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Multiple chemical sensitivity (MCS) is described as a chronic condition characterized by adverse effects from exposure to low levels of chemicals or other substances in modern human environments. Suspected substances include smoke, pesticides, plastics, synthetic fabrics, scented products, petroleum products, and paints.[1]
MCS is a controversial diagnosis, and is not recognised as an organic illness by the American Medical Association.[2] Trials have shown that generally MCS patients do not consistently react to chemicals below the odor threshold,[3] but they do react in unblinded tests when they believe they are being exposed to a trigger.[4] This has led some to believe that MCS symptoms are simply due to odor hypersensitivity,[5] or are mainly psychological.[2]
MCS has also been termed toxic injury (TI), chemical sensitivity (CS), chemical injury syndrome (CI),[6] 20th Century Syndrome, environmental illness (EI), sick building syndrome, idiopathic environmental intolerance (IEI), and toxicant-induced loss of tolerance (TILT).
Six consensus criteria were identified by researchers for the diagnosis and definition of MCS in 1989 (later edited in 1999) :[7]
The National Institute of Environmental Health Sciences (a division of the NIH) defines MCS as a “chronic, recurring disease caused by a person’s inability to tolerate an environmental chemical or class of foreign chemicals”.[9] MCS has also been described as a group of “sensitivities to extraordinarily low levels of environmental chemicals” appearing “to develop de novo in some individuals following acute or chronic exposure to a wide variety of environmental agents including various pesticides, solvents, drugs, and air contaminants” including those found in sick buildings.[10]
Environmental Medicine Specialists claim that MCS causes negative health effects in multiple organ systems, and that respiratory distress, seizures, cognitive dysfunction, heart arrhythmia, nausea, headache, and fatigue can result from exposure to levels of common chemicals that are normally deemed as safe.[11][12]
Ronald E. Gots, M.D., an environmental toxicologist and frequent defense consultant in toxic tort litigation,[13] describes MCS as “a label given to people who do not feel well for a variety of reasons and who share the common belief that chemical sensitivities are to blame. … It has no consistent characteristics, no uniform cause, no objective or measurable features. It exists because a patient believes it does and a doctor validates that belief.”[14] In editorial in the Journal of Toxicology – Clinical Toxicology Gots wrote that “The phenomenon of multiple chemical sensitivities is a peculiar manifestation of our technophobic and chemophobic society. … It may be the only ailment in existence in which the patient defines both the cause and the manifestations of his own condition.”[2]
Because of the lack of scientific evidence based on well-controlled clinical trials that supports a cause-and-effect relationship between exposure to very low levels of chemicals and the myriad symptoms reported by clinical ecologists, MCS is not recognized as an established organic disease by the American Academy of Allergy, Asthma, and Immunology, the American Medical Association (AMA), the California Medical Association, the American College of Physicians, and the International Society of Regulatory Toxicology and Pharmacology.[15][16][2] In 1994, the AMA, American Lung Association, US EPA and US Consumer Product Safety Commission published a booklet on indoor air pollution that discusses MCS among other issues. Although sometimes misrepresented as evidence that these entities no longer oppose MCS as a specific disease, the booklet describes MCS as unproven and indicates that other misdiagnosed or undiagnosed diseases cause the symptoms that the patient incorrectly attributes to MCS.[17]
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