ALLERGIES AND MULTIPLE CHEMICAL SENSITIVITY
IN MYALGIC ENCEPHALOMYELITIS / CHRONIC FATIGUE SYNDROME
by Margaret Williams
29th November 2010
At this
auspicious time of celebration of 25 years of Bart’s Fatigue
Service for those suffering from chronic fatigue --
interchangeably referred to by Wessely School members as
fatigue, chronic fatigue syndrome, CFS, CFS/ME, ME, MUS
(medically unexplained symptoms), MUPS (medically unexplained
physical symptoms) and as a functional somatic syndrome -- it is
perhaps worth recalling that as part of the “service” provided
over the last 25 years, the Head of the Unit, psychiatrist
Professor Peter White (who is also Principal Investigator of the
MRC PACE Trial) seems to have been so busy providing this
remarkable “service” that he has been unable to keep abreast of
the emerging medical science relating to the chronic
inflammatory neuroimmune disorder known internationally as
ME/CFS.
There are
many examples of Professor White’s apparent lacunae. A
particularly notable one concerns the incidence of allergies and
multiple chemical sensitivity in ME/CFS which, curiously, given
the sheer amount of published evidence, Professor White denies.
The draft
NICE Guideline on CFS/ME that was sent out for consultation
included a section on multiple chemical sensitivity (MCS) as a
component of CFS/ME and called for “proper training”
about it to be given to “those caring for an individual with
severe CFS/ME professionally”. Professor White sprang into
action over this, stating starkly:
NICE’s
response was to remove this section on MCS and it did not appear
in the final Guideline.
It is
worth recalling that Multiple Chemical Sensitivity (MCS) may be
classified in ICD-10 at T78.4 (Allergy, Unspecified) and that
“Allergy Unspecified” is coded in the UK Read Codes at SN53.
The
following examples were published during the 25 years of the
“fatigue service” of which Professor White is so proud.
Allergies,
hypersensitivities and intolerances
Multiple allergies are frequently a component of ME/CFS.
Throughout the ME/CFS literature from at least the 1970s there
is increasing reference to the existence of allergies and
hypersensitivities to foods, normal household chemicals, gas,
petrol, perfumes, prescription drugs, agricultural chemicals and
even to seminal fluid; there is also reference to adverse
reactions to tap water, an early such reference being in 1982
(Hypersensitivity to Mains Tap Water in Adults: its Clinical
Features and Treatment. CWM Wilson. Nutrition and Health
1982:1:85-91). Up to 60%
of patients with ME/CFS appear to be allergic.
Multiple Chemical Sensitivity (MCS) is a well-documented
component of ME/CFS due to the significant immune system
disruption and dysregulation that since the 1980s has been
documented in the disorder in peer-reviewed international
journals (there are over 3,000 pages on MCS on the internet
using one search engine alone).
In 1983 it was recognized that such patients fare badly, not
least because of the obstacles allergy sufferers have to
overcome in coping with their allergies on a day-to-day basis:
apart from the frightening nature of the symptoms themselves,
their worrisome unpredictability and the limitations in diet and
lifestyle they impose, many difficulties are attributable to the
ignorance of other people, including medical professionals, who
are often the worst offenders. The instability of the condition
and its liability to deteriorate is a source of much additional
distress to sufferers and the cruel and mindless attitudes they
encounter add insult to injury (The Allergy Problem: Why People
Suffer and What Should Be Done. Vicky Rippere MA; PhD; BSc;
M Phil. Thorsons, 1983).
Given the evidence of a disrupted immune system, it was known in
1989 that
raised interleukin levels could ultimately lead to raised IgE by
stimulating the B cells (in other words, if not dealt with by
the immune system, an on-going virus may result in allergies –
Int Arch Allergy Appl Immunol 1989:89:90-97).
Normal body cells cannot be attacked by the immune system unless
they have been persuaded to display on their surfaces complex
glycoprotein molecules known as class II MHC antigens (which
they do not normally display). They can be induced to do this by
gamma interferon, an anti-viral chemical produced by the immune
system when under virus attack, which make cells susceptible to
this on-going attack by the immune system, thus doing further
damage to the very system upon which the body depends for its
defence.
There have
been many published papers demonstrating the association of
numerous viruses in ME/CFS patients, most notably the
enterovirus Coxsackie B (CBV), but in 2009, emerging evidence
demonstrated the involvement of a gamma retrovirus in ME/CFS
(XMRV, which is only the third human retrovirus known, the other
two being HIV/AIDS and HTLV, the Human T-cell lymphotropic virus
that causes leukaemia and lymphoma). A retrovirus inserts
itself into the host’s DNA by using RNA and once there, it stays
for life. Viruses such as XMRV can cause blood vessels around
the body to leak, a common symptom of ME/CFS. XMRV is thought
to disrupt the immune system which, once dysregulated, cannot
control the reactivation of multiple latent viruses (including
enteroviruses) and microbial agents, nor the cascade of allergic
reactions that, once triggered, cannot be switched off, as there
is no feed-back loop in the immune system.
The
following pages provide information about MCS and about
allergies in ME/CFS
For an historical perspective of MCS and an alphabetical
bibliography of over 600 referenced scientific articles,
editorials, books, book chapters and reports on or directly
related to Multiple Chemical Sensitivity (MCS) from 1945 to
September 1999, see the document compiled by Albert Donnay of
MCS Referral and Resources, 6101 Gentry Road, Baltimore,
Maryland 21210, USA (“Bibliography of all scientific articles,
editorials, books, book chapters, reports on or directly related
to Multiple Chemical Sensitivity disorders”, available online).
In
relation to MCS, attention must be drawn to the seminal work of
two of the world’s leading experts, namely Martin Pall,
Professor Emeritus of Biochemistry and Basic Medical Sciences,
Washington State University and his work on NO/ONOO -- the
nitric oxide (NO) and peroxynitrite (ONOO) cycle in the
mechanism of MCS, the biochemical cycle being elevated in
patients with ME/CFS and related diseases -- and Mohamed
Abou-Donia, Professor of Pharmacology, Cancer Biology &
Neurobiology, Duke University Medical Centre, North Carolina and
his work on chemical disruption of the blood brain barrier.
It is
essential to recognise that MCS involves multi-system and
multi-organ damage brought about by a wide variety of chemicals
and that a key aspect of MCS is the development of
cross-sensitivity which results in sensitivity to compounds to
which there has been no previous exposure. This makes the life
of an MCS patient very uncertain. Patients with MCS must live
in a protected environment with scrupulous attention to every
detail of their life in order to avoid becoming severely ill at
any time. The systems most involved are the neurological,
immunological, endocrinological, musculo-skeletal,
gastrointestinal, cardiovascular and respiratory systems.
People who have MCS as an additional component of ME/CFS are
internationally recognised as being amongst the most severely
affected.
Major UK
Reports on allergies / sensitivities / effects of chemicals
1. The
National Task Force on ME/CFS/PVFS 1994, published by Westcare, Bristol, which was supported by the Department of
Health.
2. Risk
Assessment of Mixtures of Pesticides and Similar Substances:
Committee on Toxicity of Chemicals in Food, Consumer Products
and the Environment. Chairman: Professor I Hughes. FSA;
September 2002.
3. “ALLERGY
– the unmet need”; Royal College of Physicians, 2003. In
her Foreword, Professor Carol Black, President of the RCP, said:
“In the UK over the last twenty years, the
incidence of common allergic diseases has trebled,
giving this country one of the highest rates of
allergy in the world. In any one year, 12 million
people in the UK (one fifth of the population) are
now likely to be seeking treatment for allergy….In
publishing this report, the Royal College of
Physicians aims to put allergy higher on the
healthcare agendas of the Department of Health and
planners and managers….These proposals require
urgent action”.
In his
Preface to the report, Stephen Holgate, MRC Clinical Professor
of Immunopharmacology, School of Medicine, University of
Southampton, said:
“In drawing attention to the high and
ever-increasing prevalence and complexity of
allergy, the disease burden this creates, and the
lack of any cohesive approach to delivering an
adequate clinical service within the NHS, this
report highlights the unmet needs of the many
patients who suffer from allergy, and the impaired
quality of life they endure….the time has come to
make a determined effort to improve clinical
services for patients with allergic disease in the
UK”.
The report
referred to food allergy and intolerance, to the increased
complexity of allergies and to multi-system allergic disease and
stated:
“Primary Care Trusts therefore need to be made
aware of the burden of allergic disease and alerted
to their responsibilities to provide the resources
to meet these needs”.
3.
House of Commons Health Committee Report: “The Provision of
Allergy Services”, Volumes I and II, Sixth Report of Session
2003-2004. Like the RCP report, this substantive report found
that the prevalence of allergy has increased greatly and rapidly
in recent years, with the biggest increases coming in areas of
serious and complex allergy. Members found it “staggering”
that there is only one allergy consultant per 2 million people
in the UK. The report was critical of PCTs:
“Primary Care Trusts seem not to recognize a
problem and are certainly not commissioning
additional allergy services (no service, no data,
therefore no problem seems to be their reaction)”.
4. “CHEMICALS
IN PRODUCTS”: Royal Commission on Environmental Pollution;
Twenty-fourth Report, 2003. Chaired by Sir Tom Blundell FRS., F
Med Sci.
5.
Variability and Uncertainty in Toxicology of Chemicals in Food,
Consumer Products and the Environment: Committee on
Toxicology of Chemicals in Food, Consumer Products and the
Environment. Chairman: Professor I Hughes; FSA, March 2007.
There are
also significant reports from other countries, for example:
Memorandum from US Department of Housing and Urban
Development
on MULTIPLE CHEMICAL SENSITIVITY , April 14, 1992. MCS has
been recognized in the USA by the Departments of Justice,
Housing, Urban Development and Education since 1997. In
particular, the US Department of Housing specifically
recognises MCS as a disability granting those afflicted with
full protection of federal housing laws for the disabled
US
Information for Physicians (1996) (for more
information, see below)
The
Australasian Medical Association Guidelines for Physicians
(1997)
A
Report on Multiple Chemical Sensitivity
The Interagency Workgroup on Multiple Chemical Sensitivity;
August 1998: Executive Summary; Background and Historical
Review; Epidemiologic Considerations; Theories of Causation
and Mechanisms; Potential Tools for Future Research Studies
(Use of Biomarkers in Studying MCS); Public Health Issues in
Medical Evaluation and Care of MCS Patients; Key panels,
Workshops and Reports; Recommendations; Federal Actions;
Findings and Recommendations (Overview); References (approx
168 references); Abbreviations; Annex of Research Suggested
by Expert Reviewers
Multiple Chemical Sensitivities Under Siege
Dr Ann McCampbell, Chair, MCS Task Force of New Mexico,
November 2000
Proceedings of the First International Environmental Illness
Conference,
18th –19th May 2001, Ottawa, Canada
Multiple Chemical Sensitivity (MCS): Guidelines for South
Australian Hospitals,
Government of South Australia, May 2010. This report was
produced in response to the Social Development Committee
Parliamentary Review of MCS that was based on national and
international literature. The referenced report lists common
chemical incitants, common symptoms, requirements relating
to hospital admission of patients with MCS, appropriate
modification of the hospital environment including training
of hospital staff to avoid symptom exacerbation and the need
for special dietary requirements and medication.
International Conferences and Symposia on MCS
There have been many such conferences including the Fifth BASENM
international conference at the University of Oxford in 1998 and
the Royal Society of Medicine (Section of Clinical Allergy)
symposium on “A critical look at the immunology of (ME)CFS” also
held in 1998, at which speakers included Professor Denis
Wakefield, Professor of Pathology, Director of Immunology &
Immunopathology, Prince Henry Hospital, New South Wales;
Professor Nicholas Cohen, Department of Microbiology and
Immunology, University of Rochester, New York; Professor AW
Rook, Department of Bacteriology, UCL Medical School and Dr
William Weir, Consultant Physician and ME specialist, then at
The Royal Free Hospital, London.
Books
which specifically refer to allergies/sensitivities as being
part of ME/CFS
As well as
published medical reference papers, there are a number of
published textbooks and books on ME/CFS which refer to allergies
as being part of the disorder (resulting from the immune system
dysfunction that is recognised as the key reproducible
laboratory finding in ME/CFS).
The many
worldwide patients’ support groups also make a point of
referring to the high prevalence of allergies in ME/CFS in their
Newsletters, journals and literature, including information
packs which are sent out to doctors.
Major Textbooks on ME/CFS which refer to
allergies/hypersensitivities
1.
Myalgic Encephalomyelitis and Postviral Fatigue States: A
Melvin Ramsay (second edition); Gower Medical Publishing, 1988
(the first edition, Postviral Fatigue Syndrome: The Saga of The
Royal Free Disease, was published in 1986)
2.
Allergies are referred to in the 724-page textbook on ME: “The
Clinical and Scientific Basis of Myalgic Encephalomyelitis
Chronic Fatigue Syndrome”. Ed: BM Hyde et al; Nightingale
Research Foundation, Ottawa 1992, which is the published
proceedings of the International Symposium on ME held at the
University of Cambridge, UK in 1990).
3.
Allergies are mentioned as a component of ME/CFS in the textbook
on ME: “Postviral Fatigue Syndrome”. Ed. Professors James
Mowbray and Rachel Jenkins. John Wiley & Sons, Chichester,
1991.
4.
Betrayal by the Brain: The Neurologic Basis of Chronic Fatigue
Syndrome, Fibromyalgia Syndrome and Related Neural Network
Disorders Jay A Goldstein The Haworth Medical Press,
New York, 1996
5. The
existence of allergies in ME/CFS is referred to in a
comprehensive over-view: Chronic Fatigue Syndrome: A
Biological Approach Ed: Patrick Englebienne & Kenny De
Meirleir. CRC Press 2002.
Non-medical and self-help books
An
illustrative-only selection of books includes the following:
1982
The
Mile-High Staircase.
Toni Jeffreys. Hodder & Stoughton 1982 ISBN 0-340-279907
1985
Better
Recovery from Viral Illness.
Darrel Ho-Yen. Dodona Books, Inverness, 1985 ISBN 0 9511090 1
4
1986
Myalgic
Encephalomyelitis.
Celia Wookey. Croom Helm, 1986. ISBN 0-7099-3672-9
1988
The Body
at War.
John Dwyer. Unwin Hyman, 1988 ISBN0-04-320225-X
John
Dwyer, Professor of Medicine at the University of New South
Wales, writes:
“There
is no longer any doubt that the syndrome is primarily organic,
not psychological. Patients with classical symptoms of CFS
almost always have reduced numbers of immunoregulatory cells in
their blood” (page 198)and “A number of patients
claim to be extremely sensitive to the environment and the
numerous chemicals found in foods, drugs etc. Most people
with CFS do not have extreme sensitivity to chemicals but those
who do are even more incapacitated than patients for whom
fatigue and changes in mental function predominate”
(page 206).
1989
Living
with ME
Charles Shepherd. Cedar 1989 (William Heinemann Ltd) ISBN
0-434-11156-2
M.E.
Postviral Fatigue Syndrome
Anne Macintyre. Unwin Hyman 1989 ISBN 0-04-440318-6
M.E. What
is it?
Mike Franklin & Jane Sullivan. Century 1989 ISBN
0-7126-2966-1
Understanding ME
David Smith. Robinson Publishing, London 1989 ISBN 1 85487
019 X
Overload:
beating ME, the Chronic Fatigue Syndrome.
Jacqueline Steincamp (originally published in 1988 by Cape
Catley Ltd, New Zealand). Fontana/Collins, 1989 ISBN
0-00-637478-6
1990
Chronic
Fatigue Syndrome
Jay A Goldstein. Published by The CFS Institute, Beverly
Hills, CA.1990
ISBN
0-9625654-0-7
1991
The
Disease of a Thousand Names
David S Bell. Pollard Publications, Lyndonville, New York
1991
Many more
such books exist, but these earlier books demonstrate that
allergies as a component of ME/CFS have been known about for
decades.
1992
Running on
Empty
Katrina Byrne. Hunter House Inc, USA 1992 (subsequently
published by Bloomsbury, London) ISBN 0-7475-2138-7
1994
The Canary
and Chronic Fatigue
Majid Ali. Life Span Press, New Jersey USA 1994 ISBN
1-879131-04-8
1996
Surviving
M.E.
Joyce Fox. Vermillion (Random House UK Ltd) 1996 ISBN
0-09-181472-3
Osler’s
Web: Inside the Labyrinth of the Chronic Fatigue Syndrome
Epidemic
Hillary Johnson. Crown Publishers Inc, New York 1996 ISBN
0-517-70353-X
2000
Faces of
CFS: Case Histories of Chronic Fatigue Syndrome
David S Bell. Lyndonville Publications, New York 2000
ISBN 0-970770-0-0.
Important
Textbooks on MCS
1.
Chemical Sensitivity, In: Clinical Ecology – the
treatment of ill health caused by environmental factors.
G. Lewith
& J. Kenyon (University of Southampton), Thorsons, 1985
2. “Chemical
Exposures: Low Levels and High Stakes”. Professors Nicholas
Ashford & Claudia Miller, pub. van Nostrand Reinhold, New York,
1991. This book provides comprehensive coverage of chemical
exposures, sensitive populations, key terms and concepts,
origins and health effects, mechanisms, diagnosis, and how to
respond to the problem.
3. The
major international medical textbook on MCS is entitled “Chemical
Sensitivity” (Professor William Rea; CRC Inc). Volume I:
Principles and Mechanisms (1992); Volume II: Sources of
Total Body Load (1994); Volume III: Clinical
Manifestations of Pollutant Overload (1995); Volume IV:
Tools of Diagnosis and Methods of Treatment (1997).
4. MCS is
addressed in the standard medical textbook on environmental
medicine: “Environmental Medicine in Clinical Practice”.
H. Anthony et al. BSAEM 1997.
Notable (text)books
which address the problem of allergies, hypersensitivities and
intolerances
As well as
published medical reference papers, there are a large number of
published books which refer to the problem of allergies,
hypersensitivities and intolerances, including the following:
Food
Intolerance.
Ed: John Dobbing. Bailliere Tindall, 1987
The
Complete Guide to Food Allergy and Intolerance.
Brostoff J, Gamlin L. Bloomsbury Publications, London, 1989
Dietary
Management of Food Allergies and Intolerances: A Complete Guide.
Joneja JV; JA Halls Publishers Ltd; Vancouver, BC, Canada,
second edition 1998 (pp 426).
Publications on ME/CFS, including allergies/sensitivities
Starting
in 1984 until it ceased publication in 2002, The Medical
Information Services of The British Library Document Supply
Centre produced quarterly updates of CATS (Current Awareness
Topics) on ME/CFS and MCS from the peer-reviewed medical
journals.
Important
papers on MCS
MULTIPLE
CHEMICAL SENSITIVITY: Chemical
Injury Information Network: List of published reference papers
on MCS (available online)
The New
Chemical Victims.
Ecological Illness Law Report, 1985:3:4- 5:16-20
Environmental Illness.
William J. Rea, 1987: 207-214
The Worker
With Multiple Chemical Sensitivities: An Overview.
MR Cullen. Occupational Medicine State of the Art Reviews
1987:2:4:655-661
Ecological
Illness Law Reports.
June 1988
Chronic
Fatigue Syndrome and Chemical Overload.
RA Buist. International Nutrition Review 1988:8:4:173-175
Chemical
Sensitivity in Physicians.
WJ Rea, GH Ross et al. Clinical Ecology 1989:6:4:135-141
Chemical
hypersensitivity: A chemically-induced immune system disorder.
The UKOPRP;
Chemical Hypersensitivity, 1989
Winning
Workplace Litigation: Chemicals in the Environment: MULTIPLE
CHEMICAL SENSITIVITY.
Earon S. Davis, Ecological Illness Law Report, October 1989
USA:
Multiple Chemical Sensitivity.
J.B. Sibbison, Lancet 1991: 337:1469-1470
Special
report: Multiple Chemical Sensitivity.
B. Hileman, Chemical & Engineering News, July 1991:26-42
Considerations for the Diagnosis of Chemical Sensitivity.
William J Rea, Alfred R Johnson et al; In: Biologic Markers
in Immunotoxicology; National Research Council (U.S.)
Subcommittee on Immunotoxicology: 1992:169-192; National Academy
Press
Advancing
the understanding of multiple chemical sensitivity (MCS):
Overview and recommendations from an AOEC workshop.
KM Rest. Toxicology Ind. Health / Jul-Aug 1992:F(4):1-13
Multiple
Chemical Sensitivity (MCS): Hazards in 1992.
Hazards Publications Ltd, Sheffield S1 1FQ, UK
Hypersusceptibility to chemicals: risk factors for neurological
disease?
Editorial: A Williams. Journal of Neurology, Neurosurgery and
Psychiatry 1993:56:943-946
Comparison
of patients with Chronic Fatigue Syndrome, Fibromyalgia and
MULTIPLE CHEMICAL SENSITIVITY.
Dedra Buchwald & Deborah Garrity. Arch Int Med
1994:154:2049-2053
Psychogenic Origins of MULTIPLE CHEMICAL SENSITIVITY Syndrome: A
Critical Review of the Research Literature.
A.L. Davidoff, L. Foggarty. Arch Environ Health,
1994:49:5:316-325
Potential
Animal Models of MULTIPLE CHEMICAL SENSITIVITY with Cholinergic
Sensitivities.
Overstreet D et al, Toxicology, 1996:111:1-3:119-134
Chronic
Fatigue Syndrome as a Delayed Reaction to Chronic Low-dose
Organophosphate Exposure. PO
Behan. Journal of Nutritional & Environmental Medicine
1996:6:341-350
Recognition of Multiple Chemical Sensitivity by Federal
Authorities.
A Donnay. Pub. MCS Referral & Resources, 1996
Potential
animal model of multiple chemical sensitivity with cholinergic
sensitivities.
Overstreet DH, Miller CS
et al. Toxicology 1996:111:1-3
An
Expert’s Explanations on MCS.
I Bell. The CFIDS Chronicle Winter 1997:91-92
Profile of
patients with chemical injury and sensitivity.
Ziem G, McTamney J. Environ Health Perspect 1997:105: Suppl
2:417-436
“Substantial overlap between chemical sensitivity,
fibromyalgia and chronic fatigue syndrome exists”.
Toxicant-induced Loss of Tolerance – An Emerging Theory of
Disease?
Claudia S Miller.
Environmental Health Perspectives March 1997:105:2:445-453
Chemical
Sensitivity: Allergic to the 20th Century.
DM Jones. WDDTY. Nov 1997:8:8:1-4
Acceptance
by Federal Agencies of MULTIPLE CHEMICAL SENSITIVITY.
CFIDS Chronicle Spring 1997:49
Profile of
Patients with Chemical Injury and Sensitivity.
Grace Ziem and James McTamney. Environmental Health
Perspectives 1997:101:2: pp 26
Prevalence
and overlap of Chronic Fatigue Syndrome and Fibromyalgia
Syndrome among 100 patients with MULTIPLE CHEMICAL SENSITIVITY,
Albert Donnay: presentation at 4th International
AACFS Research & Clinical Conference of CFIDS, Mass, USA,
October 1998
The
Relationship between Chronic Fatigue Syndrome, Fibromyalgia
and
Chemical Sensitivity. A.Vojdani et al (ibid)
Multiple
Chemical Sensitivity (MCS).
Chemical Injury Information Network Leaflet 1998.
A Report
on MCS -- Background and Historical Review.
Article. US Government Web Site 1998.
A Review
of Multiple Chemical Sensitivity.
R A Graveling et al; Occup Environ Health:1999:56:73-85
(Journal of The Faculty of Occupational Medicine of the Royal
College of Physicians of London). This report was commissioned
by the UK Health and Safety Executive
MULTIPLE
CHEMICAL SENSITIVITY: A 1999 Consensus.
Arch Env Health: 1999:54:3:147-149; signatories include 34 of
the world’s most eminent experts in MCS
The
Environmental Exposure and Sensitivity Inventory (EESI): a
standardised approach for measuring chemical intolerances for
research and clinical applications.
Claudia S Miller and Thomas J Prihoda. Toxicology and
Industrial Health 1999:15:370-385
A
controlled comparison of symptoms and chemical intolerances
reported by Gulf War Veterans, implant recipients and persons
with multiple chemical sensitivity.
Claudia S Miller and Thomas Prihoda. Toxicology & Industrial
Health, 1999:15:386-397
Multiple
Chemical Sensitivity and Management.
Keith Eaton; J Nutr Env Med 2000:10:39-84
Self-reported sensitivity to chemical exposures in five clinical
populations and healthy controls.
Nawab SS, Miller Claudia S, Straus SE et al Psychiatry Res
2000:95(1):67-74
“Patients
with CFS…self-reported more sensitivity to chemical exposures
than normal controls….A possible relationship between reported
chemical sensitivity and hypothalamic-pituitary-adrenal (HPA)
axis functioning is discussed”.
Multiple
Chemical Sensitivity – Recognition and Management.
Third Scientific Report of the British Society for Allergy,
Environmental and Nutritional Medicine. Ed: KK Eaton and
HM Anthony. Pub BSAENM, Knighton 2000.
Controlled exposure to volatile organic compounds in sensitive
groups.
Fiedler N, Kipen HM. Ann NY Accad Sci 2001:933:24-37
“Sensitivities to chemicals are characterized by symptoms in
multiple organ systems in response to low level chemical
exposure…Sensitive subgroups include subjects who met Cullen’s
1987 criteria for multiple chemical sensitivity
(MCS)….Controlled…exposure studies reveal that significant
responses an be observed in chemically sensitive subjects even
when de-adaptation has not occurred”.
The
compelling anomaly of chemical intolerance.
Miller CS. Ann NY Acad Sci 2001:933:1-23
“In
science, anomalies expose the limitations of existing paradigms
and drive the search for new ones….Today we are witnessing
another medical anomaly – a unique pattern of illness involving
chemically exposed groups in more than a dozen countries, who
subsequently report multisystem symptoms and new onset chemical,
food and drug intolerances….observations…suggest that multiple
neurotransmitter pathways may be involved”.
Engaging
with Multiple Chemical Sensitivity.
Malcolm Hooper. Presentation and Conference Proceedings; MCS
International Conference, London, 2nd-3rd
September 2003
Case-control study of genotypes in multiple chemicals
sensitivity: CYP2D6, NAT1, NAT2, PON1, PON2 and MTHFR.
Gail McKeown-Eyssen et al; International Journal of Epidemiology
2004:33:971-979
Chronic fatigue syndrome and multiple chemical hypersensitivity
after insecticide exposure.
Fernandez-Sola J et al. Med Clin (Barc) 2005:124(12):451-453
[article in Spanish]
“Chronic Fatigue Syndrome (CFS) and Multiple Chemical
Sensitivity (MCS) are well-defined illnesses that may appear
after some toxic exposures….We report a consecutive series of 26
patients who developed CFS after exposure to insecticide
products. It was associated with MCS in a third of cases….The
course of the disease was…disabling in 6 cases (23%)”.
Multiple
chemical sensitivity: study of 52 cases
[article in Spanish]. Nogue S et al. Med Clin (Barc)
2007:129(3):96-98
“Multiple
chemical sensitivity (MCS) is characterized by a loss of
tolerance to various environmental chemicals….It is frequently
triggered by exposure to chemical agents, especially
insecticides. An association with chronic fatigue syndrome is
common….the patients’ quality of life is seriously affected”.
Biological
definition of multiple chemical sensitivity from redox state and
cytokine profiling and not from polymorphisms of xenobiotic-metabolising
enzymes.
Chiara de Luca et al Toxicology and Applied Pharmacology 2010:
doi:10.1016/j.taap.2010.04.017
Multiple
Chemical Sensitivity.
Malcolm Hooper; Chapter 50. In: Psychiatry – An evidence-based
text. Ed: Basant K Puri & Ian Treasden; Hodder Arnold 2010.
That MCS
is a recognised condition requiring home care is confirmed by
the Brochure from Healthcare at Home Ltd, showing Total
Allergy Syndrome as a condition for which they provide NHS
Homecare. They are the UK’s leading providers of home
healthcare, with over 100,000 patients each year.
Their
services are paid for by the NHS and by private medical
insurers, as well as self-funding patients.
Examples
of published papers on allergies / ME/CFS
There are
over 5,000 papers showing that ME/CFS is a serious organic
disorder and that the existence of allergies, hypersensitivities
and intolerances in ME/CFS patients has long been recognised.
Some extracts are included because they are illustrative.
Please
note: for
reasons of space (not to deflect from the meaning or intention
of the papers), the sequential text has been separated by means
of “…” or “….”.
“Could it
be that enteroviral infection, in predisposed or previously
sensitised subjects, sets in train some process, say of an
allergic nature, which accounts for the similarity of symptoms
and the chronic relapsing course? …. We do not know if the
‘allergic process’ is entirely self-perpetuating”.
1976
Special
Article: Benign Myalgic Encephalomyelitis or Epidemic
Neuromyasthenia.
AM Ramsay. Update, September 1978:539-542
“In
Edinburgh in 1970…Innes suggested that the enteroviral
infections had triggered off an allergy”.
1977
Enhancement of IgE-Mediated Histamine Release from Human
Basophils by Viruses: Role of Interferon.
S Ida, J
Hooks et al. The Journal of Experimental Medicine
1977:145:892-906
1978
Allergy to
food and chemicals -- the scope of the problem.
S Todd. Nursing Times March 1978:438-441
Food
Allergy: Fact or Fiction?
R Finn, HN Cohen. The Lancet Feb 1978:426-428
1979
Diagnosing
Food and Chemical Susceptibility.
WJ Rea. Continuing Education, Sept 1978:47-59
The
Environmental Aspects of Ear, Nose, and Throat Disease: Part 1.
WJ Rea. JCEORL & Allergy, July 1979:41-57
The
Environmental Aspects of Ear, Nose, and Throat Disease: Part 2.
WJ Rea. ORL & Allergy Digest, Sept 1979:41-55
1980
Food
Allergy and Intolerance in 100 Patients - Local and Systemic
Effects.
MH Lessof, DG Wraith et al. Quarterly Journal of Medicine, New
Series XLIX 1980:195:259-271
1981
Viruses as
Nonspecific Modulators of Immunological Reactivity.
BF Semenov. Acta Virol 1981:25:122-128
Intestinal
Permeability in Patients with Eczema and Food Allergy.
PG Jackson, MH Lessof et al. The Lancet June 13: 1981:1285-1286
Late-onset
atopic eczema and multiple food allergies after infectious
mononucleosis.
R StC Barnetson et al. British Medical Journal 1981:283:1086
1982
The
Immunology of Allergy.
In: Disease and the Environment. Ed. AR Rees, HJ
Purcell. Proceedings of the Inaugural Conference of the Society
for Environmental Therapy 1981:65-78
Hypersensitivity to Mains Tap Water in Adults: its Clinical
Features and Treatment.
CWM Wilson. Nutrition and Health 1982:1:85-91
Food
Intolerance: A Major Factor in the Pathogenesis of Irritable
Bowel Syndrome.
VA Jones, P McLaughlan et al. The Lancet 20 Nov 1982:1115-1117
1983
Food and
Chemical Sensitivity.
JJ McGovern, JA Lazaroni et al. Arch Otolaryngol
1983:109:292-297
Total
allergy syndrome: what evidence can be established?
N Mike, P Asquith. Proceedings of 2nd Fisons Food
Allergy Workshop, pub. The Medicine Publishing Foundation,
Oxford, 1983:79-83
1984
Myalgic
encephalomyelitis.
Cory Matthew. New Zealand Medical Journal 1984:782.
“Many
myalgic encephalomyelitis patients also experience food and
chemical intolerances, and are often therefore unusually
sensitive to the side effects of drugs”.
Adverse
reactions to foods.
DH Allen et al. The Medical Journal of Australia Special
Supplement, Sept 1984:S37-S42
Myalgic
encephalomyelitis and the general practitioner.
JC Murdoch. New Zealand Family Physician Winter
1984:127-128
“In the
long term sufferer, patients are often anxious to identify food
and chemical allergies”.
1985
The
postviral fatigue syndrome – an analysis of the findings in 50
cases.
PO Behan, WMH Behan, EJ Bell. Journal of Infection
1985:10:211-222
“Our
clinical impression, however, is that there is a high incidence
of atopic illness in patients with this syndrome”.
Evidence
for Active Epstein-Barr Virus Infection in Patients with
Persistent Unexplained Illness: Elevated Anti-Early Antigen
Antibodies.
James F Jones et al. Ann Int Med 1985:102:1:1-7
“These
screening tests do not preclude an abnormality in immune
function in these patients….previous alternative diagnoses in
these patients have included antibody negative lupus
erythematosus and allergic diathesis”.
Persisting
Illness and Fatigue in Adults with Evidence of Epstein-Barr
Infections.
Stephen E Straus,
G Tosato
et al. Ann Int Med 1985:102:7-16
“By all
regards…many of these patients appeared to be neurotic.
However, our detailed studies have uncovered a series of subtle
yet objective organic abnormalities in these patients….
Importantly, nearly all of the patients studied had increased T
cell mediated suppression…which showed increased numbers of OKT4
positive (helper-inducer) cells”.
Gut and
Joint Disease.
C Carini, J Brostoff. Annals of Allergy 1985:55:624-625
What is
the current state of knowledge of ecological illness or total
allergy syndrome? Is there an immune basis to this condition?
J Brostoff. British Medical Journal 1985:290:1884
1986
Food
Intolerance.
RH Loblay, AR Swain. In: Recent Advances in Clinical
Nutrition Ed: Wahlquist M & Truswell A. pub. John
Libby, London 1986:169-177
Immunological and Clinical Aspects of Food Allergy.
J Brostoff, GK Scadding. Adv. Med. 1986:21:286-302
Specific
allergen-induced Epstein-Barr nuclear antigen-positive B cells
from patients with chronic-active Epstein-Barr virus infections.
GB Olson, MN Kanaan et al. J. Allergy Clin. Immunol. August
1986:315-320
“Patients
in this study have significantly increased (1) responsiveness
towards specific allergens, (2) responses towards greater
numbers of allergens, (3) increased numbers of IGE-positive T
cells and B cells…and (6) elevated serum IgE levels than do
patients with mild or moderate allergic disease alone….
Patients…demonstrate an increased incidence of allergies and
symptoms, indicating various neurologic disorders”.
Correlation between allergy and persistent Epstein-Barr virus
infections in chronic-active Epstein-Barr virus-infected
patients.
GB Olson, MN Kanaan. J. Allergy Clin. Immunol. August
1986:308-314
“Eighty
percent of patients with CA-EBV (ie.
ME/CFS)
demonstrate clinically significant IgE mediated allergic
disease, including …food and drug reactions…. The data indicates
that patients…have a high association with hypersensitivity
states…percent positiveness to allergens is consistent with the
high degree of allergy observed in these patients”.
1987
Environmental Illness: A Disorder of Immune Regulation.
AS Levin, VS Byers. Occupational Medicine Oct-Dec 1987:669-681
IgE
complexes in food allergy.
C Carini et al. Annals of Allergy 1987:59:110-117
Myalgic
encephalomyelitis -- how to care for a sufferer.
UK ME Association Leaflet 1987
Chronic
Epstein - Barr Virus Infection.
James F
Jones, Stephen E Straus. Ann Rev Med 1987:38:195-209
“….the
clinical observation that most of these individuals report or
demonstrate…allergic disease (at) an uncommonly high prevalence
rate”.
The
Epstein-Barr Virus and Chronic Fatigue.
Irving E Salit.Clinical Ecology 1987 /
88:V:3:103-107
“Patients…tend to tolerate medications very poorly and many have
a history of allergies including drug allergies”.
The
‘Chronic, Active Epstein-Barr Virus Infection’ Syndrome and
Primary Fibromyalgia.
D Buchwald, DL Goldenberg, JL Sullivan, AL Komaroff.
Arthritis & Rheumatism 1987:30:10:1132-1136
“A history
of allergies was reported by 64% of patients”.
1988
Poor
sulphoxidation ability in patients with food sensitivity.
GK Scadding, R Ayesh et al. British Medical Journal
1988:297:105-107
Allergy
and the chronic fatigue syndrome.
SE Straus, J Dale et al. J.Allergy Clin. Immunol May
1988:791-795
“This
article summarises recent studies of the syndrome and emphasises
our assessment of one of its more common manifestations,
allergy…. Many patients report inhalant, food or drug
allergies…. Allergies are a common feature of patients with the
chronic fatigue syndrome…. Among the features of this syndrome
is a high prevalence of allergy, an allergy that appears to be
substantial, both by history and by skin testing”.
Viruses
and neuropsychiatric disorders.
JF Mowbray. JRSM 1988 81:311-312
“…the
possibility that temporary viral infection might produce a
permanent change leading to disease.
“When the
disease presents, the virus might not be present so that Koch’s
postulations for the disease would not be fulfilled…. We are
then considering a group of disorders in which there may be an
inherited genetic predisposition…to disease occurrence if
infection is present, associated with some other environmental
factor (which) may be chemical. There is much talk of a
symbiosis between a virus infection and food intolerance in
patients with the postviral fatigue syndrome. There is a
natural tendency to reject such a ‘fringe medicine’
approach…There are, however, simple examples of similar
concatenation of infection and environment, where the cause is
known”.
The
Myalgic Encephalomyelitis Syndrome.
JC Murdoch.Family Practice 1988:5:4:302-306. Pub.
Oxford University Press
“Many
patients with this syndrome…have had chemical toxicity
diagnosed…. Many patients with long-term symptoms develop food
sensitivities”.
“A variety
of immunological abnormalities were detected, including abnormal
T4 / T8 lymphocyte subset ratios, dysfunction of natural killer
cells, abnormal proliferation of B cells and decreased IgG
concentrations”.
New Light
on Chronic Fatigue Syndrome.
Robert A Buist J Orthomolecular Med 1988:3:3:146-149
1989
Treatment
of Patients with Chronic Fatigue Syndrome.
Nelson Gantz & Gary Holmes. Leading Article. Drugs
1989:36:6:855-862
“Several
authors have detected histories of atopy and high frequencies of
skin test reactivity to selected allergens, suggesting an
allergic mechanism may play a role in the aetiology of the
disease…. Multiple other immunological abnormalities have been
noted….the importance of such abnormalities…may serve as markers
for a subset of patients….who have measurable immunological
abnormalities”.
Thoughts
on the management of myalgic encephalomyelitis.
Michael Jenkins. British Homoeopathic Journal
1989:78:6-14
“There do
seem to be considerable overlaps between the presentations of
ME, post-viral fatigue syndrome and multiple allergies….Multiple
allergies to foods and less often to inhalants are quite
common”.
Postviral
syndrome --- how can a diagnosis be made?
SJ Bowman, J Brostoff, S Newman, JF Mowbray
JRSM
1989:32:712-716
“The 89
full responders were divided into five groups…group 2 patients
had a specific diagnosis (of) food allergy”.
The
Chronic Fatigue Syndrome: Definition, Current Studies and
Lessons for Fibromyalgia Research.
AL
Komaroff & D Goldenberg. J Rheumatol 1989:16:19:23-27
“Myalgic
encephalomyelitis…is similar in most respects to the
other chronic fatigue syndromes…on medical history,
the only clearly striking finding is a high
frequency of atopic or allergic illness (in about 50
- 70%)…. On immunologic testing, we and others have
found evidence of subtle and diffuse dysfunction”.
The
relationship between viral infections and onset of allergic
diseases and asthma.
VB Busse. Clinical and Experimental Allergy 1989:19:1-9
Chronic
Fatigue Syndrome.
GH Ross, JA Monro. CMAJ 1989:140:361
Diseases
of Food Hypersensitivity.
DD Metcalfe. The New England Journal of Medicine
1989:321:4:255-257
1990
CD8
Deficiency in Patients with Muscle Fatigue Following Suspected
Enteroviral Infections (Myalgia Encephalitica).
JR Hobbs, JF Mowbray et alIn: Protides of the
Biological Fluids. Jan 1990:36
“It is
also clear that acquisition of T cell deficiency, particularly
of the CD8 subset, can itself impair immune regulation and
predispose to atopy not previously experienced by the patient.
Three of the criteria are sufficiently frequent to suggest they
should become part of the routine screening of such patients,
and theseare a subnormal level of CD8 lymphocytes…What seems to be
especially related to the ME symptoms in our clinically selected
patients is a failure to show the expected rise and
normalisation of CD8 numbers…. In the present study, the
patients show a 40% incidence of both clinical and laboratory
evidence of atopy…. It has been shown that T cell deficiency,
particularly of the suppressor subset, can predispose to atopy,
which can indeed be acquired by patients without a genetic
family history”.
The
chronic fatigue syndrome: a return to common sense.
AM Denman. Postgrad Med Journal 1990:66:499-501
“A high
incidence of concomitant atopic disorders may prove to be a
useful diagnostic point”.
A New
Manifestation of Seminal Fluid Hypersensitivity.
N Mike, G Bird, P Asquith. Quarterly Journal of Medicine New
Series 75 1990:276:371-376
1991
Defining
the Chronic Fatigue Syndrome.
Gary P Holmes. Rev Inf Dis 1991:13:1:S53-S55
“Preferably, patients with CFS who have such abnormalities might
be considered a subset of the larger group: ie. persons with
CFS who have immune dysfunction”.
History of
the Chronic Fatigue Syndrome.
Stephen E StrausRev Inf Dis.1991:13:1:S2-S7
“There is
little doubt that classic allergy and atopy are inexplicably
prevalent in CFS. In a recent study, a high proportion (50%) of
patients with CFS were found to be reactive to a variety of
inhalant or food allergens when innoculated epicutaneously in
the classic manner. In the healthy population, reactivity
rarely exceeds 15-20%”.
Symptoms
and Signs of Chronic Fatigue Syndrome.
AL Komaroff & D BuchwaldRev Inf Dis 1991:13:1:S8-S11
“The
patients’ medical histories reveal one clearly striking finding:
a high prevalence of atopic or allergic illness (for 40 - 70%).
Review of
Laboratory Findings for Patients with Chronic Fatigue Syndrome.
D Buchwald
& A Komaroff. Rev Inf Dis 1991:13:1:S12-S18
“In fact,
allergies are a common feature of patients with
CFS”.
Chronic
Fatigue Syndrome in Northern Nevada.
Sandra Daugherty, Daniel Peterson et al. Rev Inf Dis
1991:13:1:S39-S44
“Our
investigations have…produced evidence of …a decrease in CD8
suppressor cells with resulting elevation of the ratio of CD4 to
CD8 cells”.
Fatigue:
Definition and Management.
Ivan Barofsy & Marcia West Legro. Rev Inf Dis
1991:13:1:S94-S97S
“Allergies…may predispose a person to the
development of CFS following an immunologic
assault”.
Food
allergy and pelvic pain.
BA Gbolade, R Jackson. Journal of Obstetrics and Gynaecology
1991:11:457
1992
Chronic
Fatigue Syndrome.
WK Cho & GH Stollerman. Hospital Practice 1992:221-245
“The
numerous attempts to elucidate the pathogenesis of chronic
fatigue syndrome are evoked by the names….chronic Epstein-Barr
virus infection and total allergy syndrome (twentieth century
disease)…. It is known that such patients are remarkably likely
to have a history of atopy pre-dating the onset of chronic
fatigue syndrome (50-83%)…. Patients may have an immune system
that responds over-emphatically to environmental or internal
stimuli….Aspects of the immune reaction may not be stoppable
even after an insult is over”.
Plasma and
Cerebrospinal Fluid Monoamine Metabolism in Patients with
Chronic Fatigue Syndrome: Preliminary Findings.
MA Demitrack, Stephen E Straus et al.Biol Psychiatry
1992:32:1065-1077
“Patients
with chronic fatigue syndrome are reported to have a higher
incidence of allergic conditions. Indeed, it has been
speculated that heightened allergic responsiveness may be a risk
factor for the development of the syndrome…. In particular, the
diverse clinical and immunological features have been argued to
reflect an ongoing state of immune activation”.
Reactions
to food additives.
MH Lessof. Journal of the Royal Society of Medicine
1992:85:513-515
1993
Clinical
presentation of chronic fatigue syndrome.
AL Komaroff. Ciba Foundation Symposium 173: Chronic Fatigue
Syndrome. John Wiley, Chichester 1993:43-61
“On past
medical history, the only clearly striking finding in our
studies is a high frequency of atopic or allergic illness (in
approximately 50 - 80%, in contrast to a background prevalence
of about 10% in the population at large…..Immunological studies
suggest that in CFS, the immune system is in a state of chronic
activation”.
Immunologic, Psychological and Neuropsychological Factors in
Multiple Chemical Sensitivity.
GE Simon, W Daniell et al. Annals of Internal Medicine
1993:19:2:97-103
Chronic
Fatigue Syndrome: Influence of Histamine, Hormones and
Electrolytes.
L Dechene. Medical Hypotheses 1993:40:55-60
1994
Summary
and Perspective: Epidemiology of Chronic Fatigue Syndrome.
Paul H Levine. Clin Inf Dis 1994: 18:1:S57-S60
“It has
been noted for a number of years that a history of allergies
appears to be an important risk factor for CFS, and the spectrum
of illnesses associated with a dysregulated immune system now
must include CFS”.
Comparison
of Patients With Chronic Fatigue Syndrome, Fibromyalgia, and
Multiple Chemical Sensitivities.
D Buchwald, D Garrity. Arch Intern Med 1994:154:2049-2053
“67% of
subjects with CFS reported an exacerbation of their symptoms
following exposure to air pollution, cigarette smoke, solvent
fumes or perfumes…. Disability among our patients with CFS, FM
and MCS was substantial…. In Australia, CFS represents a loss
to society of $59 million per year”.
Simultaneous measurement of antibodies to Epstein-Barr Virus,
HHV6, Herpes Simplex Types 1 & 2, and 14 Enteroviruses in
Chronic Fatigue Syndrome: is there Evidence of Activation of a
Non-specific Polyclonal Immune Response?
Farrin A. Manian. Clin Inf Dis 1994:19:448-453
“As has
been noted in other investigations, a high percentage (60%) of
patients with chronic fatigue syndrome in this study reported an
allergy to drugs or other substances”.
Effective
Allergy Practice
(1994). Report of the British Society for Allergy and
Environmental Medicine with The British Society for Nutritional
Medicine. A Document on Standards of Care and Management for the
Allergy Patient. Ed: HM Anthony, S Birtwistle, J
Brostoff, D Freed, N Williamson et al (BSAENM)
Psychogenic Origins of Multiple Chemical Sensitivity Syndrome: A
Critical Review of the Research Literature.
AL Davidoff, L Fogarty (Johns Hopkins, Baltimore). Arch Env
Health 1994:49:5:316-325
“Current
studies investigating psychogenic hypotheses of the MCS syndrome
are methodologically problematic and their conclusions
questionable….Disorders based on endocrine, nervous and immune
systems often result in multiple organic system complaints that
are difficult to diagnose….
The presence of multi-system
complaints does not constitute evidence for psychogenic
causation”.
1995
Clinical
management of chronic fatigue syndrome - Physiology.
DJ Clauw. J CFS 1995:1:3/4:185-190
Unexplained Illness: the mind versus the environment.
MJ Radcliffe, P Ashurst, J Brostoff. Journal of the Royal
Society of Medicine 1995:88:678-679
High
incidence of antibodies to 5-hydroxytryptamine gangliosides and
phospholipids in patients with Chronic Fatigue Syndrome and
Fibromyalgia Syndrome and their relatives: evidence for a
clinical entity of both syndromes.
R Klein, PA Berg. Europ J Med Res 1995/1996:1:21-26
“Chronic
fatigue syndrome and fibromyalgia syndrome also demonstrate
similar immunological abnormalities such as…allergic / atopic
reactions”.
1996
The
Neuroimmunology of Chronic Fatigue Syndrome.
Lucinda VS Scott, Timothy G Dinan Journal of Chronic Fatigue
Syndrome 1996:2:4:49-59
“An
increase in peripheral turnover of 5-HT may explain the
heightened allergic responsiveness as well as the
musculoskeletal pain seen in CFS”.
Chronic
Fatigue Syndrome. Information for Physicians.
Issued in September 1996 by The National Institute of Allergy
and Infectious Disease (NIAH); National Institutes of Health (NIH),
US Department of Health and Human Services.
“Many CFS
patients have a history of allergies years before the onset of
the syndrome…Sometimes patients report a worsening of allergic
symptoms or the onset of new allergies after becoming ill with
CFS….
Allergies are common in people with CFS…(there is a) high
prevalence of allergies in the CFS population…Many patients are
extremely sensitive to drugs”.
1997
Clinical
Crossroads – A 56 year old woman with Chronic Fatigue Syndrome.
AL Komaroff. Beth Israel Deaconess Medical Centre
Clinical Conference. JAMA 1997:278:14:1179-1188
“In
addition to the symptoms included in the case definition, many
patients with CFS also frequently report…intolerance of
pharmaceuticals that affect the central nervous system…”
Draft
Clinical Guidelines on the Evaluation of Prolonged Fatigue and
the Diagnosis and Management of Chronic Fatigue Syndrome.
Produced by a Working Group convened by The Royal Australasian
College of Physicians, December 1997. Published by The Medical
Journal of Australia.
“Many
patients with CFS have experienced atopic symptoms since
childhood and the atopic symptoms often flare in CFS….People
with CFS may have increased susceptibility to drug side
effects”.
Chronic
Fatigue Syndrome.
Mark A Demitrack, N Cary Engelberg. Current Therapy in
Endocrinology and Metabolism 1997:6:152-160
“An abrupt
onset precipitated by a stressor (and) exacerbation
of allergic responses are characteristic of
glucocorticoid deficiency….
We suggest that some of
the reputed immunologic disturbances in patients
with CFS (eg. exacerbation of allergic responses)
could also reflect a relative glucorticoid
deficiency”.
Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain
Syndrome.
Don L Goldenberg, Curr Op Rheumatol 1997:9:125-142
“Allergies
are common in CFS…There was a 73% incidence of atopy in the CFS
patients”.
Neuroendocrine Correlates of Chronic Fatigue Syndrome. A Brief
Review.
Mark A Demitrack. J Psychiat Res 1997:31:1:69-82
“…non-specific indices of immune activation reported in CFS (eg.
increased allergic sensitivity) may well be secondary to a
chronic reduction in circulating cortisol levels”.
Interstitial cystitis: unexplained associations with other
chronic diseases and pain syndromes.
Alagiri M et al Urology 1997:49: (5A Suppl):52-57
“Allergies, irritable bowel syndrome, sensitive skin (and)
fibromyalgia were the most common diseases in the interstitial
cystitis population…. Interstitial cystitis has as yet an
unexplained association with certain other chronic diseases and
pain syndromes”.
1998
Neurally-mediated
hypotension and chronic fatigue syndrome.
PO Rowe, H Calkins. Am J Med 1998:105 (3A):15S-21S
“There is
a high prevalence of allergic disease amongst those with CFS….
Both viral infection and allergic reactions to food antigens
enhance the excitability of mechanically sensitive vagal
afferents…(providing) a potential link between these clinical
situations and the development of neurally-mediated hypotension
(NMH) in patients with allergy, (suggesting the need) to include
general medical management techniques to prevent exacerbations
of food and inhalant allergies in those with CFS”.
Chronic
Fatigue Syndrome.
A Chaudhuri et al. Proc R Coll Phys Edinb 1998:28:150-163
“…patients often suffer from atopies…. There is
incontrovertible evidence that CFS patients suffer from atopy
more frequently than normal population, for which an aberrant
cytokine response is a possible explanation”.
Chronic
Fatigue in Overlapping Syndromes.
A Chadhuri, P Behan. CNS. Summer 1998:1:2:16-20
“The
organic nature of CFS soon became apparent from a detailed study
of symptoms and neuroendocrine tests…. Symptoms of CFS are
influenced by specific drugs and anaesthetics that
can alter cell membrane ion channel function”.
Evidence
for and pathophysiologic implications of HPA axis dysfunction in
fibromyalgia and chronic fatigue syndromes.
Mark A Demitrack, Leslie J Crofford. Ann NY Acad Sci
1998:840:684-697
“Buchwald
and colleagues…described a high prevalence of symptoms not
previously thought to be characteristic of fibromyalgia, such as
recurrent rashes, a history of allergies….
Among the principal
symptoms of glucocorticoid deficiency (is an) exacerbation of
allergic responses”.
Allergology: Blimps versus nuts.
H Anthony et al. The Lancet 1998:351:221-222
“’Environmental Medicine in Clinical Practice’ is the
acceptable face of clinical ecology and contains a lot more hard
science than you might expect….
(clinical ecologists) do have
observations about the many medically unexplained symptoms that
tend to be labelled as somatisation or hypochondria….
The
official line put out by traditionalists that ‘there is no
evidence’ for clinical ecology will not do; there is
evidence, and these authors have presented it”.
The
relationship between chronic fatigue syndrome, fibromyalgia and
chemical sensitivity.
A Vojdani, P Choppa. Fourth International AACFS Research &
Clinical Conference on CFIDS Oct 1998: Abstract page 100
Prevalence
and Overlap of Chronic Fatigue Syndrome and Fibromyalgia
Syndrome Among 100 Patients With Multiple Chemical Sensitivity.
Fourth International AACFS Research & Clinical Conference on
CFIDS Oct 1998 Abstract page 53
1999
Interferon-induced proteins are elevated in blood samples of
patients with chemically or virally induced chronic fatigue
syndrome.
Vojdani A; Lapp CW. Immunopharmacol Immunotoxicol
1999:21(2):175-202
“Overlapping symptomatologies between Chronic Fatigue Syndrome
(CFS) and Chemical Sensitivity have been observed by different
investigators. Therefore, it is of great importance to develop
biomarker(s) for possible differentiation between viral induced
CFS (without sensitivity to chemicals) versus chemically induced
CFS….
To elucidate mechanisms involved in viral versus chemical
induction of 2-5A Synthetase and PKR, MDBK cell lines were
cultured either in the presence of absence of HHV6, MTBE, or
benzene, heat shock proteins and interferon-beta….
When MDBK
cells were incubated either with MTBE + benzene or HHV6 in the
presence of absence of anti-IFN-beta or anti-HSP70, the
activities of both 2-5 A and PKR in HHV6 infected cells were
inhibited by more than 90%….
This variation in the induction of
2-5A and PKR by anti-HSP70 or IFN beta indicates involvement of
IFN-beta in viral induction 2-5A and PKR, and HSP involvement in
chemical induction of these enzymes”.
2000
Symptom
patterns in long-duration chronic fatigue syndrome.
F Friedberg et al J Psychsom Res 2000:48:59-68
“The
pattern of comorbid disorders in the chronic fatigue syndrome
groups was consistent with hypersensitivity and viral
reactivation…. Evidence for hypersensitivity in CFS was
found….
A related finding suggests the presence of drug
hypersensitivity as well…. Hypersensitivity reactions may
influence CFS symptoms generation….
A hypersensitivity mechanism
and viral infection may contribute to illness persistence in
CFS”.
Chronic
fatigue syndrome, fibromyalgia, and multiple chemical
sensitivitities in a community-based sample of persons with
chronic fatigue syndrome-like symptoms.
Jason LA et al Psychosom Med 2000:Sept-Oct: 62(5):655-663
“The aim
of this study was to determine illness comorbidity rates for
individuals with CFS, FM and MCS….Individuals with MCS or more
than one diagnosis reported more physical fatigue…..
People with
CFS, MCS or FM endure significant disability in terms of
physical, occupational and social functioning, and those with
more than one of these diagnoses also report greater severity of
physical and mental fatigue”.
2001
Delayed-type hypersensitivity and chronic fatigue syndrome: the
usefulness of assessing T-cell activiation by flow cytometry. Brunel JL et al J Allerg Immunol (Paris), April 2001:
33(4):166-192
“This
article describes the detection of delayed-type hypersensitivity
responses to certain common environmental antigens in almost 50%
of patients with this syndrome”.
Chronic
Fatigue Syndrome following a toxic exposure.
D Racciatti et al. Sci Total Environ, 10 April
2001:270:1-3:27-31
“All
subjects were investigated by clinical examination,
neurophysiological and immunologic studies and neuroendocrine
tests….
Patients exposed to toxic factors had disturbances of
hypothalamic function (and) showed more severe dysfunction of
the immune system with an abnormal CD4 / CD8 ratio (and)
decreased levels of NK cells (CD56+)”.
2002
Role of pathological delayed-type hypersensitivity in chronic
fatigue syndrome: importance of the evaluation of lymphocyte
activation by flow cytometry and the measurement of urinary
neopterin
[Article in French]. Brunet JL, Fatoohi F, Liaudet AP, Cozon
GJ. Allerg Immunol (Paris) 2002 Feb;34(2):38-44.
“This article describes the detection of delayed-type
hypersensitive responses to certain common environmental
antigens in almost fifty per cent of patients with this
syndrome….
The results showed that the intensity of the DTH
(delayed type hypersensitivity) response correlated with the
number of T-cells activated in vitro”.
2004
Illness and disability in Danish Chronic Fatigue Syndrome
patients at diagnosis and 5-
“Work disability was very high and increased further, social
isolation remained high, emotional adjustment improved. There
were increased problems with reading and with allergies…..
CONCLUSION: CFS patients exhibit severe, long-term functional
impairment. Substantial improvement is uncommon, less than 6%.
Allergies and aspects of cognition may worsen, emotional
adjustment often improves”.
2005
Are attention deficit hyperactivity disorder and chronic fatigue
syndrome allergy related?
Bellanti JA et al Allergy Asthma Proc 2005:26(1):19-28
“…there are a group of diseases that the allergist-immunologist
may be called up to manage…that appear to be initiated by
allergic mechanisms….
In patients with CFS, there appears to be a
fundamental dysfunction of the neuroendocrine-immunological
system with deficiencies of immunological and neurological
function which, together with chronic viral infection, may lead
to a sequence of events responsible for the symptoms of this
disorder….
An understanding of the interactive responses involved
in the neuroendocrine-immunological network is essential for a
comprehension of the pathophysiology of…CFS…and the role of
allergies appears to be an important triggering event…”.
2008
Lower frequency of IL-17F sequence variant (His161Arg) in
chronic fatigue syndrome.
Metzger K, Fremont M, Roelant D, De Meirleir K. Biochem
Biophys Res Commun 2008:376(1):231-233
“Chronic fatigue syndrome (CFS) is characterized by immune
dysfunctions including chronic immune activation, inflammation,
and alteration of cytokine profiles. T helper 17 (Th17) cells
belong to a recently identified subset of T helper cells, with
crucial regulatory function in inflammatory and autoimmune
processes. Th17 cells are implicated in allergic inflammation,
intestinal diseases, central nervous system inflammation,
disorders that may all contribute to the pathophysiology of
CFS….
We investigated the association between CFS and the
frequency of rs763780, a C/T genetic polymorphism leading to
His161Arg substitution in the IL-17F protein. The His161Arg
variant (C allele) antagonizes the pro-inflammatory effects of
the wild-type IL-17F. A significantly lower frequency of the C
allele was observed in the CFS population, suggesting that the
His161Arg variant may confer protection against the disease.
These results suggest a role of Th17 cells in the pathogenesis
of CFS”.
Anaesthesia for patients with idiopathic environmental
intolerance and chronic fatigue syndrome.
Fisher MM, Rose M. Brit J Anaesth 2008:101(4):486-491
“Idiopathic
environmental intolerance syndrome (EI), formerly known as
multiple chemical sensitivity syndrome (MCSS), and chronic
fatigue syndrome (CFS) are controversial diseases and there is
little information in the literature regarding the appropriate
conduct of anaesthesia in such patients….
The patients had a
significant incidence of adverse events related to
anaesthesia….Anaesthesia is likely to be associated with adverse
effects in these patients…”.
2010
Relationships among rhinitis, fibromyalgia, and chronic fatigue.
Baraniuk JN, Zheng Y. Allergy Asthma Proc 2010:31(3):169-178
“This
article shows the relevance of CFS and allied disorders to
allergy practice. CFS has significant overlap with…central
nervous system maladaptations (central sensitization) recorded
by functional magnetic resonance imaging (fMRI). Neurological
dysfunction may account for the overlap of CFS with idiopathic
nonallergic rhinopathy. Scientific advances are in fMRI…and,
potentially, infection with xenotropic murine leukaemia-related
virus provide additional insights to novel pathophysiological
mechanisms….
As allergists, we must accept the clinical
challenges posed by these complex patients...”.
Idiopathic
environmental intolerance (EI): from molecular epidemiology to
molecular medicine.
De Lucca C et al (Rome). Indian J Exp Biol 2010:48(7):625-635
“Inherited
or acquired impairment of xenobiotics metabolism is a postulated
mechanism underlying environment-associated pathologies such as
multiple chemical sensitivity, fibromyalgia, chronic fatigue
syndrome…and others, also collectively names idiopathic
environmental intolerances (EI)….
These disabling conditions
share the features of polysymptomatic multi-organ syndromes,
considered by part of the medical community to be aberrant
responses triggered by exposure to low-dose organic and
inorganic chemicals and metals, in concentrations far below
average reference levels admitted for environmental
toxicants….
Free radical/antioxidant homeostasis may also be
heavily implicated…in the chronic damage of cells and tissues,
which is in part correlated with clinical symptoms….
More
clinical studies of…the possible role of inflammatory mediators,
promise a better understanding of this pathologically increased
sensitivity to low-level chemical stimuli…”.
These
examples serve to illustrate the long-recognised organic basis
and the high incidence of allergies, hypersensitivities and
intolerances that are often a component of ME/CFS.
In light
of this corpus of empirical evidence it is notable that
Professor White seems to have retained an inflexible belief --
a belief that has not changed in quarter of a century -- that
simple graded exposure (analogous to his belief in the curative
properties of incremental graded exercise) will reverse the
documented organic pathophysiology illustrated above.
Further information on the MRC and the PACE Trials
