A 4-Year-Old Girl with Manifestations of Multiple Chemical Sensitivities

Environmental Health Perspectives, Dec, 2000 by Alan Woolf

The family was counseled, about keeping a home symptom diary. Pulmonary function testing was recommended when the patient becomes old enough to cooperate. Coping measures and feedback to empower the patient were discussed. Anticipatory guidance was given on working with school officials to limit the environmental impact on the patient's school attendance. Follow-up 9 months later revealed continued respiratory and other symptoms with limited effectiveness of avoidance strategies, environmental controls, herbs, and medications. The patient had missed 15 days of her half-day kindergarten due to her symptoms, which seemed to be worsened by the school's use of a new carpet-cleaning solution.

A controversial syndrome in adults known as MCS is characterized by a range of disparate symptoms involving the skin, vascular, genitourinary, musculoskeletal, gastrointestinal, pulmonary, and central nervous systems, which are "triggered" by low-dose exposures to chemicals, foods, biologicals, or other toxic agents in the environment. Often adult MCS syndrome is initially precipitated by an exposure to a chemical in the workplace; subsequently the patient develops more and more intolerance to an array of foods, chemicals, and other "incitants" until he or she is functionally disabled. However, many clinicians question the validity of MCS as a medical entity and include it among "fashionable diagnoses" such as chronic fatigue syndrome or fibromyalgia, representing somatization of essentially psychologic complaints (1). Clinicians, researchers, and health policy makers cannot even agree on the name of this entity. MCS is also known as idiopathic environmental intolerance, environmental illness, environmental hypersensitivity, and universal reactors. MCS as a construct is felt by some to overlap with sick building syndrome (2,3) or the Gulf War syndrome (4,5).

MCS was recently reviewed by Kipen and Fiedler (6). Yet children, such as the case presented here, whose illnesses resemble the adult syndrome of MCS have been referred to our PEHSU. The American Academy of Pediatrics includes MCS in its recently published Handbook of Pediatric Environmental Health, but offers no diagnostic criteria (7). Indeed it suggests that such diverse childhood maladies as attention deficits, learning disorders, sick building syndrome, and hyperactivity syndromes can share elements with and overlap MCS.

Pediatric case definition. The case described in this paper meets certain definitional characterstics of MCS, such as a) effects on more than one body system; b) the occurrence of a variety of chemical, food, and biologic agent triggers at low-level concentrations; c) spreading of the incitant agents responsible for symptoms; d) progressive involvement of body systems; and e) the lack of a diagnostic or an abnormal laboratory assay. Although this child had been previously diagnosed with milk intolerance, asthma, and sinusitis, no one unifying set of diagnoses or explanations seemed to satisfy her range of symptoms or the progressive nature of her sensitivities. As the case with this child, many adults with MCS report the spreading nature of their intolerance to low-level environmental toxic agents--more and more toxicants must be avoided as time goes on. Diverse precipitants of symptoms have been postulated: biological agents, electromagnetic radiation, off-gassing construction materials and home decorations, foods, pesticides, synthetics, perfumes, other toiletries, and the like are cited as common offenders.