Some of the more common IEI complaints are also symptoms of depression (impaired attention and memory, fatigue, insomnia or hypersomnia, low energy, anhedonia, and loss of libido) and anxiety (restlessness or feeling keyed up, irritability, difficulty concentrating, mind going blank, muscle tension, and sleep disturbance). Although the number of different complaints has been reported to be as high as 252 in a clinic sample of 295 IEI patients in Germany, the most common symptoms are cognitive dysfunction with an emphasis on attention and memory difficulties, headache, fatigue, shortness of breath, poor sleep, myalgia, and arthralgia. The typical IEI case, whether involved in litigation or not, presents with an idiosyncratic set of nonspecific, multiorgan system complaints including neurological, gastrointestinal, pulmonary, cardiovascular, genitourinary, musculoskeletal, or lymphatic, as well as general systemic complaints of malaise, commonly found in epidemiological studies of the general population in the United States and the Nordic countries. Proponents of a toxicogenic theory of IEI contribute to patient and plaintiff beliefs about the source and chronicity of IEI by reinforcing or instilling these beliefs through diagnostic and treatment methods deemed unsubstantiated by the scientific community, ,, ,,. Nonchemical agents such as electromagnetic fields are included, specifically, nonionized electromagnetic fields associated with computer display terminals, cell phones and wireless station phones and their transmission towers, electrical transmission lines and transformers, and electrical wiring in buildings. The focus may be on one specific agent that follows a social trend, such as dampness in buildings that is associated with molds. Foods and food additives of all kinds may also trigger reactions. The chemicals on the list of inhaled environmental agents implicated are limitless but typically include odorous volatile organic compounds and solvents, many of which are ubiquitous in ambient air. Symptoms can appear suddenly and disappear in a mater of seconds, or they can last for hours or days. There is no specific time course for symptoms once triggered by a perceived or actual environmental agent. After onset of IEI, individuals typically report adverse reactions triggered by exposure to multiple environmental agents at doses tolerated by most people. The onset of IEI is nonspecific and unique to patient history, and it may be associated with a specific environmental exposure event or chronic low-level exposure to multiple environmental agents. The toxicogenic theory of IEI presupposes that chemical intolerance to low levels of virtually any environmental agent accounts for any and all multiorgan system complaints, even in cases with well-documented alternative medical diseases or psychiatric disorders that can account for the symptoms. This latter group has rejected the toxicogenic theory of IEI. Proponents of the toxicogenic theory of IEI have traditionally been identified as “clinical ecologists”, a group who now work under the umbrella of the American Academy of Environmental Medicine and reference themselves as “environmental physicians.” However, in the United States, there is no recognized medical specialty of “environmental medicine.” It is important to distinguish this group from the legitimate and recognized medical specialty of the American College of Occupational and Environmental Medicine. The descriptor IEI has been adopted by medical societies including the American Academy of Allergy Asthma and Immunology, the American College of Occupational and Environmental Medicine, and the American Academy of Clinical Toxicology. The fundamental issue is whether these effects are explained by a toxicogenic or a psychogenic theory. Idiopathic environmental intolerance patients report distress and disruptions in their occupational, social, and personal functioning. Not explained by any known medical or psychiatric or psychological disorder.
Īssociated with diverse environmental factors tolerated by the majority of people.Īn acquired disorder with multiple recurrent symptoms.Idiopathic environmental intolerance is a descriptor without any implication of chemical etiology, immunological sensitivity, or susceptibility. The designation IEI should displace the term multiple chemical sensitivity as well as other labels such as environmental illness, ecological illness, and chemical intolerance because they suggest unproven causation and physiological mechanisms. Idiopathic environmental intolerance (IEI) is a descriptor originating from a 1996 workshop convened by the International Programme on Chemical Safety of the World Health Organization Workshop (IPCS/WHO) and agencies of the German government.
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