Diagnosing MCSS

Multiple Chemical Sensitivity Syndrome (MCS or MCSS) goes under many names: EI (environmental illness), idiopathic environmental intolerance, chemical AIDS, and total allergy syndrome. The condition is very controversial, and many doctors believe it is a psychological disorder rather than a pathological syndrome. On the one hand, it has been difficult to persuade doctors and employers to believe that MCSS is a real disease; on the other hand, sufferers have lost jobs, been unable to continue living in their homes, avoided social situations, and found it impossible to pump gas into their automobiles for fear of becoming ill.

Most people with MCSS see some 6 doctors or more before they find a physician who will believe they suffer from an actual physical condition, rather than a psychological aversion to a specific odor or substance. MCSS has generated reams of data, both medical and scientific, but has yet to be embraced by the medical community as a true physical ailment. Many scientists and organizations are struggling to keep from giving recognition to the condition so that any efforts to research the syndrome fall by the wayside.

Spiting Naysayers

In spite of the naysayers, in the year 1999, a group of 89 researchers and clinicians succeeded in creating a definition for MCSS. The definition for the syndrome includes the following criteria:

*Symptoms can be reproduced

*The condition is chronic

*Exposure to even low levels of the offending chemicals brings on symptoms

*The symptoms resolve or at least improve when the inciting chemical(s) is/are removed

*Symptoms occur in response to multiple unrelated chemical substances

*Multiple organ systems are affected

Brave Individuals

Thanks to the brave individuals who have dared to believe in the very real symptoms of those who suffer from MCSS, our understanding of the syndrome has grown. Since MCSS was defined, it has been found that skin testing can be used to identify specific sensitivities to chemicals like formaldehyde, phenyl isocyanate, and phthalic anhydride. Patients tested in this manner have been found to have wheals, or raised areas of the skin that are visible to the eye and are measurable diagnostic findings.

These positive results have led to other forms of diagnostic testing for the syndrome including the neutralization-provocation test. It is telling that patients suspected of suffering from MCSS have tested positive for both patch testing (this test attempts to identify delayed hypersensitive responses) as well as inhalation challenge testing. In addition to these three diagnostic tests, MCSS patients were found to have objective medical findings for fiberoptic rhinolaryngoscopy and biopsy.

There is a downside to testing. Skin prick tests have been known to cause extreme nausea in MCSS patients, and it is not unheard of to find an MCSS patient who has an extreme allergic reaction (anaphylaxis) to a patch test. Symptoms must be induced before a rhinolaryngoscopic exam is performed, and this, too, is not a pleasant experience. Patients must also bear in mind that the inhalation challenge test is not indicated for those who suffer from extreme sensitivity.