Objective: We describe patients with MCS, the evolution of the Quick Environmental Exposure and Sensitivity Inventory (QEESI) score with a special focus on people whose fillings were removed. Methods: We have conducted a retrospective longitudinal cohort study in patients diagnosed with MCS and attended in the outpatient Internal Medicine department of the University Hospital of San Juan de Alicante, from January 1, 2008 to January 1, 2021. Sociodemographic, clinical, QEESI and treatment-related variables were collected. We performed descriptive and inferential analyses. Mixed linear models were used to analyze the QEESI. Calculations were carried out with an α error of 5%. Results: Thirty-three patients were included (72.7% women, mean age 56.2). MCS was mainly triggered by mercury (N = 20) and food intolerance (N = 22). The mean interval from symptoms onset was 120 months (SD 81.6). 114 QEESIs were analyzed: 82 (N = 17 without amalgams) and 32 (N = 16 with amalgams). In patients without amalgams, severity scores increased across all subscales except the masking index (vs. with amalgams). Mean scores for the group without amalgams (vs. with amalgams) were: chemical intolerance, 62.8 points (vs. 63.4 and 46.7); other intolerances, 52.7 points (vs. 62.8 and 50.3); symptom severity, 63.2 (vs. 76.7 and 63.3); masking index, 3.9 (vs. 3.2 and 2.8); and life impacts, 63.1 (vs. 58.4 and 49.8). Conclusion: The profile of patient with MCS is a middle-aged woman who is a frequent user of healthcare services, presents a long diagnostic delay and has borne a great personal, work and socioeconomic impact. The QEESI is useful for the clinical follow-up of patients, including the optimal treatment response in the case of amalgams. Clinical Significance: People affected by Multiple Chemical Sensitivity deserve the attention, understanding and help of health professionals and family members, to face an invisible illness for those who do not suffer from it. Support is needed and doctors must raise awareness, and make an effort to understand and address this pathology. We suggest that protocolized amalgam extraction in accredited and prepared centers can reduce symptoms and improve quality of life, generating clinical, personal, family, occupational, social and occupational benefits.
References
[1]
Nogué Xarau, S., Dueñas Laita, A., Ferrer Dufol, A. and Fernández Solà, J. (2011) Sensibilidad química múltiple. Medicina Clínica, 136, 683-687. https://doi.org/10.1016/j.medcli.2010.04.010
[2]
Lacour, M., Zunder, T., Schmidtke, K., Vaith, P. and Scheidt, C. (2005) Multiple Chemical Sensitivity Syndrome (MCS)—Suggestions for an Extension of the US MCS-Case Definition. International Journal of Hygiene and Environmental Health, 208, 141-151. https://doi.org/10.1016/j.ijheh.2005.01.017
[3]
Nogué, S., Fernández-Solá, J., Rovira, E., Montori, E., Fernández-Huerta, J.M. and Munné, P. (2007) Sensibilidad química múltiple: análisis de 52 casos. Medicina Clínica, 129, 96-99. https://doi.org/10.1157/13107370
[4]
Ortega Pérez, A. (2005) «Sensibilidad a múltiples compuestos», una enfermedad comúnmente inadvertida. Medicina Clínica, 125, 257-262. https://doi.org/10.1157/13078105
[5]
Berg, N.D., Berg Rasmussen, H., Linneberg, A., Brasch-Andersen, C., Fenger, M., Dirksen, A., et al. (2010) Genetic Susceptibility Factors for Multiple Chemical Sensitivity Revisited. International Journal of Hygiene and Environmental Health, 213, 131-139. https://doi.org/10.1016/j.ijheh.2010.02.001
Gregory, S., et al. (1993) Immunologic, Psychological, and Neuropsychological Factors in Multiple Chemical Sensitivity: A Controlled Study. Annals of Internal Medicine, 19, 59-67.
[8]
Bell, I.R. (1996) Clinically Relevant EEG Studies and Psychophysiological Findings: Possible Neural Mechanisms for Multiple Chemical Sensitivity. Toxicology, 111, 101-117. https://doi.org/10.1016/0300-483x(96)03395-1
[9]
Yunus, M.B. (2008) Central Sensitivity Syndromes: A New Paradigm and Group Nosology for Fibromyalgia and Overlapping Conditions, and the Related Issue of Disease versus Illness. Seminars in Arthritis and Rheumatism, 37, 339-352. https://doi.org/10.1016/j.semarthrit.2007.09.003
[10]
Nogué Xarau, S., Alarcón Romay, M., Martínez Martínez, J., Delclós Clanchet, J., Rovira Prat, E. and Fernández Solà, J. (2010) Sensibilidad química múltiple: Diferencias epidemiológicas, clínicas y pronósticas entre la de origen laboral y la de origen no laboral. Medicina Clínica, 135, 52-58. https://doi.org/10.1016/j.medcli.2009.12.013
[11]
Bornschein, S., Hausteiner, C., Römmelt, H., Nowak, D., Förstl, H. and Zilker, T. (2008) Double-Blind Placebo-Controlled Provocation Study in Patients with Subjective Multiple Chemical Sensitivity (MCS) and Matched Control Subjects. Clinical Toxicology, 46, 443-449. https://doi.org/10.1080/15563650701742438
[12]
Van den Bergh, O., Devriese, S., Winters, W., Veulemans, H., Nemery, B., Eelen, P., et al. (2001) Acquiring Symptoms in Response to Odors: A Learning Perspective on Multiple Chemical Sensitivity. Annals of the New York Academy of Sciences, 933, 278-290. https://doi.org/10.1111/j.1749-6632.2001.tb05831.x
[13]
Arnold Llamosas, P.A., Arrizabalaga Clemente, P., Bonet Agustí, M. and de la Fuente Brull, X. (2006) Hipersensibilidad química múltiple en el síndrome del edificio enfermo. Medicina Clínica, 126, 774-778. https://doi.org/10.1157/13089106
[14]
Fernández-Solà, J., Lluís Padierna, M., Nogué Xarau, S. and Munné Mas, P. (2005) Síndrome de fatiga crónica e hipersensibilidad química múltiple tras exposición a insecticidas. Medicina Clínica, 124, 451-453. https://doi.org/10.1157/13073217
[15]
Patini, R., Spagnuolo, G., Guglielmi, F., Staderini, E., Simeone, M., Camodeca, A., et al. (2020) Clinical Effects of Mercury in Conservative Dentistry: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials. International Journal of Dentistry, 2020, Article ID: 8857238. https://doi.org/10.1155/2020/8857238
[16]
Higueras, P., Esbrí, J., González-Corrochano, B., López, M., García-Noguero, E., Coronado, A., Lazcano, W. and Saturnino, L. (2012) Consideraciones ambientales sobre el mercurio en el distrito minero de Almadén (Ciudad Real). De re Metallica, 19, 53-65.
[17]
Peraire Ardèvol, M. (2011) Liberación de mercurio por parte de las obturaciones de amalgama dental. Riverside County Office of Education, 16, 43-47.
[18]
Langworth, S. (1997) Experiences from the Amalgam Unit at Huddinge Hospital: Somatic and Psychosomatic Aspects. Scandinavian Journal of Work, Environment & Health, 23, 65-67.
[19]
Kern, J.K., Geier, D.A., Bjorklund, G., King, P.F., Homme, K.G., Haley, B.E., Sykes, L.K. and Geier, M.R. (2014) Evidence Supporting a Link between Dental Amalgams and Chronic Illness, Fatigue, Depression, Anxiety and Suicide. Neuroendocrinology Letters, 35, 537-552.
[20]
Loria-Kohen, V., Marcos-Pasero, H., de la Iglesia, R., Aguilar-Aguilar, E., Espinosa-Salinas, I., Herranz, J., et al. (2017) Sensibilidad química múltiple: Caracterización genotípica, estado nutricional y calidad de vida de 52 pacientes. Medicina Clínica, 149, 141-146. https://doi.org/10.1016/j.medcli.2017.01.022
[21]
Miller, C.S. and Prihoda, T.J. (1999) The Environmental Exposure and Sensitivity Inventory (EESI): A Standardized Approach for Measuring Chemical Intolerances for Research and Clinical Applications. Toxicology and Industrial Health, 15, 370-385. https://doi.org/10.1177/074823379901500311
[22]
Hojo, S., Sakabe, K., Ishikawa, S., Miyata, M. and Kumano, H. (2009) Evaluation of Subjective Symptoms of Japanese Patients with Multiple Chemical Sensitivity Using QEESI. Environmental Health and Preventive Medicine, 14, 267-275. https://doi.org/10.1007/s12199-009-0095-8
[23]
Aguilar-Aguilar, E., Marcos-Pasero, H., de la Iglesia, R., Espinosa-Salinas, I., Ramírez de Molina, A., Reglero, G., et al. (2018) Características y condicionantes de la ingesta dietética y actividad física en un grupo de pacientes diagnosticados de sensibilidad química múltiple. Endocrinología, Diabetes y Nutrición, 65, 564-570. https://doi.org/10.1016/j.endinu.2018.07.009
[24]
Ortega-Benito, J.M. (2002) Prestación de servicios sanitarios basada en la evidencia: Hipersensibilidad química múltiple o intolerancia ambiental idiopática. Medicina Clínica, 118, 68-72. https://doi.org/10.1016/s0025-7753(02)72284-7
[25]
Nerdrum, P., Malt, U.F., Høglend, P., Oppedal, B., Gundersen, R., Holte, M., et al. (2004) A 7-Year Prospective Quasi-Experimental Study of the Effects of Removing Dental Amalgam in 76 Self-Referred Patients Compared with 146 Controls. Journal of Psychosomatic Research, 57, 103-111. https://doi.org/10.1016/s0022-3999(03)00542-7
[26]
Nethercott, J.R. (1999) Multiple Chemical Sensitivity: A 1999 Consensus. Archives of Environmental & Occupational Health, 54, 147-149.
[27]
Lago Blanco, E., Puiguriguer Ferrando, J., Rodríguez Enríquez, M., Agüero Gento, L., Salvà Coll, J. and Pizà Portell, M.R. (2016) Sensibilidad química múltiple: Evaluación clínica de la gravedad y perfil psicopatológico. Medicina Clínica, 146, 108-111. https://doi.org/10.1016/j.medcli.2015.09.016
[28]
Vliet, E.C., Kelly-McNeil, K., Natelson, B., Kipen, H. and Fiedler, N. (2002) Anxiety Sensitivity and Depression in Multiple Chemical Sensitivities and Asthma. Journal of Occupational and Environmental Medicine, 44, 890-901. https://doi.org/10.1097/00043764-200210000-00006
[29]
Lax, M.B. and Henneberger, P.K. (1995) Patients with Multiple Chemical Sensitivities in an Occupational Health Clinic: Presentation and Follow-Up. Archives of Environmental Health: An International Journal, 50, 425-431. https://doi.org/10.1080/00039896.1995.9935978
[30]
Spencer, A. (2000) Dental Amalgam and Mercury in Dentistry. Australian Dental Journal, 45, 224-234. https://doi.org/10.1111/j.1834-7819.2000.tb00256.x
