Nonspecific environmental syndrome definition

Non-specific environmental syndrome – definition

Somatization syndromes in environmental medicine include

1. The Idiopathic Environmental Intolerance IEI = acquired disorders with numerous and recurring complaints in connection with diverse environmental influences that are well tolerated by the majority of the population. The complaints cannot be explained by a known medical or psychiatric / psychological disorder.

2. The Sick Building Syndrome SBS = acquired disorder with disorders with numerous and recurring complaints from a group of people who are all in the same room or building, with improvement after leaving these rooms.

(The SBS must be differentiated from the Building Related Illness BRI, where specific triggering substances, such as asbestos, can be detected.)

Both definitions replace the older term Multiple Chemical Sensitivity MCS. MCS is not uniformly recognized as an independent clinical picture.

Synonyms: Multiple Chemical Sensitivity Syndrome (MCS syndrome), multiple chemical sensitivity, multiple chemical intolerance, multiple chemical hypersensitivity, Idiopathic Environmental Intolerance (IEI), idiopathic environmental disorder, idiopathic chemical disorder, idiopathic chemical disorder

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Non-specific environmental syndrome – ICD10

F45.9 unspecified

(to be differentiated from T78.4 allergy, unspecified)

Non-specific environmental syndrome – frequency

The frequency is given as 2 to 10% in the general population (10 to 20% in environmental medical outpatient clinics).

Non-specific environmental syndrome – accused chemicals:

Amalgam 44%

Wood preservative 20%

Solvents 2%

Heavy metals 2%

Nonspecific environmental syndrome – emergence

The unspecific environmental syndromes cannot be fully explained by the action of chemical substances. Therefore, a comprehensive explanation approach (bio-psycho-social model) has prevailed.

Biological models:

The biological disease mechanisms include:

• A loss of tolerance to environmental chemicals in low doses due to their toxic effect
• Classic conditioning: Stress symptoms are attributed to environmental factors in low dose range, possibly even after a single exposure to a high dose
• Psychoneuroimmunological influences
• Inflammatory mechanisms in nerve tissue
• Incorrect control of the sensitivity of nerve cells (sensitization: increase in strength of a reaction of the entire organism with repeated presentation of the same stimulus and kindling: increase in response intensity to rather rare and weak stimulation of brain areas)
• Symptoms can be due to an undiagnosed physical or psychiatric illness (e.g. depression, anxiety disorder, somatization disorder, porphyria).

Psychological models:

The following psychological processes involved were identified in non-specific environmental syndromes:

• Simple stress response
• Adjustment disorders
• Paranoid syndrome

There is also a mechanism in which physical discomfort arises as an expression of psychological stress, but which the person concerned relates to external environmental factors. The cause is disturbance in the control, perception and expression of feelings.

Non-specific environmental syndrome – clinical picture

The complaints are triggered by numerous different, chemically unrelated substances. The triggering concentrations do not cause any harmful or annoying effects in the general population. Both, the number of substances that trigger the reaction, and the variety of symptoms experienced, increase over the course of the disease. The course is chronic in half of those affected.

Central nervous system:

• Headache
• Tiredness
• Weakness
• Disturbances in memory and concentration
• Sleep disorders
• Dizziness
• Fainting

In addition there are irritation symptoms of the mucous membranes:

• Eyes (burning eyes)
• Mouth and throat (runny nose)
• Respiratory tract (irritable cough)

Indigestion is also possible:

• Feeling of fullness
• Flatulence
• Diarrhea
• Stomach cramps

In 66% of those affected by an unspecific environmental syndrome, other mental illnesses appear:

Non-specific environmental syndrome – Diagnosis

Since a large number of environmental factors must be excluded, the diagnosis of non-specific environmental syndromes requires a wide range of expert knowledge:

• Environmental medicine
• Toxicology
• Hygiene, occupational and social medicine
• Internal Medicine
• Neurology
• ENT
• Dermatology
• Psychosomatic medicine

Non-specific environmental syndrome – treatment

Given the complexity of the disease, which can lead to persistent incapacity to work, the treatment is carried out in cooperation with the environmental clinic. There are currently no scientifically founded somatic therapy concepts for the unspecific environmental syndrome. This uncertainty provides the breeding ground for unwarranted views in which patients and their contact persons (doctors, naturopaths, “environmental toxicologists”, “clinical ecologists”) confirm each other’s fears and causal concepts. Acceptance then is depending upon the extent in which the advisor confirms the affected person’s own concept of illness. It is all the more important not to leave those affected alone with their symptoms. Right from the start, a detailed and respectful approach to the individual’s ideas about his complaints and to the peculiarities of his personality and individual vulnerability is required. In addition to providing information about the nonspecific environmental syndrome, methods of cognitive behavioral therapy and psychodynamic therapy are used:

• Relaxation exercises
• Social skills training
• Stimulus exposure
• Group therapy to deal with mental problems
• Interaction groups on environmental issues

However, most of those affected perceive psychotherapeutic approaches as inadmissible “psychiatrization” and are therefore reject them altogether.

On the other hand, the standard recommendation of “avoiding environmental toxins” is extremely dubious. Chances of success of the attempt to remove all substances and particles that are conceivably chemically contaminating from a home are doubtful at best. The usefulness of the measure is even more questionable, due to the the fact that the complaints by definition occur precisely at concentrations of substances that do not cause any complaints in other people, and that no clear trigger can be identified for IEI / SBS. Therefore, removal of amalgam fillings -as expected- rarely eliminates the complaints of an unspecific environmental syndrome definitely and completely.

In addition, a myriad of nutritional supplements and herbal medicines are recommended, mostly with the intention of providing “antioxidants”

• Glutathione,
• Vitamins B12, C, D, E, riboflavin, folic acid
• α-lipoic acid
• Coenzyme Q10
• Omega-3 fatty acids
• Curcumin
• John’s wort

In practice, the attending physician has to find a compromise between the required reluctance to use scientifically unproven forms of therapy and his openness to new things.

Sources:

Nasterlack, Michael; Kraus, Thomas; Wrbitzky, Renate: Multiple Chemical Sensitivity: Eine Darstellung des wissenschaftlichen Kenntnisstandes aus arbeitsmedizinischer und umweltmedizinischer Sicht Dtsch Arztebl 2002; 99(38): A-2474 / B-2116 / C-1981

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