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Symptom Profile of Multiple Chemical Sensitivity in Actual Life

From the Department of Psychosomatic Medicine (M.S., H.K., K.Y., T.K.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; the Educational Physiology Laboratory (N.K., K.O., Y. Yamamoto), Graduate School of Education, The University of Tokyo, Tokyo, Japan; the Graduate School of Frontier Sciences (N.S., Y. Yanagisawa), Institute of Environmental Studies, The University of Tokyo, Tokyo, Japan; and the Environmental Medical Center (K.S., M.M., S.I.), The Kitasato Institute Hospital, Tokyo, Japan.

Address correspondence and reprint requests to Hiroaki Kumano, MD, PhD, Department of Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7–3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail: hikumano-tky{at}umin.ac.jp

Objective: This study was conducted to confirm the definition of multiple chemical sensitivity (MCS) in actual life: that multiple symptoms are provoked in multiple organs by exposure to, and ameliorated by avoidance of, multiple chemicals at low levels. We used the Ecological Momentary Assessment to monitor everyday symptoms and the active sampling and passive sampling methods to measure environmental chemical exposure.

Methods: Eighteen patients with MCS, diagnosed according to the 1999 consensus criteria, and 12 healthy controls participated in this study. Fourteen patients and 12 controls underwent 1-week measurement of physical and psychologic symptoms and of the levels of exposure to various chemicals. Linear mixed models were used to test the hypotheses regarding the symptom profile of MCS patients.

Results: Some causative chemicals were detected in 11 of 14 MCS patients. Two other patients did not report any hypersensitivity episodes, whereas passive sampling showed far less exposure to chemicals than control subjects. Another subject reported episodic symptoms but was excluded from the following analyses because no possible chemical was detected. Eleven of the 17 physical symptoms and all four mood subscales examined were significantly aggravated in the interview based on "patient-initiated symptom prompts." On the other hand, there were no differences in physical symptoms or mood subscales between MCS patients and control subjects in the interview based on "random prompts."

Conclusions: MCS patients do not have either somatic or psychologic symptoms under chemical-free conditions, and symptoms may be provoked only when exposed to chemicals.

Key Words: multiple chemical sensitivity • ecologic momentary assessment • linear mixed model • active sampling and passive sampling methods

Abbreviations: AS = active sampling; AS–PS method = active sampling and passive sampling methods; C_AS = the concentration of exposure estimated by the AS method; CFS = chronic fatigue syndrome; C_PS = the concentration of exposure estimated by the PS method; CS = chemical sensitivity; DAMS = Depression and Anxiety Mood Scale; DNPH = 2,4-dinitrophenyl-hydrazine; ED = electronic diary; EESI = Environmental Exposure and Sensitivity Inventory; EMA = Ecological Momentary Assessment; FM = fibromyalgia; M.I.N.I. = Mini International Neuropsychiatric Interview; MCS = multiple chemical sensitivity; PS = passive sampling; RSD = relative standard deviation; RSD_AS = RSD of repeatability test in the AS method; RSD_PS = RSD of repeatability test in the PS method; VOCs = volatile organic compounds.

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