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Sensitive to Sensitivity 2002 Alaska Governor

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Title: Sensitive to Sensitivity 2002 Alaska Governor


1
Sensitive to Sensitivity 2002 Alaska Governors
Safety and Health Conference
  • Dr. Robert A. Perkins, PE, CIH
  • Civil and Environmental Engineering
  • University of Alaska Fairbanks
  • 19 March 2002

2
  • http//www.faculty.uaf.edu
  • Perkins
  • Presentations

3
Topics
  • Overview of Sensitivity
  • Chemical Sensitivity
  • Toxicology of Sensitivity
  • Multiple Chemical Sensitivity
  • Workplace Stress
  • Conclusion

4
Types of Sensitivity
  • Emotional
  • Artistic
  • Allergic
  • Smells
  • Sounds, Music
  • Toxicological, Chemical
  • sensitive vs. resistant subpopulations

5
Factors Affecting
  • Heat and Cold
  • Physiological
  • Hormonal
  • Stress
  • Fatigue
  • Depression

6
Laboratory Animals
  • Temperature
  • affects responses
  • many drugs and chemicals
  • So does stress
  • Today
  • Light dark cycles
  • Populations in cages

7
In General, Sensitivity
  • Humans and other mammals are sensitive to various
    factors.
  • Sensitivity might vary with exogenous factors
  • Endogenous factors
  • Might vary with time.

8
Chemical Sensitivity
  • Irritants vs. Sensitizers
  • Primary Irritants
  • Affect most people
  • Chemical contact dermatitis
  • Many agents
  • acids, solvents
  • dies, insecticides
  • soaps

9
Sensitizers, Dermatitis
  • Initial contact may not produce dermatitis
  • Dermatitis develops later
  • very low, non-irritating concentrations
  • previously could have been handled without any
    problem.
  • Hereditary Allergy (Atopy)
  • hives
  • latex

10
Irritant vs. Sensitizer (Allergen)
  • Irritant affects all or almost all,
  • Allergen affects few.
  • except very potent sensitizers, poison oak
    oleoresin, epoxy resin and components.
  • Allergy sometimes called hypersensitivity.
  • Patch testing

11
Air Contaminants
  • Irritants
  • Asphyxiants
  • CNS Depressants

12
Irritants
  • Upper Respiratory Tract
  • Lung
  • URT and Lung

13
URT Irritants
  • Chemical
  • Particulates
  • Mineral
  • Biological
  • Coughing, lacrimation, difficulty breathing
  • Inflammation of membranes

14
Allergens
  • Many biological particulates are also allergens
  • one or a series of exposures has no apparent
    effect.
  • Later a challenge dose provokes the reaction

15
Classes of Allergens
  • Microorganisms and their toxins
  • Arthropod bites or stings
  • Allergens and toxins from higher plants
  • Protein allergens from vertebrate animals.

16
Summary
  • A sensitizer (or allergen) is not the same as an
    irritant.
  • May be difficult to distinguish
  • Many substances are both
  • Small doses of irritant may not effect many
    people
  • Many allergens
  • many people are sensitive to chemicals while
    others are not affected.

17
Toxicology of Hypersensitivity
  • Immune system
  • Innate or nonspecific
  • Adaptive or specific

18
Adaptive immunity
  • Antigens
  • Antibodies
  • T cells
  • B cells

White Blood Cell (T or B)
19
T cells
  • Type of white blood cell
  • Many different types of T cell
  • Some are programmed to attack bodys cells
  • infected with a virus
  • cancer
  • Many types have regulatory functions within the
    immune system

20
Antigen
  • Causes production of antibodies
  • Bacteria
  • Bacterial toxins

21
Antigenic determinant sites
22
Antigen
  • Must have at least 2 determinant sites for
    antibody generation
  • One determinant site (a partial antigen or
    hapten) can bind chemically to a carrier molecule
    that has one determinant site of its own.
  • Important for drug and chemical allergies

23
Antibodies
  • Thousands of genetically different B cells, each
    produces its own specific type of antibody.
  • Once activated, replicates and releases many
    copies of the same antibody.
  • Antibodies attach to the antigen
  • other enzymes attach the antigen

24
Hypersensitivity reactions
  • Type I, Anaphylaxis
  • IV Cell-mediated (delayed) hypersensitivity

25
Type I Hypersensitivity
  • Minutes
  • May cause systemic disorder or local reaction.
  • Location depends on portal of entry or the
    allergen.

26
Mechanism
Minutes after antigen finds an antibody bound to
mast cell, chemicals are released
27
Local
  • Localized swelling skin allergy, hives
  • Nasal and conjunctival discharge -allergic
    rhinitis and conjunctivitis
  • Hay fever - bronchial asthma
  • Allergic gastroenteritis - food allergy

28
Systemic
  • Usually injected,
  • needle or bee sting
  • Very serious

29
Type IV
  • Delayed hypersensitivity
  • Involves T cells
  • Tuberculin reaction is example

30
Examples
  • TDI (elicits a Type I response)
  • Formaldehyde (both Type I and Type IV)

31
TDI
  • Toluene diisocyanate
  • A small molecule that acts as hapten
  • combines with native proteins
  • new compound that is recognized as foreign
  • Future exposures result in allergic reaction
  • especially broncoconstriction

32
  • Only 5 to 10 of exposed have this reaction.
  • But these develop at very low doses.
  • TLV, 0.005ppm
  • 0.02 STEL
  • In some individuals airways seem to become
    hyper-reactive to many agents
  • smoke and other air pollutants

33
Formaldehyde
  • Plywood, medium-density fiberboard, and
    particleboard.
  • Many industrial products and processes
  • Very common chemical

34
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35
Formaldehyde Actions
  • Both an irritant and a sensitizer
  • Primary irritant of skin
  • Irritation of mucosal surfaces
  • protective responses sneezing, coughing, and
    tearing

36
Sensitizer
  • Rare to find antibodies
  • Bronchial provocation tests for asthma
  • 12 of 230 who were suspected responded
  • 3 of 15 another test
  • Type I exists in some individuals
  • Type IV on skin.

37
Summary of Toxicology and IH
  • Mechanisms are well-known for some chemicals and
    toxins
  • Hypersensitivity (allergy) can be demonstrated in
    laboratory

38
Annoying Smells
  • URT Irritation
  • Odor
  • Travel to the brain via different nerves.
  • Both activated by a single stimulus to the nose,
    so are often confused.

39
  • People often experience odor and irritation as a
    unitary perception

40
After Dalton, 2001
41
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42
Annoyance
  • Annoyance
  • not sensory
  • or physiological effect
  • Psychological discomfort from the presence and
    increasing concentration of an odor.

43
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44
Reported Sensory Irritation
  • Adaptation
  • specific, reversible decreased sensitivity
  • common in occupation settings
  • Expectation and Perceived Irritation
  • subjects told
  • industrial solvent
  • natural extract

45
  • Social cues
  • Used actors as other subjects
  • Exposed to solvent odor
  • Negative cues
  • 70 reported irritation
  • Positive
  • 12
  • Neutral
  • 34

46
Summary
  • The frequent lack of correspondence between
    exposure concentration, objective signs of
    exposure-related symptoms, and adverse reports
    has led to problems setting occupation exposure
    limits.
  • Dalton, 2001

47
MCS
48
Multiple Chemical Sensitivity
  • Multiple chemical sensitivities is an acquired
    disorder characterized 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. Cullen

49
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50
  • Kurt (1995) in his research. He defined MCS as
    "a symptom complex triggered by odor or a
    perceived exposure occurring at exposure levels
    below those of allergic sensitivity or
    irritation analogous to the symptoms of panic
    disorder as defined by (DSM-III-R) lacking
    objective clinical pathologic criteria and
    responsive to panic disorder management."

51
History
  • 1979 U.S. District Court for the District of
    Hawaii rules MCS disabling and orders the
    Department of Health, Education, and Welfare to
    provide Social Security disability benefits to an
    individual (Slocum vs. Califano).
  • 1984 A California bill to require research on
    MCS is passed by both houses of state
    legislature, but is opposed by California Medical
    Association and vetoed by Gov. Deukmajian.

52
  • 1985 "Report of the Ad Hoc Committee on
    Environmental Hypersensitivity Disorders"
    prepared by the Ontario Ministry of Health,
    Canada, calls for research on MCS and assistance
    for MCS patients.
  • 1986 Oregon Court of Appeals orders workers'
    compensation benefits for furniture store
    employee on basis of MCS (Robinson vs. Saif
    Corp.).
  • 1987 California Court of Appeals awards workers'
    compensation benefits to employee who was found
    to have MCS resulting from long-term exposure to
    polychlorinated biphenyls (Kyles vs. Workers'
    Compensation Appeals Board).

53
  • 1989 Ohio Court of Appeals reinstates an order
    of the Ohio Civil Rights Commission finding
    unlawful employment discrimination for dismissal
    of an employee with MCS (Kent State University
    vs. Ohio Civil Rights Commission).
  • 1990 Pennsylvania Human Relations Commission
    orders a landlord of an MCS patient to take
    measures to accommodate her, including reduction
    in the use of pesticides (Atkinson vs. Lincoln
    Realty).
  • 1992 Department of Housing and Urban Development
    recognizes MCS as a disability requiring
    reasonable accommodations under the Fair Housing
    Act Amendments and the Rehabilitation Act of
    1973.

54
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55
MCS is
  • Controversial, chronic, polysymptomatic
    condition.
  • Patients report illness from exposure to low
    levels of many different environmental chemicals
  • drugs, food

56
Severe MCS
  • Severe, daily multisystem symptoms
  • Occupationally and socially disabling
  • Preponderantly middle-aged, white women with
    above-average education.

57
Other conditions with core MCS symptoms
  • Chronic fatigue syndrome
  • Fibromyalgia
  • Persian Gulf Syndrome
  • Solvent-exposed workers
  • Chemical odor intolerance
  • unpleasant reaction to odor
  • multiple nonspecific symptoms
  • no distinct relationship to toxicology property
    of any particular chemical.

58
Jackies Story
  • Had happy life
  • Almost overnight becoming so weak, dizzy,
    exhausted, and "spacy" that you couldn't function
    any more. Imagine sleeping for 10 to 12 hours a
    night and waking up every morning feeling just as
    exhausted as when you went to bed.
  • sent to a psychiatrist because your doctor thinks
    you're just "depressed" and need to "snap out of
    it"

59
  • Quit job
  • ..too weak to hold your head up for more than a
    few minutes at a time. Imagine having to resort
    to using a wheelchair for going shopping, etc.,
    because you were so dizzy and had such balance
    problems that it made it difficult to walk.

60
  • ..diagnosed in 1991 with "Chronic Fatigue
    Syndrome" (CFS) by a reputable Infectious Disease
    Specialist in Gainesville, Florida. He said there
    was basically no treatment for CFS and that I
    would just have to learn to rest and not try to
    push myself anymore. Following this advice, I
    suffered for 4 more years with no improvement in
    my symptoms - I could barely remember what it
    felt like to feel "good".

61
  • Finally, in September 1995, I read a book called
    "Tired or Toxic?" by Sherry Rogers - which has
    totally changed my life! In the pages of this
    book, I found that every one of my bizarre
    symptoms could be caused by exposure to toxic
    chemicals in my environment. I learned that our
    bodies can only handle so many toxins before our
    immune systems will "overload" and not be able to
    process them any more

62
  • I realized that my "chemical poisoning" began
    when I spent over 10 years living in mobile
    homes. Mobile homes are made of lots of
    particleboard, glued wallpapers, synthetic
    carpets, etc. - all of which outgas formaldehyde.
    Formaldehyde is very toxic and causes many of the
    symptoms I experienced dizziness, spaciness,
    etc. It also weakens the immune system, making
    you more vulnerable to other toxic chemicals

63
  • Formaldehyde is in MANY things these days. It's
    in most cosmetics - including BABY SHAMPOO and
    BABY LOTION. Look for "Quaternium-15" on the
    label - that's formaldehyde in disguise. It's
    also in the clothes you wear - if they're
    permanent press or polyester. It's in your
    polyester/cotton bed sheets. It's even in a lot
    of the food you eat. And, yes - formaldehyde is
    the stuff they embalm people with. At this rate,
    we won't need to be embalmed by the time we die!

64
  • As a child, I was constantly exposed to the
    cigarette smoke. I also had many "silver"
    fillings placed in my mouth, which I now know are
    made of about 50 MERCURY! Mercury is even more
    toxic than ARSENIC and yet it's placed in our
    mouths because it's cheap and easy to use! This
    mercury leaks out of the fillings and can slowly
    cause health problems, similar to the way arsenic
    poisoning happens slowly over time. (NOTE I
    recently underwent amalgam removals and hope this
    will also help improve my health!)

65
  • Then in 1987, when Gorden and I got engaged, my
    doctor prescribed birth control pills for me. I
    now know that birth control pills also weaken the
    immune system - especially the ones with high
    amounts of estrogen. They also lead to candida
    overgrowth (yeast infections). The candida
    further weakens the immune system and also
    releases toxins into the bloodstream. I had
    immediate reactions to the birth control pills -
    they totally "confused" my hormonal system.

66
  • In 1989, I started working in a "sick building".
    It was a new building with all new carpeting, new
    paint, new partitions, new furniture, etc. I now
    know that all these things outgas MANY toxic
    chemicals. Since my immune system was already
    weakened, this was too much for it to handle.

67
  • In 1993 we started spraying our house with
    Dursban to get rid of fleas. We had no idea this
    pesticide was as toxic and dangerous as it is! I
    couldn't tell at the time how much it was
    affecting my health because I already had such
    severe symptoms. Looking back, I now see that
    many "new" symptoms began right around the time
    we started using the Dursban

68
  • "CFS" was something I had no idea how to treat -
    it left me a "victim". "MCS" on the other hand,
    gives me many things I can do to help myself get
    well. Recovering from this illness involves
    cleaning up your environment, avoiding toxic
    chemicals as much as possible, eating as many
    organic foods as possible (almost all regular
    foods are loaded with pesticides), taking
    nutritional supplements, using "neutralizing"
    allergy shots, and many other things. The first
    thing we did was to find an "Environmental
    Medicine Specialist" here in Florida

69
  • While we were there, we stayed at a place called
    "The Natural Place". It's run by a couple with
    MCS, and it's totally non-toxic! They allow NO
    scented products, cigarette smoking, or
    pesticides on the premises. They have all 100
    cotton beds and bedding, no carpeting, solid wood
    cabinets, etc., and provide air filters for each
    unit. The most interesting thing happened while
    we stayed there MY SYMPTOMS GREATLY IMPROVED!!

70
  • We are so thankful for this. Now my goal is to
    help other sufferers who think they have "CFS" or
    "Fibromyalgia" to "make the connection" and get
    better too - as well as to help to educate others
    about the health risks of using certain products
    so they can learn to protect themselves. I hope
    my story has given you hope and encouragement if
    you are sick, and enlightenment if you are still
    healthy!

71
Is MCS a disease
  • Four aspects of a disease
  • Etiology (cause)
  • Pathogenesis (natural history)
  • Morphologic changes (cells or tissues)
  • Functional derangement (clinical significance)

72
The Interagency Workgroup on Multiple Chemical
Sensitivity
  • No single accepted case definition of MCS has
    been established proposed definitions all differ
    in key criteria, and some definitions suggest a
    broad spectrum of possible symptoms. The
    validated epidemiologic data required to clarify
    the natural history, etiology, and diagnosis of
    MCS are not available.

73
Immune Mechanisms
  • The role of the immune system in MCS is difficult
    to assess from many of the published reports
    because the laboratory methods are inadequately
    documented or, in some cases, clearly deficient.

74
Inflammation
  • Inflammation has been suggested as being causally
    related to MCS as a result of the initiation of
    mediators released from cell membranes by the
    action of free radicals produced from toxic
    chemical exposures.
  • There is no convincing evidence that such
    mediators are involved with MCS although the
    hypothesis has not been adequately tested.

75
Neurologic Mechanisms Including Altered Sense of
Smell
  • Neural stimulation is defined as the
    "progressive amplification of responsivity by
    the passage of time and repeated, intermittent
    exposures"
  • In a study of odor responsivity among persons
    diagnosed with MCS, tested 31 subjects to assess
    odor detection thresholds to rose-scented alcohol
    and an unpleasant-smelling pyradine no
    differences were found between the MCS subjects,
    controls, and asthma patients.

76
Psychological Mechanisms
  • Psychiatric factors have been seen as the cause
    of MCS, an effect of having MCS, a predisposing
    factor in the development of MCS, and a co-morbid
    occurrence with MCS.
  • Some believe that, if present, psychiatric
    symptoms are a secondary accompaniment to a
    chronic disease process and some believe that MCS
    is primarily the symptomatic manifestation of a
    psychiatric disorder.

77
Bottom Line, ASTDR
  • Definitive data that would confirm or refute
    hypothesized mechanisms for MCS are generally
    lacking
  • Investigators have used different definitions of
    MCS and because MCS classification in studies is
    based on self-reporting, it is difficult to
    compare patient groups used in various studies to
    each other or to evaluate the application of
    theories to the patient groups.

78
MCS Summary, Perkins
  • No agreement among the medical establishment and
    scientists regarding
  • What MCS is
  • What might cause it

79
How about Neurasthenia
  • Vague shifting symptoms related to multiple organ
    systems have been reported for many years.
  • 1880, Beard
  • Thought related to stresses of modern
    civilization.

80
Autointoxication
  • 1900, explains multiple symptoms in otherwise
    normal individuals.
  • tiredness, lack of energy and well-being
  • Visceroptosis
  • falling down of intestines
  • 1918, Chronic intestinal stasis
  • intestines produced toxins faster than liver
    could detoxify
  • Removed colon or kinks in intestines.

81
  • The only thing that distinguishes environmental
    illness or MCS from all other patients with this
    pattern of symptoms is the attribution of
    symptoms to environmental and/or chemical
    exposures
  • Critical Reviews in Toxicology

82
Digression on Causation
  • Colleague in next office
  • Laugh give me headache

83
Workplace stress
84
"Workplace stress"
  • The harmful physical and emotional responses that
    can happen when there is a conflict between job
    demands on the employee and the amount of control
    an employee has over meeting these demands. In
    general, the combination of high demands in a job
    and a low amount of control over the situation
    can lead to stress

85
  • According to the NIOSH view, exposure to
    stressful working conditions (called job
    stressors) can have a direct influence on worker
    safety and health.
  • Individual and other situational factors can
    intervene to strengthen or weaken this influence.

86
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87
Stress can cause
  • increased blood pressure
  • increased metabolism (e.g., faster heartbeat,
    faster respiration)
  • decrease in protein synthesis, intestinal
    movement (digestion), immune and allergic
    response systems
  • increased cholesterol and fatty acids in blood
    for energy production systems
  • localized inflammation (redness, swelling, heat
    and pain)
  • faster blood clotting

88
How do I know if someone is (or if I am) having
trouble coping with stress?
  • Physical headaches, grinding teeth, clenched
    jaws, chest pain, shortness of breath, pounding
    heart, high blood pressure, muscle aches,
    indigestion, constipation or diarrhea, increased
    perspiration, fatigue, insomnia, frequent illness

89
  • Psychosocial anxiety, irritability, sadness,
    defensiveness, anger, mood swings,
    hypersensitivity, apathy, depression, slowed
    thinking or racing thoughts feelings of
    helplessness, hopelessness, or of being trapped
  • Behavioural overeating or loss of appetite,
    impatience, quickness to argue, procrastination,
    increased use of alcohol or drugs, increased
    smoking, withdrawal or isolation from others,
    neglect of responsibility, poor job performance,
    poor personal hygiene, change in religious
    practices, change in close family relationships.

90
ACGIH
  • Considering role of physical stress
  • heat, cold,
  • Adjusting TLVs

91
Industrial Hygienists Role
  • Bad IH
  • Good IH

92
  Summary
  •  Low exposure doses may cause problems for
    sensitive individuals
  • Well below TLV
  • No scientific evidence for MCS
  • Workplace stress can increase problems
  • IHs must consider their role in stress.
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