for persons with depression. This report may trivialise the illness - “just being tired”. And a lot more.

Professor Brian Goble brings together the effects of chemicals in two reasonably specialised but very interesting papers on the following Australian Chemical Trauma Alliance (ACTA) web page: http://www-mugc.cc.monash.edu.au/~deg

He was exposed to Agent Orange and other chemicals in Vietnam and appears as an expert witness in many different chemical cases with very good success. (Fees reasonable and will do a report). <goble@kin.on.net> <http://www-mugc.cc.monash.edu.au/~degob1/goble>

Another good ACTA article is “Don't Fight The Healing Process”. ACTA’s address is:

c/o Tracy Brown, 178 Chapel St, Armidale, NSW, 2350, Australia. <acespade@northnet.com.au>

[1]Graveling R A et al. A review of multiple chemical senstivity. Occ Env Med. 1999, 56, 73-85.

[2] Miller Claudia S. Toxicant Induced Loss of Tolerance. Environmental Health Perspectives, 1997, 105, Supplement 2, March, 445-453. Presented also at the Marj Gordon Memorial Seminar. Reprint requests to: Claudia S Miller, Dept of Family Practice, Environmental and Occupational Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, Texas 78284-7794, USA.