Assignment 1
Chemical Sensitivity: A Medical Perspective CVOH 221 – Topics in Occupational Health and Safety

Student: Sandeep Singh Purba
Date Due: June 5th, 2012

Table of Contents

I. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pg 2

II. Allergy vs. Chemical Sensitivity. . . . . . . . . . . . . . . . . . . . . Pg 2

III. Principles of Chemical Sensitivity. . . . . . . . . . . . . . . . . . . . Pg 3

IV. Awareness of Chemical Sensitivity in Various Medical Fields. . . . . . . . . Pg 4

V. Methods for Accommodation and Prevention of Chemical Sensitivity. . . . . . Pg 4

VI. Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pg 5

VII. Research Process. . . . . . . . . . . . . . . . . . . . . . . . . . . Pg 6

VIII. Sources of Information. . . . . . . . . . . . . . . . . . . . . . . . Pg 7

IX. Interview Excerpts. . . . . . . . . . . . . . . . . . . . . . . . . . Pg 8

X. Works Cited. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pg 10

I. Introduction
Today, more than ever, there are many substances that pollute the earth and the surrounding environment that pose health risks. They include biological factors such as pollens, foods, water, a wide variety of bacteria, viruses, fungi and parasites; chemical factors such as inorganic and organic compounds; and physical forces such as heat and cold, weather, cyclic phenomenon, radon, light, sound and electromagnetic fields (Rea, 1992, 1). As the number of dangerous environmental pollutants continues to increase, so do reports of sensitivity to these contaminants. Technology has helped with the identification of sensitivities to these pollutants; however, due to the unique symptoms of each case, diagnosis is a lengthy and drawn-out process (Spencer, 2008, 28). Adding to the complexity of the issue is that there are typically overlapping conditions. Exposure many not contribute to all the symptoms in the patient, but multiple exposures over an extended period of time may contribute to the individual’s ill health.
Chemical sensitivity has become a matter gaining more attention over the past decade as a growing number of people become aware of the matter. More workplaces are becoming scent-free zones and promoting the use of healthier alternatives to a variety of products such as cleaning agents. II. Allergy vs. Chemical Sensitivity
There is often confusion between the two terms are they both present symptomatic similarities. Chemical sensitivity and allergy have the same physical outcomes; however, the bodily targets vary. Allergies often trigger a reaction with the immune system and the resultant symptoms are predictable and can be expected.
Chemical sensitivity, on the other hand, is an adverse reaction to ambient levels of toxic chemicals contained in air, food, and water or physical surroundings (Rea, 1992, 2). The reaction occurs in various tissues or organs rather than the immune system. It is dependent on the chemicals and pharmacologic nature of the substances involved; the individual susceptibility of the exposed person, the length of time, amount and variety of other body stressors, and synergism at the time of reactions (Rea, 1992, 8). III. Principles of Chemical Sensitivity
According to Rea (1992), there are six factors affecting the onset of chemical sensitivity. These factors being: * Total Toxic Load (Body Burden) – the sum of all pollutants in the body at one time. When the body becomes overloaded, chemical sensitivity may occur. * Nutritional State – a health nutritional state eliminates toxins and prevents depletion of nutrients from the body. * Synergisms – the working together of two things to produce an effect greater than the sum of the individual effects. * Competition for Storage and Removal – some chemicals cannot be removed from the body while other chemicals are present * Bioaccumulation of Toxic Substances – the accumulation is dependent upon the dose level, interval and duration of exposure * Biological Half-Life of Toxic Substances – the half-life may have little relationship to the detoxification mechanisms available as low doses may be slowly metabolized.
These factors shape the ways in which the medical communities perceive and control chemical sensitivity and the various methods of diagnosing and treating this condition. IV. Awareness of Chemical Sensitivity in Various Medical Fields
The Canadian Medical Association and the American Medical Association, thus far, do not formally recognize chemical sensitivity as a disease. Greater recognition of the issue has been made as there have been many cases presented to both Associations through insurance claims and case studies (Canadian Human Rights Commission, 2007). The Royal College of Physicians and Surgeons of Canada is currently leading the path to greater recognition. It currently recognizes environmental sensitivities, which include chemical sensitivity, and the College is carrying out education on diagnosis and treatment methods (CHRC, 2007). This is not the case in many medical schools and institutions where connections between the environment and health are typically ignored or addressed as a simple concept of occupational health rather than a core concept of the curriculum (CHRC, 2007). However, as awareness and recognition increases over time, changes in the medical society will eventually follow. Public and political awareness are particularly important for conditions such as chemical sensitivity because recognition of environmental causes has diverse implications for many interests in society (Rest, 1992, 73). A few results from this recognition include: scent-free and least toxic-cleaning policies, and advocacy for smoking, vehicle idling and pesticides policies and laws. V. Methods For Accommodation and Prevention of Chemical Sensitivities
Accommodation of people with chemical sensitivities should involve the person affected. Various evaluations of the workplace and the home environment may need to be conducted to determine the cause of sensitivity. There are many sources for obtaining information regarding construction and renovation for people with environmental sensitivities.
As for workplaces, there are many health and productivity benefits outweighing the possible costs of designing, planning, and implementing policies to minimize the aforementioned factors in the workplace that would be harmful to people with chemical sensitivities.
Using products that are more health-conscious can benefit all individuals, especially those afflicted with chemical sensitivities. VI. Conclusions
This report was created to provide a brief overview of the medical standpoint and perspectives on chemical sensitivities. Since chemical sensitivities do not have a standard symptomological profile, people’s responses to various pollutants in their immediate environment vary enormously. Some individuals may have a debilitating response to the chemicals while others experience milder symptoms. The symptoms are reproduced with repeated exposures, and resolved by avoiding or eliminating chemicals that may trigger the symptoms.
Recognition of chemical sensitivities is slowly developing in many Canadian associations, and public policies, laws and regulations are moving to protect people from triggering factors. Less chemically toxic alternatives are available for construction, renovation, repair and maintenance projects, and modifications to building plans aid to reduce the prevalence and development of chemical sensitivities.
Improving the overall quality of the individual’s environment promotes better health and productivity. This, in turn, can prevent the development of sensitivities in others. Awareness and prevention are useful tools in reducing the incidence of chemical sensitivities; thus creating, overall, a healthier environment for all. VII. Research Process
The criteria I used to select this topic were very simple and straightforward. My goal was to look at an issue, which has been gaining attention in both the public and health fields. This issue was brought to my attention in preparation for an interview when asked to refrain from wearing any scented products as the work environment was a scent-free area. The issue intrigued me as I discovered many individuals I knew were sensitive to a scent or product (Busse, 2008, 89).
The difficulties and challenges associated with this topic was the lack of concrete statistical information. Because chemical sensitivity does not a definitive symptoms profile, diagnosis is difficult. Also, because chemical sensitivity is not yet recognized as a valid diagnosis (Spencer, 2008, 26), there wasn’t as much information as I would have liked; however, contacting some of the predominant agencies aware of Chemical Sensitivity and the interview information proved to be productive and helpful.
Another difficulty was contacting an expert for an interview. It took quite a while to contact someone who was willing to be interviewed. Unfortunately, the interview was conducted via emails over an extended period of time. Ideally, it would be best-conducted in person; however, this method allowed me to ask additional questions easily if I had any concerns or inconsistencies. My expert also provided me with additional materials relating to the topic.
Various researching techniques needed to be implemented to obtain information to complete the assignment. My skills in searching the databases were improved as a result. Various search queries resulted in various results. Although all the information was not able to be included, most articles gave a brief introduction to the research topic. VIII. Sources of Info 1. Chemical Sensitivity Vol.1 by William J. Rea
William J Rea, M.D., is a thoracic and cardiovascular surgeon with a strong passion for the environmental aspects of health and disease. He is the founder of the Dallas Environmental Health Center, and is currently director of the facility. He has written a variety of medical textbooks, including Chemical Sensitivity, Vol. 1-4, and has published more than 100 peer-reviewed research papers related to thoracic and cardiovascular surgery as well as environmental medicine.
His books – Chemical Sensitivity, Vol. 1-4 – provided great detail regarding the mechanisms in which chemical sensitivity may be triggered, and the organ outcomes considering a variety of exposures. For the purposes of this assignment, Volume 1was used as the other Volumes looked into more specific topics relating to Chemical Sensitivity. 2. Advancing the Understanding of Multiple Chemical Sensitivity
This book is an amassed collection of papers, studies and reports covering a variety of topics relating to chemical sensitivity. These topics include clinical experiences with patient cases, description of diagnosis methods and treatment techniques, a wide range of research studies, suggestions of possible models and mechanisms for chemical sensitivity, and the chemical interactions with the body causing the sensitivity.
The authors with published materials in the written collective have reputable positions in their fields with many years of experience with chemical sensitivity; however, the materials published were not peer-reviewed and edited only for technical content and consistency between submitted papers. 3. The Medical Perspective on Environmental Sensitivities
This report addresses issues such as the definition and prevalence of environmental sensitivities; recognition by medical authorities; education and training within the medical community; origins, triggers and symptoms of sensitivities; impact of environmental sensitivities in the workplace; government policies and standards for building codes, air quality and ventilation as they affect individuals with environmental sensitivities; and guidelines for accommodation within the workplace. It provides excellent information regarding many factors associated to chemical sensitivity and addresses the various regulations surrounding environmental and chemical sensitivities. IX. Interview Excerpt
As the interview was conducted via email, the format was more open-discussion rather than determined questions. The main questions and the answers are included and summarized below: * Q: What are the symptoms of chemical sensitivity usually encountered during work with chemically sensitive individuals?
R: Most patients experience a variety of symptoms. These include fatigue, headaches, dizziness, disorientation, nausea, rashes, asthma or shortness of breath, memory problems and in some cases depression, anxiety and irritability. Some patients have stronger symptoms while others experience them in moderation. It is different for each and every case. That is one of the challenges of diagnosing patients with MCSs (multiple chemical sensitivities); the symptoms vary greatly from patient to patient and there is no specific disease profile to compare the symptoms too. * Q: Has the incidence of cases decreased? And if so, which directions have the shifts in incidence taken place?
R: The general trend with MCS has been more women are affected than men. However, in the past few years, more and more children have become affected by MCS. This is quite disturbing as it indicates either that we have been exposing ourselves to a wider variety or stronger chemicals, or transmission into our bodies has increased greatly. Children today are exposed to many more sources of pollution and chemicals. This is signalled by the rising number of children with cases of asthma and allergies (Caress, 2009, 48). * Q: How has recognition of chemical sensitivity changed over the past decade? Has there been a dramatic change in regards to the Canadian Medical Association and the College of Physicians and Surgeons?
R: The Associations from both countries have become more and more aware of chemical sensitivities and they have adapted their policies. Unfortunately, these associations do not acknowledge this as a “disease”, per se, but as a disorder. The implications of distinguishing MCS as a disorder rather than a disease have been great as the legal backing varies. There is more strength in conviction with transmission and suffering from a disease rather than having a disorder.

X. Works Cited
Busse, Jason W., et al. (2008). Managing environmental sensitivity: an overview illustrated with a case report. The Journal of the Canadian Chiropractic Association. Volume 52(2). Pages 88-96. Retrieved May 20th 2010. From: http://proquest.umi.com.ezproxy.lib.ryerson.ca/pqdlink?index=1&did=1489722231&SrchMode=1&sid=1&Fmt=6&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1275934288&clientId=10120
Canadian Human Rights Commission. (2007). The Medical Perspectives on Environmental Sensitivities. Retrieved June 1st, 2010. From: http://www.chrc-ccdp.ca/research_program_recherche/esensitivities_hypersensibilitee/toc_tdm-en.asp
Caress, Stanley M. ; Setineman, Anne C. (2009). Prevelance of Fragrance Sensitivity in the American Population. The Journal of Environmental Health. Volume 71(7). Pages 46-50. Retrieved May 24th 2010. From: http://proquest.umi.com.ezproxy.lib.ryerson.ca/pqdlink?index=2&did=1650912951&SrchMode=1&sid=2&Fmt=6&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1275925529&clientId=10120
Medicine.Org. Exclusive Interview: Dr. William J. Rea of the Environment Health Center-Dallas Speaks on Chemical Sensitivity. Retrieved May 28th, 2010. From: http://www.medicine.org/profiles/blogs/exclusive-interview-dr-william.
Rea, William J. (1992). Chemical Sensitivity: Volume 1. Boca Raton, Florida; Lewis Publishers.
Rest, Kathleen M. (1992). Advancing the Understanding of Multiple Chemical Sensitivity. Princeton, New Jersey; Princeton Scientific Publishing Co., Inc.
Sears, Margaret E, Research Consultant and Adjunct Investigator, Children’s Hospital of Easter Ontario Research Institute, Correspondence via Email June 1st – 6th, 2010.
Spencer, Taylor R.; Schur, Paul M. (2008). The Challenges of Multiple Chemical Sensitivity. The Journal of Environmental Health. Volume 70(10). Pages 24-27. Retrieved May 20th 2010. From: http://proquest.umi.com.ezproxy.lib.ryerson.ca/pqdlink?index=8&did=1493608761&SrchMode=1&sid=2&Fmt=6&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1275925529&clientId=10120

--------------------------------------------
[ 1 ]. The Canadian Human Rights Commission will be further referred to as the CHRC