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- About Fragrances: Did you know.. Fragrances can make you ill.
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This paper attempts to draw together information from medical toxicology teaching texts, occupational Health standards, and review of past and current medical literature to demonstrate the existence of chemical injury. From this information it could be concluded that denial of the existence of chemical injury by Government, Medical and other Institutions contradicts (in many cases)their own standards, research and medical findings. Solvents are recognised to have the potential to cause detrimental effects on human health. Why then is the potential for adverse health effects not recognised when these same solvents are used in common compounds such as perfumes and perfumed products. Overseas research is now beginning to identify the adverse effects that perfume chemicals can have in our environment, contributing to Sick Building Syndrome (SBS), Indoor air pollution and chemical sensitivity.
Perfume is a common product used by most of the population in one form or another and is extremely difficult to avoid in a public indoor environment. Perfumes and perfumed products contain a large array of chemicals such as aromatic oils (both natural & synthetic), solvents, preservatives etc that add to indoor air pollution. In this way it is analogous to the issue of cigarette smoke in public environments in that those most severely affected by it are exposed ‘passively’ and have no choice in the matter. It was only through extensive campaigning and intervention by the medical profession that cigarette smoking was banned in many public areas.
The various sections of this paper are summarised below:
1. Industry Standards and Solvent Sensitivity: Demonstrates that the potential for chemical injury, sensitisation and subsequent low level harm is recognised within Worksafe’s Occupational Standards. Provides a definition for solvent sensitivity.
2. Perfume sensitivity, Indoor Air Pollution and SBS:
Highlights the problems associated with solvents and other chemicals when used in common everyday substances such as perfumes & perfumed products. Demonstrates that indoor air pollution is a major health problem and how it is contributing to SBS. There is also reference to the relationship between SBS and MCS.
3. Definitions and Models of MCS: Provides definitions of
Multiple Chemical Sensitivity from
- Cullen’s 1987 overview of Workers with MCS published in the Occupational Medicine Journal
- Ashford & Millers definition published in a 1992
- US Dept of Health & Human Services description published in 1998
- The 1999 Consensus statement published in Archives of Environmental Health
and Lists the current models of MCS
4. Medical models of solvent/perfume/odour sensitivity/intolerance:
Provide reference to medical models that are intended to explain how ‘chemicals’ and odours can produce systemic symptoms, and explain terms such as neurogenic inflammation and Cacosmia.
5. Concerns, Rights and Health Issues: These issues raise concerns for the health of children, particularly when the chemicals used for fragrance are also used as flavourings in medications and processed foods. A major concern is that toxicology risk assessment for chemicals is flimsy and can only measure what is currently known. Even scent free or fragrance free labelling does not guarantee that the product is suitable for susceptible individuals. This then raises the question of the right to clean air, free of perfume odours and chemicals.
6. Recognition of perfume/scent sensitivity in the US: This sections give examples of sectors within the US community that are taking the issue of air pollution by perfumed products seriously enough to ban their use in certain situations.
7. Chemical Sensitivity prevalence and recognition: Gives
the prevalence figures for chemical sensitivity in the US, and a list of National & International bodies that accept MCS as a valid illness.
Many members of ASEHA Qld Inc and other similar organisations
have been injured as the result of an acute, high level occupational exposure.
Following such an exposure, there is little assistance to diagnose and effectively treat the resultant health damage. Once chemical injury has occurred there is no acknowledgment of the damage caused to organ systems such as skin, liver, respiratory or Central Nervous System. In many cases chemically injured people are:
- misdiagnosed and mistreated;
- subject to discrimination and human rights abuses;
- they cannot access appropriate care in a timely manner;
- they cannot access care in a 'safe' environment in spite of statements
made that we are entitle to 'high quality, safe, appropriate health care
delivered in an environment in which you feel safe…' (Queensland Health.
Leaflet). We define 'safe' as low in volatile organic compounds and perfume
As many chemically injured persons cannot find the expertise to assist them with necessary health care, they lose the ability to work and support themselves. Proving chemical injury is difficult, as people either do not have access to biological testing that could establish harm, or testing does not exist. (Worksafe Standard section 8.3) As a result compensation for damage caused by workplace exposure is difficult to obtain and many people who have paid for and should be supported by insurance payments, are on social welfare and dependent on the public health care system for necessary health care.
1. Industry Standards and Solvent Sensitivity
The existence of chemical injury/sensitivity is validated by
ASEHA is concerned about the ability of the health care system to provide safe facilities and appropriate assistance to those injured by chemicals. The Worksafe Standard for air levels of contaminants in the occupational environment is clear that chemical injury as an organic disease state does occur with sections devoted to sensitisers, solvents and odours.
Some points of interest in the Worksafe Standard are as follows:
Introduction p. 5
- 1.2 exposure standards are based only on current knowledge;
- 1.4 exposure standards do not guarantee protection for every worker
because of individual susceptibility and biological variation, and it is
inevitable that some workers will suffer adverse health impacts;
- 1.6 atmospheric exposure standards only consider absorption by inhalation
and are only valid on the assumption that skin absorption cannot occur.
Most substances used are untested/lack data
Chapter 2. Unlisted substances p. 6
- 2.1 most substances used in industry have not been assigned exposure
standards. This does not imply that the substances are safe or non-hazardous;
- 2.2 there is a lack of data on health effects of some substances to assign
Lack of biological tests
Chapter 8. Biological monitoring p. 13
- 8.3 there is limited knowledge of suitable and definitive biological tests
for most substances.
Odour and chemical interactions validated
Chapter 9 Odour thresholds p.14
- 9.1 odours can serve as a useful warning signal as to the presence of a
substance in the environment;
- 9.2 there may be interference from other substances;
Chapter 11 Effects on the skin p. 16
- 11.1 some substances can readily penetrate the skin and this method of
exposure can pose a far greater danger than inhalation exposure;
- 11.3 some substances such as solvents can accelerate or alter the rate of
- 11.6 it is 'good practice' to avoid any unnecessary contact with all
Sensitisation and low level exposures validated
Chapter 12 Sensitisers p. 17
- 12.1 Some substances (TDI, Formaldehyde) can cause a specific immune
response in some people. This is known as 'sensitisation';
- 12.2 Following sensitisation 'an affected individual may subsequently
react to exposure to minute levels of that substance'. Although low values
have been assigned the exposure standard may not be adequate to protect a
hypersensitive individual and persons who are sensitised to a particular
substance should not further be exposed to that substance. (NOHSC. 1995)
Chapter 15 Mixtures of substances p. 28
- 15.12 At present the understanding of interaction effects is incomplete.
The knowledge that such effects occur is reason to maintain the
concentrations of individual substances as low as is practicable under
complex exposure conditions.
Part 2 Interpretation p. 70
'Exposure Standard' means an airborne concentration of a particular substance in the workers breathing zone, especially to which according to current knowledge, should no cause adverse health effects nor cause undue discomfort to nearly all workers .
It is unethical to ignore the perceived small percentage to which these standards cannot be applied.
Why are we having so much trouble gaining recognition of the organic disease state induced by chemicals when Worksafe clearly acknowledges the problem exists and confirms the need for avoidance - even to low levels? The basis of chemical induced illness has always been in teaching toxicology texts such as Casarett & Doull's Toxicology: A basic science of poisons. More proven evidence of toxicity can be found in substance abuse such as glue and petrol sniffing.
Solvent sensitivity is acquired following exposure to a solvent or solvents that results in sensitisation or injury. While this is thought to occur only in an occupational setting following a single acute exposure, chronic exposure to solvents can cause the same spectrum of effects as a single acute exposure. (Amdur, MO et al. 1991). Because organic solvents have a special affinity for lipid-rich tissues, including brain tissue, they have been implicated in producing a wide range of CNS symptoms. These same solvents may be used as an ingredient in perfumes and perfumed products.
2. Perfume Sensitivity, Indoor Air Pollution and SBS
Perfume and Chemical Sensitivity
A search of the US National Institutes of Environmental Health Sciences (NIEHS) database for articles on solvent and perfume sensitivity revealed the same search with thousands of articles on Multiple Chemical Sensitivity (MCS) - too many to read. The number of entries on that section of the database searched was 10,741. Of these approximately 20% related to solvent sensitivity, 14% to perfume sensitivity and 50% to multiple chemical sensitivity. The American President has charged the US NIEHS with the responsibility for research into chemical sensitivity and there is a large body of recent research on their database.
Throughout history humans have drawn fragrances from the natural environment. The first synthetic perfuming ingredient was introduced in the late 1800's and since then chemicals have been used extensively to mimic perfumes from nature. It is estimated that there are 3,000 chemicals used in the manufacture of fragrances with synthetic organic chemicals constituting 80-90% of the raw materials. A single fragrance may contain as few as 10 chemicals or as many as several hundred.
Like many other chemicals and chemical mixtures in widespread use today, perfumes are ubiquitous in the environment and unavoidable. Little is known about the impact fragrances have on human health. Because of intellectual property rights, ingredients are trade secrets and this makes it difficult to link claims of adverse reactions to particular chemicals. The secrecy also makes it difficult for researchers to study health effects of perfumes.
Chemicals in perfumes, colognes, deodorants, cosmetics etc worn by individuals, combine with chemical mixtures in the indoor environment and exacerbate 'sick building syndrome'. A study by the US EPA investigated the effects of 31 perfumed products in indoor air and a total of 150 chemicals were identified. Of the main chemicals identified, few have been tested for carcinogenicity although some are known mutagens, carcinogens, and others have toxic effects at high concentrations. (Wallace. 1991). Some chemicals found in perfumes e.g. butyl phthalate accumulate in fatty tissue, they exhibit weak oestrogenic action and recent research indicates that these may affect the male reproductive system or cause breast cancer.
Mixtures of volatile organic compounds used in perfumes is cause for concern as, individually, these are extremely potent chemicals. Given the large number of compounds in an individual perfume, the likelihood of these combinations enhancing carcinogenic, mutagenic or oestrogenic activity is high. As health impacts of perfumes such as migraine and asthma have already been noted, and the percentage 'at risk' individuals i.e. those in the population with allergic disease is high, we can only conclude that using perfume does not constitute a low-level exposure - but is a major public health hazard.
Indoor Air Pollution and Sick Building Syndrome (SBS)
Indoor air quality has traditionally been an issue in the industrial sector where standards have been established in an effort to limit worker exposure to airborne contaminants. While low levels of indoor air contaminants in the workplace have been assigned, it is important to realise that measured levels of contaminants in buildings may be misleading as these may vary over time or from one part of a building or another. A given measurement may reflect a 'best case' scenario that is not necessarily representative of usual exposures. Some other problems include:
- additive effects of pollutants on each other;
- the absorption of VOCs by particulate matter;
- excess heat can add to the central nervous system effects of VOCs,
enhancing symptoms such as headaches and fatigue. There seems to be an interaction between chemosensory receptors in the body and thermosensory neuroreceptors so that cooler temperatures are associated with less reactivity. (Oliver and Shackleton. p. 6)
While exposure levels established by regulatory authorities apply to the industrial sector, lower levels can cause problems. However, it is now also recognised that poor air quality is a broader health problem in offices, schools, homes, institutional settings and most of the population is potentially at risk. Poor indoor air quality can cause or contribute to the development of chronic diseases such as asthma, multiple chemical sensitivity, hypersensitivity pneumonitis, while causing a broader array of conditions such as headache, nausea, dry eyes, nasal congestion, fatigue. While asthma, hypersensitivity pneumonitis and MCS are signs of SBS, MCS and SBS can overlap. (Oliver and Shackleton p.3) Those with certain existing medical conditions such as asthma, allergy, connective tissue disorders or are immunosuppressed by medications such as steroids or chemotherapeutic agents are at greater risk than the general population. (Oliver and Shackleton p.1/2)
Some causes of SBS are poor ventilation, indoor air contaminants such as volatile organic compounds, pesticides, lead, carbon monoxide, carbon dioxide, nitrogen dioxide, biological contaminants such as moulds or dust, ozone, environmental tobacco smoke, polycyclic aromatic hydrocarbons, asbestos, wood resins. Some 250 VOCs have been identified in office air including air contaminants that were previously thought only to be found outdoors. (Baker. 1997)
Health effects from poor indoor air quality is becoming an important public health issue. This is particularly relevant given the high percentage of the population with allergic disease such as asthma. Prevention strategies need to be implemented to either prevent or reduce indoor air contaminants. Some of these strategies could include;
- building materials/furnishings low in VOCs;
- odourless cleaning compounds which have also been chosen for their low toxic effects;
- a no smoking ban within a specific radius around buildings so that smoke cannot be drawn back into the building;
- a ban on the wearing of perfume and perfumed personal products in the work environment;
- a ban on freshly dry cleaned clothing in public buildings.
- a ban on indoor air deodorisers
Oliver and Shackleton in their article The Indoor Air We Breathe; a public health problem of the 90s state that " Multiple chemical sensitivities and sick building syndrome are complex issues that are often reduced to ideological and political positions that are not constructive to their resolution'. (Oliver & Shackleton. p. 13)
3. Definitions and Models of MCS
A wide array of names has been given to syndromes suffered by individuals with a heightened reaction to chemicals, each with its own specific implications as to the underlying cause, mechanism, or manifestations of the disease. Sometimes these overlap. A major hindrance in achieving recognition of chemical sensitivity and appropriate assistance for the chemically sensitive is the difficulty in gaining agreement on a definition. Working case definitions for MCS since 1987 are similar.
The main working case definition for chemical sensitivity by Cullen in 1987 remains applicable today. He defined chemical sensitivity as 'an acquired disorder characterised by recurrent symptoms, referable to multiple organ systems, occurring in response to demonstrable exposure to many chemically unrelated compounds at doses far below those established in the general population to cause harmful effects. No single widely accepted test of physiologic function can be shown to correlate with symptoms'. The seven major diagnostic features distinguished are:
- The disorder is acquired in relation to some documentable environmental exposure, insult, or illness.
- Symptoms involve more than one organ system
- Symptoms occur and abate in response to predictable stimuli.
- Symptoms are elicited by exposures to chemicals of diverse structural classes and toxicological modes of action.
- Symptoms are elicited by exposures that are demonstrable
- Exposures that elicit symptoms are very low (many standard deviations below 'average; exposures)
- No single widely available test of organ system function can explain symptoms. (Cullen. 1987)
Ashford and Miller 1992
Ashford and Miller in 1992 proposed the following definition for diagnostic purposes 'The patient with multiple chemical sensitivity can be discovered by removal from the suspected offending agents and by rechallenge, after an appropriate interval, under strictly controlled environmental conditions. Causality is inferred by the clearing of symptoms with removal from the offending environment and recurrence of symptoms with specific-challenge'. (Ashford. 1991)
US Dept Of Health and Human Services 1998
The United States Department of Health and Human Services in its Public Health Reports, Sept-Oct. 1998 also gave a clinical definition of chemical sensitivity that is as follows:
- symptoms are reproducible on exposure;
- the condition is chronic;
- symptoms occur following low-level exposure;
- removal of precipitating exposures results in resolution of improvement in symptoms;
- the condition is acquired;
- there is an acute inciting event, followed by a chronic component;
- there are no objective tests to adequately explain the symptoms.(Oliver and Shackleton. 1998)
1999 Consensus statement
More recently (1999) a consensus statement by eminent occupational medicine practitioners was printed in Environmental Health Perspectives (Bartha et al. 1999). In this, the signatories to the consensus statement called for MCS to be formally recognised and diagnosed using the following criteria from a study by Nethercott et al that was funded by the US NIOSH and the US NIEHS:
- The symptoms are reproducible with repeated chemical exposure
- The condition is chronic
- Low levels of exposure result in manifestations of the syndrome
- The symptoms improve or resolve when incidents are removed
- Responses occur to multiple chemically unrelated substances
- Symptoms involve multiple organ systems.
The Consensus Statement agreed with the 1994 statement of the American Lung Association, American Medical Association, US EPA, and US Consumer Product Safety Commission, that "complaints" of MCS should not be dismissed as psychogenic, and a thorough work-up is essential'. (Bartha et al. 1999)
Models of Chemical Sensitivity
There are many models of chemical sensitivity and these may overlap:
- Reactive airways dysfunction syndrome (RADS);
- Reactive upper airways dysfunction syndrome (RUDS);
- Sick Building Syndrome (SBS);
- Multiple Chemical Sensitivity (MCS);
- A further model called reactive intestinal dysfunction syndrome (RIDS) was recently noted (Lieberman and Craven. 1998);
- A paper summarising the clinical phenomena of MCS outlines the concepts and evidence for the olfactory-limbic, neural sensitisation model was
published in 1997 (Bell. 1997).
4. Medical Models Of Solvents/Perfume/OdourSensitivity/Intolerance
Testing of perfumes show that these can cause dermal allergic reactions, but this is not the only route of absorption. Perfumes can be inhaled and absorbed via the olfactory bulb. Little is known about the olfactory system but the nasal passage offers a unique route of exposure for chemicals to be absorbed directly into the brain indicating a need for more research on neurogenic inflammation. A study recently to hand indicated that exposure to perfume via the eyes can elicit symptoms. In this particular study researchers found that symptoms arising from eye exposure were similar to 'sick building syndrome and multiple chemical sensitivity. Their findings point to the importance of studying the sensory nervous system, not only in the airways, butin other systems as well. (Allergy. 1999)
Studies by the Anderson Laboratory in Vermont (USA) have shown the following symptoms experienced from exposure to perfumes from fair fresheners, colognes, fabric softeners: some combination of eye, nose and/or throat irritation; respiratory difficulty; possibly bronchoconstriction or asthma-like reaction; central nervous system reactions such as dizziness, incoordination, confusion, fatigue. In a study of emissions from disposable diapers, mixtures of chemicals were found that could cause or exacerbate
asthmatic conditions. (Anderson C and Anderson J. 1999) .
Odour intolerance or Cacosmia
Chemical odor intolerance or cacosmia is a symptom that involves a sensory response or illness from the odour of common chemicals such as new carpet, newsprint, disinfectant, paint, natural gas, perfume, tar, pesticide, car exhausts, tobacco smoke. 'Cacosmia is defined by a population subset, with or without occupational xenobiotic exposures or disability, that has distress and symptom amplification and neuropsychiatric and somatic symptoms, none of which are explained fully by psychological measures. Prospective clinical studies are possible with such individuals. The data are also consistent with a time-dependent sensitisation model for illness from
low-level chemical exposures'. (Bell. 1996)
Cacosmia - effects on learning and memory
A study in the American Journal of Psychiatry examined the interrelationships among occupational exposure to mixtures of organic solvents, neurobehavioural functioning and complaints of cacosmia. In this study, cacosmia was defined as nausea, headaches and subjective distress in individuals exposed to neutral environmental exposures. A battery of cognitive tests was administered to men with and without a history of solvent exposure and exposed workers were found to have a wide range of cognitive impairment. There was a highly significant relationship between a history of cacosmia and performance decrements on measures of learning and memory. (Ryan 1988)
Symptoms noted from odour intolerance include nausea, headaches, forgetfulness, difficulty concentrating, depressed effect, heightened irritability, dizziness, motor incoordination, weakness in the extremities.
While it is believed these symptoms will spontaneously disappear, some individuals complain that the symptoms have not disappeared in spite of the fact that the last exposure occurred several months earlier. (Ryan 1988)
Professor Kaye Kilburne (Ralph Edgington Professor of Medicine, Los Angeles) set out to address the dilemma of a test to demonstrate neurologic dysfunction on humans exposed to chemicals in the workplace environment. Comparison measurements of exposed and unexposed individuals showed that many brain functions were slowed and diminished, including balance, reaction times, colour, discrimination and visual fields. It was clear from the sampling that ten classes of common chemicals caused adverse effects on human brain function.
Most exposures were to mixtures of common chemicals although one chemical usually predominated, indicating that effects of individual chemicals interact and many synergise for a total effect that exceeds an additive effect. Chemicals included classes of insecticides and mixtures such as chemical waste. Pesticides were organochlorines, organophosphates, pyrethroids. Gases included ammonia, chlorine, formaldehyde, hydrogen sulphide, carbon monoxide. Among these chemicals are solvents - chlorinated and nonchlorinated - such as toluene, PCBs, plastic monomers (PVC, styrene). Some of these were from combustion products of diesel exhausts, incineration of industrial and domestic waste and yielded PCBs and toxic metals. The effects of chemicals on the brain were generalised and Prof Kilburne stressed that prevention by avoidance is the only practical and safe strategy. (Kilburne 1999)
Another form of brain injury caused by solvents is substance abuse as in paint sniffing, glue sniffing, petrol sniffing and more recently perfume sniffing. This has become a problem in some sections of the community. However, while this form of solvent exposure is voluntary, the use of solvent laden perfume is like tobacco smoke - a public health hazard - it is inflicted upon the community unnecessarily and is now ubiquitous in the environment. Those sensitive to solvents/perfumes are exposed against their will, and to the detriment of their health and wellbeing. Recent studies showing levels of synthetic musk compounds in ambient air and human body fat are indicative that
these substances do constitute a public health problem that needs to be addressed. (Gutterman. 1999)
5. Concerns, Rights And Health Issues
Child health a concern
We now find perfumes in a multitude of 'personal' products with more than 1000 body fragrances; commercial products ranging from cleaning compounds, air fresheners, laundry products, paper products, candles and nappies. In fact, it is difficult now to find unperfumed products and perfume has become ubiquitous in the environment. Of major concern is the effect of perfumes on child health and the developing Central Nervous System. Children are at greater risk of such products because of their smaller size, higher respiratory rate and thinner skin. Little research has been done on this issue.
Flimsy toxicology exposed
It is clear that the science base for risk assessment of most chemicals is not very strong. Toxicology and medical science are limited in their scope and knowledge and can only deal with what is known at the time chemicals are evaluated. In 1991, the US National Research Council estimated that only 2% of around 60,000 chemicals that are widely used have been comprehensively studied for toxic effects. Of that 2% many were studied in animals, few in humans. Those compounds that have been studied for chronic, low-level effects have rarely been evaluated for neurologic (central, peripheral, autonomic), neurobehavioural, immune, endocrine, reproductive and pulmonary effects. Rarely have these been studied in combined exposures that actually exist in the real world. (Ziem and Davidoff. 1992)
Chemicals used for fragrance are also used for flavouring
Many people do not realise that perfume sensitivity is a serious public health risk. The issue of detectable levels of synthetic musk compounds in the air we breathe is cause for concern as they build up in the food chain in much the same way as Polychlorinated biphenyls (PCBs) and DDT. Synthetic musk compounds have been found in fish, mussels, human fat, milk and blood. (Gutterman. 1999) It is also worth noting that the same chemicals that are used to produce perfumes are used in the food and pharmaceutical industry to produce flavourings. As many of these are not adequately tested we are concerned about their effects on the population. In particular, we are concerned about effects of the mixtures of flavourings with medications, pesticides, and other chemicals natural and added in food. While these are individually subject to risk assessment, the reality is that food is a mixture of chemicals and adding solvents to this mixture may result in a dangerous, high level exposure with enhanced carcinogenic, neurogenic or oestrogenic potential - especially to children.
Product labelling such as unscented or fragrance free does not necessarily mean the product contains no fragrance materials. Sometimes manufacturers add masking chemicals to cover those containing scent. However, some people exhibit a heightened sense of odour and can detect fragrance in products labelled unscented or fragrance free.
While some individuals enjoy perfumed products, there is a growing outcry from those in the community who claim that exposure to perfume impacts adversely on their health. Many report that exposure to perfume incapacitates them so much that they have to forego their usual activities and/or wear an odour mask in an effort to avoid exposure.
The right to breathe clean air
The fragrance issue will become as controversial as the cigarette smoke issue, i.e. people's right to wear perfume over the right of another to breathe clean air.
6. Recognition Of Perfume/Scent Sensitivity In Us
Californian legislation regulates fragrance inserts in printed material
The Californian State Government passed a regulation in 1992 that fragrance advertising inserts in magazines or printed material shall contain only microencapsulated oils. Some magazines in the USA now offer a 'scent free' version on request. (Fisher. 1998)
Minnesota school urges students and teachers to be fragrance free
Faculty and students of the University of Minnesota School of Social Work are now banned from using perfume following a ban on scented body products. The ban was instituted because fragrances trigger allergic reactions in some people. This has been dubbed multiple chemical sensitivity. Officials of the school say the ban has been well received and as the school shares its building with several other departments, students and faculty in those departments are also being asked to observe the ban. (Fisher. 1998)
7. Chemical Sensitivity Prevalence and Recognition
While the physiology of Chemical Sensitivity has not been fully investigated, it is generally believed that MCS occurs as a result of effects on the limbic system, immune system and the respiratory tract. The increasing importance of Chemical Sensitivity as a public health problem is attested to by the fact that it has now been recognised by many reputable organisations, including the US EPA.
Chemical Sensitivity Prevalence
Chemical Sensitivity has emerged in the last 20 years with growing numbers in the population affected. The number of people diagnosed with MCS in the American population is unknown. However, in a 1996 survey of 4000 adults in California carried out by the California Health Services Department, 6.3% of respondents report a diagnosis of MCS. An additional 15.9% reported 'chemical sensitivity' associated with multiple reactions, without a specific diagnosis of MCS. (American Journal of Epidemiology. 1999)
Bell et al reported a substantial proportion of various populations presenting to an occupational medicine setting reported cacosmia:
- approximately 60% of solvent exposed workers (mainly blue-collar workers)
- 30% of a sample of almost 4,000 office workers (mainly female, professional, white collar workers)
- 15-30% of college students and active, retired, elderly individuals (Bell et al. 1997)
Ryan et al state that more than 20 million people in the USA are exposed to toxic substances in the home or workplace. For the vast majority of those people, mixtures of organic solvents are the most frequent source of exposure (Ryan et al. 1988)
Claudia Miller, Associate Professor of Environmental and Occupational Medicine at the University of Texas Health Sciences Centre in San Antonio, says that several studies indicate:
- 15-30% of the population report sensitivity to chemicals, including fragrances;
- 4-6% report that chemical intolerance has a major impact on their quality of life and of these
- 80% report that exposure to fragrances is bothersome.
- Many Gulf War Veterans report chemical intolerances since the war, including sensitivity to fragrances. (Fisher. 1998)
State Health Department surveys of civilians in New Mexico and California showed that 2-6% have been diagnosed as having chemical sensitivity while a further 16% reported 'unusual sensitivity to everyday chemicals. (American Journal of Epidemiology. 1999)
In a random telephone survey of a US rural population (North Carolina) in 1993, questions were asked about allergy and sensitivity. Of the 1446 households contacted, 1027 (71%) agreed to participate. 35% reported allergy with thirty percent reporting symptoms once per week, 61% reported symptoms of allergy once per month. Daily allergy symptoms were reported by 5.3% of the total population. Chemical sensitivity was reported by 33%, with 35% of those reporting symptoms once per week, 53% reported symptoms once or less per month and 3.9% of the total population reporting symptoms on a daily basis. Both allergy and chemical sensitivity were distributed widely across age, income, race and educational groups. Simultaneous allergy and chemical sensitivity were reported by 16.9% of the population, allergy without chemical sensitivity by 16%, chemical sensitivity without allergy by 18.2% and neither condition by 48%. The conclusion of the survey was that if the prevalence of sensitivity to chemical irritants is equivalent to that of allergy, as was found in the study, then support for the scientific investigation of chemical sensitivity is justified. (Meggs et al 1996)
A report to the Victorian Health Minister entitled 'Strategies to manage the rising epidemic of allergic diseases in Australia' noted that one in three Europeans suffer with allergy and that the incidence of allergic disease is higher in Australia. Figures suggest that 41% of the population suffer with hayfever. If we can conclude from the study by Meggs et al that the prevalence of sensitivity to chemical irritants is equivalent to that of allergy, sensitivity to chemical irritants represents a very significant percentage of the general population, and, therefore should be high on the list of service provision in the health system with suitable low VOC, perfume free
areas set aside for those needing care. Some highlights from the activities of the Swedish Allergy Program 1995 are as follows:
- 1/3 of all adults suffer with allergic disease
- 60% of women and 40% of men suffer from sick building syndrome in their working environment
- In Sweden the cost of health care and loss of production from allergic disease cost SEK 5,600 million per year…
- and that cost doubled in 10 years (National Institute of Public Health, Sweden. 1995)
Recognition of Chemical Sensitivity
When first described in the 1950s, Chemical Sensitivity was met with great scepticism by medical practitioners until the 1980s and 1990s when it began to move into the mainstream of clinical practice in the USA. (Oliver and Shackleton. 1998). The International Organisations that recognise MCS are listed in Appendix 1.
The ways in which these bodies are recognising MCS are many and include
- Initiation of research, clinical studies, reviews, reports and workshops into the mechanisms and etiology of chemical injury
- Initiation and funding of building projects for environmental modifications to
- Public Housing
- The workplace
- Public buildings
- Recognition of MCS within Disability Acts and legislation
- Requests to refrain from wearing scented products, to their ban in public indoor environments
- Integration of MCS into mainstream medical databases
- Recognition of MCS as a medical diagnosis
- Issuing of safety standards for consumer products, such as carpets,suspected of causing MCS and other illnesses
- Provision and establishment of Environmental Health Clinics
- Prior notification schemes for pesticide use in the local environment and within flats and units, including warning signs on building where hazardous products are being used.
- Temporary discontinuation of use of specific cleaning chemicals etc in order to provide safe access to public places
- Decisions by US Federal and State Courts that affirm MCS as a handicap or disability.
Conclusion and Issues
From the information contained within the Worksafe Standards we must conclude that chemical injury does exist and that injury can occur at levels lower than workplace standards because of 'individual susceptibility and biological variation'. Worksafe standards further tell us that many substances used in industry have not been assigned any exposure standards and that 'there is limited knowledge of suitable and definitive biological tests for most substances'. They also tell us that 'at present the understanding of interaction [of chemicals] effects is incomplete and 'the knowledge that such effects occur is reason to maintain concentrations of individual substances as low as is practicable under complex exposure conditions'. So it comes as a shock each time a representative of government, Industry or the Medical Profession tells us almost the exact opposite.
Research into Sick Building Syndrome in the US is demonstrating that the indoor air can contain a complex and large number of chemical substances that can cause ill health in the general population. For those individuals with pre-existing allergies or medical conditions the risks or injury are greater. Finding a solution, or the resolve to finding a solution to the problem of widespread illness due to the chemical load in our environment, seems to be a contributing factor in the non-acceptance of chemical injury. Chemicals are widespread in our environment and have become an integral part of modern living. To accept chemical injury is to accept that our environment is potentially dangerous and to accept that means something has to be done to change it. In some sectors of the US and overseas, they are doing something about it by performing meaningful research into the area, or resolving to reduce the overall burden of pollutants by banning perfumed substances or using alternative building materials, or providing acceptable housing and health care facilities for the chemically injured. According to research into SBS, the effects on individuals are basically diminished physical capacity and mental/cognitive skills. In a recent UK study perfumes have been shown to produce headaches and a range of other health problems. (Edwards, Rob. 1999). This means decreased productivity and therefore it is in the best interests of government and industry to reduce the cause of the problem.
Chemical injury, MCS and SBS are extremely controversial areas. Oliver and Shackleton's comment that "MCS and SBS are complex issues that are often reduced to ideological and political positions that are not constructive to their resolution" says it all. While all this controversy rages about names and degrees of severity there are people with chemical sensitivity who are suffering. There is a lack of adequate perfume/chemical free health care facilities, a lack of practitioners willing and able to assist, and a lack of political will to provide the necessary funding.
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2nd Draft 8th February 2000
Prepared by Dorothy M. Bowes, President, ASEHA Qld Inc
Reviewed by Dr Sharyn Martin, Cert.Appl.Sc., B.Sc., PhD.
Abstract and conclusion by Dr Sharyn Martin
APPENDIX 1 Recognition of MCS
Recognition of MCS by International Organisations
American Academy of Environmental Medicine (Denver, Co)
Association of Occupational and Environmental Clinics (Washington, DC)
Association of Trial Lawyers of America, Consumer & Victims Coalition Committee
Environmental Employees Collectively Organised (EPA Headquarters Professionals Union, formerly the National Federation of Federal Employees)
International Labor Organisation (Geneva)
The Labor Institute (New York City)
National Academy of Sciences/National Research Council (Washington, DC)
National Association of Social Workers (Washington, DC)
American Thoracic Society
American Public Health Association
American Society of Heating, Refrigerating, and Air Conditioning Engineers
American Conference of Governmental Industrial Hygienists
The American Medical Association .
The American College of Physicians
The California Medical Association www.mcsrr.org/factsheets/mcsrecog.html
22 US Federal Government Agencies, commissions, Institutes and Departments
23 State Government Agencies, Commissions, Legislatures and Departments
13 Local Government Agencies, Commissions, Councils and Departments
8 Federal Court decisions
20 State Court decisions
14 State Workers Compensation Board decisions
4 Canadian Federal Agencies
6 Canadian Provincial Agencies
US Federal Agencies
- The US Agency for Toxic Substances and Disease Registry - coordinates Interagency research on MCS
- US Army, Medical Evaluation Board - certified a diagnosis of MCS for Gulf War Veterans in 1993
- US Congress - in a VA/HUD Appropriations Bill in 1992
- US Department of Education - require accommodation of MCS sufferers via modification of their environment
- US Department of Health. National Institutes of Environmental Health Sciences - research priorities - hypersensitivity diseases resulting from
allergic reactions to environmental substances.
- US Department of Health. National Library of Medicine - in their 1995 MESH Headings used multiple chemical sensitivity as a subject heading on all
papers indexed after 1994.
- US Department of Housing and Urban Development - confirms recognition of MCS as a disability entitling sufferers to reasonable accommodation and went on to build a special accommodation block for the chemically sensitive.
- US Department of Justice recognised MCS in its Americans with a Disabilities Act of 1990
- US Department of Veterans Affairs - recognised MCS as a medical diagnosis in a Gulf War Veteran
- US Environmental Protection Agency, Office of Research and Development - described MCS as 'an ill defined condition marked by progressively more
debilitating severe reactions to various consumer products such as perfumes, soaps, tobacco smoke, plastics, etc'.
- US Equal Employment Opportunity Commission - recognised MCS as a disability requiring workplace accommodation, in that particular case a
private office and an air filter.
- US National Council on Disability in its report to the President and Congress on progress implementing the Americans with Disabilities Act (ADA)
recommended that Congress and the Administration should address the needs of people with 'emerging disabilities' such as those with Environmental Illness ( MCS)
- US President's Committee on Employment of People with Disabilities - in its report to the President entitled Operation People First, recommended
'reasonable accommodation' for those with MCS.
- US Social Security Administration recognised MCS in its enforcement of the Social Security Disability Act and in its Programs Operations Manual System.
US State and Local Authorities
- Arizona Department of Economic Security, Rehabilitation Services Administration and Statewide Independent Living Council specified that
services related to housing include modifications to accommodate people with MCS.
- Attorney General of California - recognised MCS as a disabling condition in the report of the Attorney General's Commission on Disability.
- Attorneys General of 26 States - Alabama, Arizona, Connecticut, Florida, Indiana, Kansas, Minneapolis, Minnesota, Missouri, North Dakota, New Jersey, New Mexico, North Virginia, New York, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, Wisconsin, West Virginia - successfully petitioned the US Consumer Product Safety Commission to issue safety standards and warning labels governing the sale of carpets, carpet adhesives and padding suspected of causing MCS and other illnesses. 1991
- Contra Costa Medical Advisory Planning Commission in public meeting announcements included the following notice. 'Please help us to accommodate
individuals with EI/MCS and refrain from wearing scented products to this hearing'. 1994.
- Florida State Legislature - created a voluntary pesticide notification registry for persons with pesticide sensitivity or MCS, provided that their
condition is certified by a physician specialising in occupational medicine, allergy/immunology or toxicology. This legislation requires lawn-care
companies to alert registries in advance of chemical application within half a mile of their home. Similar registries have also been adopted in Colorado, Connecticut, Louisiana, Maryland, Michigan, New Jersey, Pennsylvania and West Virginia.
- Maryland State Legislature directed the Maryland Department of the Environment to carry our a study of Chemical Hypersensitivity Syndrome.
- Minneapolis Advisory Committee on People with Disabilities in a letter to the Minneapolis Public Housing Authority expressed a need for proper living
conditions for people with environmental sensitivities . 1994.
- Minneapolis Public Housing Authority in letters to Twin Cities Human Ecology Action League (HEAL) and the US Department of Urban Development
expressed an interest in working with HEAL to develop houses for people with MCS. 1994.
- New Jersey Department of Health commissioned a comprehensive review of MCS with recommendations for state action - Chemical Sensitivities: a report to the New Jersey Department of Health' 1989.
- New Mexico Department of Energy, Minerals and Natural Resources, State Park and Recreation Division reduced barriers to access for MCS sufferers. These include no smoking in restrooms, temporary discontinuation of specific cleaning and disinfecting chemicals on special request, switching to less toxic/allergenic cleaning and pesticide products.
- New York State Department of Health gave a grant of $100,000 to Mt Sinai Occupational Health Clinic for MCS research ( part of a larger annual grant to the Clinic)
- Pennsylvania Human Rights Commission upheld an appeal to the Commonwealth court of Pennsylvania that a landlord must make reasonable accommodation for a tenant suffering with MCS, including prior notification of painting and pest control.
- San Francisco Board of Supervisors requests citizens attending public meetings 'to refrain from wearing perfume or other scented products to allow
individuals with MCS to attend'. 1993.
- Santa Clara City Council in its 'Public Services Self-Evaluation/Transition Plan' includes several provisions for accommodating individuals with MCS. These include: wherever possible the purchase and use of less toxic hypoallergenic and non-fragrance materials; the posting of notices at entrances to public buildings warning of construction, remodelling or toxic cleaning activities; a notice requesting that those with MCS attending meetings should contact the City's ADA Office to discuss meeting accessibility; In order to allow participation by those with MCS notices are issued to ask people not to wear scented products to meetings at City facilities.
- Santa Cruz City Council in its Self-Evaluation and Transitional Plan included provisions requiring smoke free and fragrance free environments for
public meetings; the elimination of chemical air fresheners/fragrance-emission devices and the use of the least toxic maintenance products and application methods in all City buildings as well as signage warning of the use of hazardous materials in public areas.
- Washington State Governors' Committee on Disability Issues and Employment in their booklet entitled ' Reasonable Accommodation: A guide for Employers, Businesses and Persons with Disabilities' discusses MCS in detail.
- Washington State Interim Inter-Agency Work Group for MCS Syndrome in a final report to the Secretary of the Department of Health and the Director of Labour and Industries, defined MCS as 'a disorder characterised by recurrent symptoms, involving multiple organ systems, triggered or
aggravated by a variety of chemicals, at levels that may be far below those causing symptoms in the general population. 1994.
- Washington State Board of Health noted in its 1994 Washington State Public Health Report that 'several hundred Washington residents have reported a condition diagnosed by some physicians as MCS'.
US Federal Courts in decisions affirming MCS as a
handicap or disability under the:
- Rehabilitation Act: Vickers v Veterans Administration 1982, Rosiak v Department of the Army 1987
- Social Security Disability Act: Kouril v Bowen 1990, Kornok v Harris 1980,
Slocum and Califano 1979
- Fair Housing Act: United States v Association of Apartment Owners of Dominis West 1993
US State Courts regarding:
- Housing Discrimination: Lincoln Realty Management Co. v Pennsylvania Human Relations Commission, 1991
- Employment Discrimination: County of Fresno v Fair Employment and Housing Commission of the State of California, 1991
- Workers Compensation: Robinson v Saif Corp, Kyles v Workers Compensation Appeals Board, 1987; McCreary v Industrial Ccommission of Arozina, 1992
- Health Services Discrimination: Hall, Buffalo, Molloy and Lent v Kenneth Kizer/Molly Coe, California Department of Health Services 1989. The
Plaintiffs won the right to receive oxxygen for MCS.
- Product liability: Bandura v Okin Exterminating Co, 1987
- Sick Building Syndrome: Bahura, Watkins, Shapiro, Lively-Diebold, Biggs v S.E.W. Investors et al, 1993. Compensation for MCS resulting from toxic
exposures in the EPA's Waterside Mall headquarters building.
Recognition by Canadian Authorities
- Canada Mortgage and Housing Corporation in its 'Clean Air Guide' and in 2 reports commissioned in 1990 - Housing for the Environmentally
Hypersensitive and Survey of the Medical Impact on Environmentally Hypersensitive People of a Change in Habitat.
- Health and Welfare Canada (now Health Canada) in the published proceedings of two workshops sponsored on MCS in 1990 - Environmental Hypersensitivities Workshop, a supplement to chronic diseases in Canada. Jan. 1991.
- Nova Scotia Department of Health - established and funded an Environmental Health Clinic with the specific purpose of examining and treating
'environmental illness'. 1989
- Ontario Ministry of Health recognised MCS in their 'Report of the Ad Hoc Committee on Environmental Hypersensitivity Disorders'. They went onto
sponsor a networking workshop for MCS clinicians and researchers in 1990 and funds MCS projects. In 1994 it funded a new environmental health clinic at the Womens' College Hospital in Toronto
- Ontario Ministry of Housing provided funding for the Barrhaven project a 'healthy buildings' project for people suffering with MCS
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