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Table 4 Patients with environmental sensitivities have unique phenotypes, are complex to treat, rarely regain full health and are becoming more prevalent

From: Expert clinician’s perspectives on environmental medicine and toxicant assessment in clinical practice

Key challenges Clinician Quotes
Attitude towards patients with environmental sensitivities OEPs We don’t deal with the long-term because this is what normal life is. None of these very, molecular or unseen chemical injuries are being monitored, because that’s still really research.
There often is a lot of worry and psychological overlay with all of these cases, as they’ve been hunting around for months to find out what’s wrong with them.
You have to be a little bit careful in this area otherwise you can get a (bad) reputation.
Dose-response relationships are important. Whether there’s a plausible biological mechanism that can explain the mechanism from the exposure... It’s important not to create alarm.
I’ve seen a few multiple chemical sensitivity cases and you know most people write them off, but I tend to feel that there’s something going on there. There may be a psychological overlay; I don’t deny that, but there’s often a triggering event.
There’s only a few of us that drifted more towards a better understanding of patients holistically.
IPs The canaries are the ones that are set up early on in life to have more difficulty dealing with the environment, because in terms of liver and cellular detox, they’re not that well-equipped for the environment. So in terms of the bell-shaped curve, they’re at one end. And then the rest of us are in the rest of the bell-shaped. And then there’s the bulldozer, these guys go through life and they smoke and drink and they spray everything and you have to run them over at ninety.
Could it be overexposure therefore causation because the dosage was high enough, or could it be failure of elimination, because in the genetic diversity of the human race, some people are just crappy at clearing drugs, pills, potions and pesticides out of their system.
As you go through life, many things you’ll get over. But other things are there as a toxic record, if you like. Toxic Load. So it’s kind of the building blocks. And you get to a point, where it takes just a small event, whether it’s a viral infection, or some other toxic event, that pushes them through their ability to compensate and then they can go off in various directions, whether it’s chronic fatigue, autoimmune disease, degenerative disease, cancer, they are just options thereafter.
Observations of patients with environmental sensitivities IP I didn’t think see those allergies ten years ago.
The whole ADHD has been kind of like a tsunami in the making in recent times.
The increased number of people with mold-related illness… I do see more of what I now appreciate biotoxin exposures, rather than all pesticides, poisons and other types of toxins.
They’ve become a lot more difficult; more chronic illness, more environmental intolerances, more food intolerances and allergies, more chemical sensitivity… a rise of auto-immune diseases.
The biggest thing that has changed is the degree of education. The patients are much more aware and now they are far more likely to seek advice and tend to come earlier.
Thankfully patients are getting more informed about ideas and will often come in, rather than I’ve got something terrible happening and I’ve got no idea what it’s about, they will often be saying, I’ve got some terrible problems and I’m wondering about this, that and the other.
OEP Greater awareness of the population generally...I think GPs are becoming more aware of things like MCS and fibromyalgia… and for which patients were often rubbished thirty years ago.
Observations of phenotypes of patients with environmental sensitivities OEP The majority of people with Multiple Chemical Sensitivity have got some sort of an allergic, or highly reactive predisposition.
It’s not so much how much toxin they’ve been exposed to; it’s the individual response to that which becomes important.
One-fifth of the population who are already predisposed, develop this neuropathic pain, for which they have become a hypervigilant responder. They will give you a history of childhood asthma, maybe long-standing hay fever, working out in the farm areas with their exposures there.
A lot of these people have an allergic background, and I think that shows that they’re at risk to (environmental) sensitization.
IP These patients are extraordinarily sensory-sensitive in every way… they tend to be artistic, highly creative, able to read another person, very sensitive to another person’s emotions. When I go on their history, sometimes it’s he was a normal kid, but he was very, very sensitive to whatever things are around.
The blond-haired, blue-eyed freckly, or red-haired child of Scottish or Irish descent whose got behavioral problems are much more prone to salicylate sensitivity. And usually, if they are salicylate-sensitive, they’ll usually have a reaction to other chemicals, to artificial colors, flavors and additives.
People of Scottish-Irish descent are much more sensitive to gluten than other people.
The Irish for celiac disease, the Chinese for lactose intolerance is quite common.
These are the individuals who come in wearing white gloves and masks over their face. They’re all very, very detailed-minded, perfectionists in their views on life.
Sensitivity to smells and sensitivity to sound, to all of the senses, out of a group has an extraordinary advantage: that you hear the tiger, you know the poison in the plum, you become, effectively, the early warning radar. Their hypersensitivity might be a bit over the top but it keeps them out of harm’s way at a much higher rate than others... this may explain why the cancer rate in my patients is almost zero.
Observations of genotypes of patients with environmental sensitivities IP Some people are just crappy at clearing drugs, pills, potions and pesticides out of their system. And those who have it remain for a long period of time, may have vulnerabilities.
People with the HLA DRB-1 and the HLA-DQ test do put them into a category that makes perfect sense about why the person reacted (to biotoxins in a water-damaged building).
I have a sense that neurological sensitivity and methylation disorders and hypersensitivity to toxins, are different aspects of the very same thing, of the very heightened response of the central nervous system to particular inputs.
A reaction to chemicals implies they have some sort of genetic defect in their Phase II detoxification pathways.
Difficulties treating environmental sensitivities IP The more symptoms and systems involved and the more chronic the illness, the more challenging it is; especially people with multiple chemical sensitivity, because then they have difficulty tolerating the treatment as well.
Complicated chronic fatigue together with chemical sensitivity and pain… and severe neuroimmune dysfunctions. Those are the hardest to treat.
Very few people that I see get cured for Chronic Fatigue Syndrome … maybe 90% or more of the Chronic Fatigue Syndrome and chemically sensitive people, never go back to the level of health that you would expect from a fit and healthy person of their age but they adapt well and are able to go back to life and do things with the knowledge of their limitations.
Autism is clearly the hardest of the neurodevelopmental problems, complex neurodevelopmental disorders.
Older severely autistic are the most challenging and also the severely allergic, especially with anaphylactic type reactions.
Epilepsy, that’s probably the most difficult one.
I’ve got a patient today with high bisphenol and phthalate levels. What do you do about it, besides stopping the exposure? So then, the question is, when they’ve got all these things and they’ve stopped the exposure and they are still very sick people, how do you go about dealing with that?