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NICNAS MCS Report – final report and submissions

Monday 6 December 2010

NICNAS: Multiple Chemical Sensitivity - Identifying Key Research NeedsAustralia's National Industrial Chemicals Notification and Assessment Scheme (NICNAS) has published its final report into Multiple Chemical Sensitivity.

Here's the preface and table of contents:

 

Multiple Chemical Sensitivity: identifying key research needs

A SCIENTIFIC REVIEW OF MULTIPLE CHEMICAL SENSITIVITY: IDENTIFYING KEY RESEARCH NEEDS

Report prepared by the National Industrial Chemicals Notification and Assessment Scheme (NICNAS) and the Office of Chemical Safety and Environmental Health (OCSEH)

November 2010

PREFACE

What this review is about

Multiple Chemical Sensitivity (MCS) is a term used to describe a condition presenting as a complex array of symptoms linked to low level exposure to chemicals. There is uncertainty about the event(s) and the underlying biological mechanisms that lead to symptoms. This uncertainty has hampered the development of a clinical basis for the diagnosis and treatment of individuals with MCS.

Those with MCS often face situations where their symptoms may be poorly understood or mis-diagnosed, and may be provided with health care that is less than optimal. Difficulties with the diagnosis of MCS are accompanied by a lack of consensus for its treatment other than avoidance of agents that may trigger symptoms.

Significant gaps in understanding MCS, together with community concerns over the presence of chemicals in the environment have led the Australian Department of Health and Ageing (DoHA), through the Office of Chemical Safety and Environmental Health (OCSEH) and the National Industrial Chemicals Notification and Assessment Scheme (NICNAS), to prepare this scientific review of MCS.

Scope of the review

The aim of this review is to examine current scientific research on MCS and to identify priority areas for further study to inform and engage the clinical and scientific research community.

The report therefore examines evidence about:

  • Identifying MCS, symptoms and triggers;
  • Mode(s) of action for chemical interactions within MCS;
  • Approaches to clinical diagnosis and treatment of MCS.

The report also highlights research efforts and further activities that would enhance diagnosis, treatment and better clinical management practices of MCS in Australia.

Conduct of the review

The review has two key areas of focus. Firstly, it reviews scientific information to identify biologically plausible hypotheses to explain the underlying mechanisms of MCS. The elucidation of the biological basis for MCS will undoubtedly provide direction for clinical diagnosis and improve treatments options for MCS. If the underlying biological mechanism(s) can be determined for MCS, there is potential to not only better treat symptoms but to effect a significant alleviation of the condition.

Secondly, to better support the diagnosis and management of individuals with MCS, the review identifies current diagnosis and treatment practices and gaps in clinical research and medical education in Australia. The review findings point to specific priorities for further scientific and clinical research on MCS.

CONTENTS

1 EXECUTIVE SUMMARY
     1.1 OVERVIEW
     1.2 FINDINGS
          1.2.1 Research into the cause(s) of MCS
          1.2.2 Clinical research needs

2 UNDERSTANDING MULTIPLE CHEMICAL SENSITIVITY
     2.1 WHAT IS MULTIPLE CHEMICAL SENSITIVITY?
     2.2 WHAT ARE THE SYMPTOMS OF MCS?
     2.3 WHAT CHEMICALS TRIGGER THE SYMPTOMS OF MCS?
     2.4 CAN MCS BE CLINCALLY DEFINED?
     2.5 DOES MCS HAVE A DISEASE CLASSIFICATION?
     2.6 DO INDIVIDUALS WITH MCS SHARE COMMON CHARACTERISTICS?
     2.7 IS MCS RELATED TO OTHER SYNDROMES OR DISORDERS?

3 MECHANISMS OF MULTIPLE CHEMICAL SENSITIVITY
     3.1 OVERVIEW OF POSSIBLE MCS MODE (S) OF ACTION
          3.1.1 Immunological dysregulation
          3.1.2 Respiratory disorder/neurogenic inflammation
          3.1.3 Limbic kindling/neural sensitisation
          3.1.4 NMDA receptor activity and elevated nitric oxide and peroxynitrite
          3.1.5 Toxicant-induced loss of tolerance (TILT)
          3.1.6 Altered xenobiotic metabolism
          3.1.7 Behavioural conditioning
          3.1.8 Psychological/psychiatric factors
          3.1.9 Other proposed mechanisms
     3.2 FURTHER RESEARCH FOR ELUCIDATING MODE(S) OF ACTION
          3.2.1 Chemical initiators/triggers and biological gradients
          3.2.2 Challenge studies for determining causation
          3.2.3 Investigations for key modes of action

4 DIAGNOSIS, TREATMENT AND MANAGEMENT OF MULTIPLE CHEMICAL SENSITIVITY
     4.1 DIAGNOSIS AND PREVALENCE OF MCS
          4.1.1 Studies on the prevalence of MCS in Australia
          4.1.2 Studies on the prevalence of MCS in other countries

     4.2 MCS CASE DEFINITION AND PREVALENCE DATA
     4.3 TREATMENT FACILITIES
     4.4 TREATMENT/MANAGEMENT STRATEGIES
     4.5 CLINICAL APPROACHES TO MCS IN AUSTRALIA
     4.6 CLINICAL RESEARCH NEEDS
          4.6.1 Longitudinal Study
          4.6.2 Education/Training

5 APPENDIX 1 - A SURVEY OF AUSTRALIAN CLINICIANS APPROACHES TO MULTIPLE CHEMICAL SENSITIVITY
     5.1 THE SURVEY PROCESS
          5.1.1 Stakeholder contact
          5.1.2 Questionnaire
          5.1.3 Interviews
          5.1.4 Workshop

     5.2 PROBLEMS ENCOUNTERED
     5.3 THE COMMON GROUND
          5.3.1 Initial Presentation
          5.3.2 Diagnosis
          5.3.3 Prognosis and Treatment
          5.3.4 Education

     5.4 IMPLICATIONS FOR TREATMENT/MANAGEMENT
          5.4.1 Common MCS treatments
          5.4.2 Recognising and responding to MCS individuals
          5.4.3 Principles for the management of MCS

     5.5 SUGGESTIONS FOR CLINICAL RESEARCH

6 APPENDIX 2 - VIEWS OF NATIONAL GOVERNMENTS AND PROFESSIONAL MEDICAL ORGANISATIONS
     6.1 US PROFESSIONAL ORGANISATIONS
          6.1.1 American Academy of Environmental Medicine (AAEM)
          6.1.2 American Academy of Allergy, Asthma and Immunology (AAAAI)
          6.1.3 American College of Physicians (ACP)
          6.1.4 American College of Occupational and Environmental Medicine (ACOEM)
          6.1.5 American Medical Association (AMA)
          6.1.6 Californian Medical Association (CMA)
          6.1.7 Association of Occupational and Environmental Clinics (AOEC)
          6.1.8 National Academy of Sciences – National Research Council (NRC)
          6.1.9 Other Organisations

     6.2 US GOVERNMENT
          6.2.1 Agency for Toxic Substances and Disease Registry (ATSDR)
          6.2.2 Department of Defence (DOD)
          6.2.3 Department of Veterans Affairs
          6.2.4 National Institute of Environmental Health Sciences (NIEHS), National Institute of Health
          6.2.5 Environmental Protection Agency (EPA)
          6.2.6 Occupational Safety and Health Administration (OSHA)

     6.3 CANADIAN GOVERNMENT
     6.4 GERMAN GOVERNMENT
     6.5 UNITED KINGDOM PROFESSIONAL ORGANISATIONS
          6.5.1 Royal College of Physicians and Royal College of Pathologists
          6.5.2 British Society for Allergy, Environmental and Nutritional Medicine (BSAENM)
          6.5.3 Institute of Occupational Medicine, Edinburgh

     6.6 NEW ZEALAND GOVERNMENT
     6.7 DANISH GOVERNMENT
     6.8 INTERNATIONAL PROGRAM ON CHEMICAL SAFETY (WHO/ILO/UNEP)

REFERENCES

 

Download

The full report (and submissions) can be downloaded from the NICNAS website:

PDF

Multiple Chemical Sensitivity - Final Report (PDF, 471KB)

PDF

Multiple Chemical Sensitivity - Summary of Revisions (PDF, 26KB)

PDF

Multiple Chemical Sensitivity - Submissions to the Draft Report - October 2010 (PDF, 22KB)

PDF

Multiple Chemical Sensitivity Review - Information Sheet - February 2010 (PDF, 76KB)

PDF

Multiple Chemical Sensitivity - Draft Report - February 2010 (PDF, 587KB)

PDF

Multiple Chemical Sensitivity - Submissions to the Draft Report - November 2008 (PDF, 54KB)

Alternative download location

If, for any reason, the above downloads become unavailable they can be downloaded on our website:

PDF

Multiple Chemical Sensitivity - Final Report (PDF, 471KB)

PDF

Multiple Chemical Sensitivity - Summary of Revisions (PDF, 26KB)

PDF

Multiple Chemical Sensitivity - Submissions to the Draft Report - October 2010 (PDF, 22KB)

PDF

Multiple Chemical Sensitivity Review - Information Sheet - February 2010 (PDF, 76KB)

PDF

Multiple Chemical Sensitivity - Draft Report - February 2010 (PDF, 587KB)

PDF

Multiple Chemical Sensitivity - Submissions to the Draft Report - November 2008 (PDF, 54KB)

List of submissions to the Report

Here is NICNAS's full list of submission to their MCS Report:

 


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