Diagnosis and treatment of sensitivities

People with environmental sensitivities often consult several medical practitioners before their condition is recognized. When first seen, patients may be experiencing many symptoms, which are due to constant or frequently repeated exposure to environmental conditions that cannot be tolerated.

Physicians take a systematic approach to establishing connections between patients’ symptoms and their environment, because there is no single or definitive diagnostic test for environmental sensitivities. Investigation requires a complete assessment of the patient’s chronological health and exposure histories,^65,69 a thorough physical examination and routine tests. Other possible conditions are ruled out, or are treated so that their contributions to ill health are minimized. Then, the consensus diagnostic criteria for environmental sensitivities,⁴ strengthened by discriminating symptoms,⁵ may be used to "rule in" the condition of environmental sensitivities, using a diagnostic checklist for physicians.^65,156

The theory that an illness was caused by toxins might be strengthened if elevated levels are found upon chemical analysis of the blood, urine, hair or tissue. However, toxins are ubiquitous in our bodies, so information must be considered in the context of exposure history and symptoms. Conversely, not detecting a toxic chemical in the blood or urine is not evidence that it did not precipitate illness. The chemical may have been metabolized and excreted, or it may have been sequestered in fat, organs or bone and therefore be at lower levels in the blood or urine by the time they are sampled. Nevertheless, monitoring levels of toxic chemicals and biomarkers such as enzymes may play an important role in following patient progress. Establishing standard monitoring is necessary for other research regarding environmental sensitivities and for studies of methods to reduce body burdens (e.g. heat, exercise and medications such as chelating agents that will accelerate excretion ^g).^132,133,157 Lack of availability and access to analytical expertise and services, as well as lack of funds to pay for tests, may limit the ability to identify and monitor biomarkers and toxin levels.

Once a diagnosis of environmental sensitivities has been established, there are a variety of strategies for treating and living with the condition.^158,159 Avoidance of symptom triggers and removal of toxic chemicals stored in the body are key to treating environmental sensitivities. Safe housing, school or workplace, and food and water are top priorities. Drinking purified or spring water may lower exposure to water-based contaminants.160 Home and workplace cleanups/renovations, and possibly air filtration both at home and at work, may be necessary.

Food sensitivities are common in people with environmental sensitivities and may be managed with an elimination or rotation diet. One example of food intolerance that is commonly missed is celiac disease, an autoimmune response to gluten in many grains. It is assessed annually up to the age of 6 in Italy, but in Canada testing is not routine and may be preceded by months or years of symptoms. The delay between onset of symptoms (some of which are vague and may be missed by physicians) and diagnosis with a simple test leads to deterioration of health and well-being, and serious possible consequences including neurological problems and diabetes.^161-164 As with the broader range of environmental sensitivities, celiac disease is chronic; the related malabsorption and "leaky gut" may lead to diverse toxicities; it is under-diagnosed; and the most effective and important treatment is gluten avoidance.

Once exposure to incitants is eliminated, helpful interventions include:

• treating gastrointestinal infections which, if untreated, can lead to absorption of internal toxins and large-molecule food antigens, or conversely, may lead to poor absorption of nutrients;
• regimens to enhance detoxification and elimination such as sauna and exercise therapy;
• reduction of heavy metal contamination using oral and intravenous chelation for toxic metals (shown to be safe to treat lead in children;¹⁶⁵ it is currently in clinical trials for children with autism

• oral and intravenous vitamins;

• securing hormonal homeostasis, given that many of the toxins observed are endocrine disruptors;

• correcting biochemical irregularities;

• desensitization for foods and/or inhalants;

• psychological, social and spiritual support;

• occupational accommodation; and

• financial support for safe workplaces, housing, food and water.

Summary

Diagnosis of people with environmental sensitivities involves systematically identifying and treating conditions contributing to ill health, then determining if remaining symptom patterns meet the diagnostic criteria. Early recognition, avoidance of symptom-triggering agents, environmental control, treatments that may reduce residual toxins and recovery of normal biological processes are key to regaining health for people with sensitivities. Without safe food, water, shelter and workplaces, people with environmental sensitivities may become severely debilitated and unemployed.^12,60,78

g. A chelating agent binds with a toxic metal such as lead or mercury, and causes it to dissolve in the blood so that it can be excreted by the kidney and liver.