Multiple chemical sensitivity: A primer for pulmonologists

Multiple chemical sensitivity is a commonly used diagnostic term for a group of symptoms without apparent organic basis. The symptoms are characteristic of dysfunction in multiple organ systems, wax and wane according to exposure to low levels of chemical agents in the patient's environment, and sometimes begin after a distinct environmental change or insult such as an industrial accident or remodeling. Although traditional medical organizations have not agreed on a definition for this syndrome, it is being increasingly recognized and makes up an increasing percentage of the caseload at occupational/environmental medicine clinics. The prominence of pulmonary complaints and the specific overlaps with asthma symptomatology make it a challenge for the practicing pulmonologist. Recognition of pulmonary aspects of psychiatric syndromes such as hyperventilation, anxiety disorders, and posttraumatic stress disorders is critical to optimum management and therapy. Although there is often dispute about whether the symptoms have a functional or organic basis, an informed approach to evaluation, diagnosis, and management and a careful assessment of impairment, disability, and work relatedness are necessary. Careful exclusion of organic causes, both toxicologic and nontoxicologic, is critical, followed by a judicious approach to coping with what at the end of practical evaluation seems to be mostly functional symptoms. Medical care is often best integrated from a psychosocial perspective.