Mcs, Multiple Chemical Sensitivity; Iei, Idiopathic Environmental Intolerance

(Multiple chemical sensitivity, environmental illness)

Idiopathic environmental intolerance is characterized by recurrent, non-specific symptoms, which frequently occur at low exposure in the environment, not chemically related substances occur. The symptoms are many and often involve multiple organ systems, but the physical findings are unremarkable, the diagnosis is a diagnosis of exclusion. Psychotherapeutic support and avoiding the identified trigger is recommended, although just barely let this define.

There is no universally accepted definition, but generally idiopathic environmental tolerance is defined as the development of many symptoms that are attributed to exposure to identifiable or unidentifiable chemical substances (by inhalation, contact or ingestion), without clinically detectable organ dysfunction or physical symptoms associated comes.

Idiopathic environmental intolerance is characterized by recurrent, non-specific symptoms, which frequently occur at low exposure in the environment, not chemically related substances occur. The symptoms are many and often involve multiple organ systems, but the physical findings are unremarkable, the diagnosis is a diagnosis of exclusion. Psychotherapeutic support and avoiding the identified trigger is recommended, although just barely let this define. There is no universally accepted definition, but generally idiopathic environmental tolerance is defined as the development of many symptoms that are attributed to exposure to identifiable or unidentifiable chemical substances (by inhalation, contact or ingestion), without clinically detectable organ dysfunction or physical symptoms associated comes. Etiology trigger Among the known triggers for idiopathic environmental intolerance: alcohol and drugs caffeine and additives carpet and furniture odors smell of petrol and engine exhaust art supplies perfumes and other Dufstoffe pesticides and herbicides mechanisms Immunological and non-immunological theories have been proposed. but these fail because there is no consistent dose (impact) reaction on contact with the suspected substances d. H. the symptoms can not trip when the patient high doses of the substance that seems to provoke the response at low doses, is suspended. Also, there is a lack of consistent objective evidence of systemic inflammation, a Zytokinüberschuss or a corresponding symptoms activating the immune system. Many physicians assume a psychological cause and see this rather as a kind of somatic symptom disorder (somatization). Others believe the syndrome for a sort of panic attack (panic attacks and panic disorder) or agoraphobia (somatization). Dieidiopathische environmental intolerance occurs in 40% of patients with chronic fatigue syndrome (chronic fatigue syndrome), and in 16% of patients with fibromyalgia on (fibromyalgia). Idiopathic environmental intolerance occurs more in women. Although measurable biological abnormalities are rare (z. B. reduced B cell number, increased IgE levels), they occur quite some patients. However, these abnormalities appear with no consistent pattern, its meaning is uncertain, and the investigation of these anomalies to determine an immunological basis for the disorder should be discouraged. Symptoms and signs There are numerous symptoms (eg. As palpitations, chest pain, sweat tendency, shortness of breath, fatigue, skin rashes, dizziness, nausea, choking, trembling, numbness, coughing, hoarseness, difficulty concentrating) and usually more than one organ system is affected. The majority of patients presented a long list of suspicious substances that have been identified by them or a previously consulted a doctor. These patients often take a lot on yourself, and to these substances to go out of the way, change their homes and workplaces, avoid foods that contain “chemical additives”, wear them in public, sometimes a surgical mask or avoid large gatherings of people. The physical examination is typically unremarkable. Diagnostic exclusion of other causes first The diagnosis involves the exclusion of known diseases with similar manifestations: allergies (. Eg hay fever, food allergies) Atopic diseases (eg asthma, angioedema.) Building-related diseases connective tissue diseases (eg SLE.) Endocrine disorders ( z. B. carcinoid syndrome, pheochromocytoma, mastocytosis) Atopic disorders are excluded by the typical clinical history, skin prick test and serum assays for specific IgE. The consultation with an allergy specialist may be helpful. Diseases which are associated with the living and working environment, including the “sick building syndrome” in which many people live in a place or work and symptoms develop (Building-related diseases: Specific BRI) should be taken into account. If symptoms and complaints do not indicate a strong connective tissue or rheumatic autoimmune disease (eg. As joint, skin and / or mucosal manifestations), should the investigation to a variety of autoantibodies (z. B. antinuclear antibodies [ANA] , rheumatoid factor, extractable nuclear antigens [ENA]) can be avoided. In such cases, the pretest probability is low and false-positive results are more likely to be genuine positives; a weak positive ANA is present at about 20% of the population. avoid treatment Psychological therapies Sometimes suspected trigger Despite an unclear cause-and-effect relationship targets the treatment sometimes on the avoidance of suspected substances on what can be difficult because many of them are ubiquitous. However, the patient should not be encouraged to socially isolating, expensive and very destructive avoidance behavior. A supportive relationship with a family doctor provides the reassurance and protects the patient from unnecessary tests and procedures, is helpful. Psychotherapeutic investigation and intervention can help, but to defend themselves, many patients against this approach. However, this is not a priority to convince the patient that the cause is psychological, but to help them cope with their symptoms and improve their quality of life. Useful techniques include psychological desensitization (often as part of cognitive behavioral therapy) Phobic and graduated Exposition- Specific Disorders: Treatment). Psychotropic drugs can be helpful if they are aimed at co-existing psychiatric disorders (eg. As major depression). Key points Based on current evidence, the idiopathic environmental intolerance not be explained by non-psychological factors. For the diagnosis of diseases, connect, similar manifestations (eg., Allergic disorders) may have and pull the sick building syndrome into consideration. Try to immunological abnormalities only when they are indicated by the clinical findings Support psychological therapies such as gradual exposure and drug treatment of coexisting psychiatric disorders.

Health Life Media Team

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