Multiple Chemical Sensitivity

1. Multiple Chemical Sensitivity Misnomer – call it Hypersensitivity Causes – are obvious Science - under development

2. Community Outrage

3. Multiple Chemical Sensitivity Multiple Chemical Sensitivity (MCS) is discussed in detail in the recent Wagerup Parliamentary Inquiry Report page 22: This condition has a range of symptoms: overall lethargy muscle cramps and pains skin rashes sinus pain mucous membrane irritation, nose bleeds headaches frequent micturition and thirst sleeplessness dry persistent cough, sore throat diarrhoea cognitive function impairment with short term memory loss concentration impairment depression Naturally a combination of these symptoms leads to frustration and despair.

4. Large numbers suffer Researchers in North Carolina found 16 to 33 percent of the people interviewed reported that they are unusually sensitive to chemicals, and in the California and New Mexico health departments’ surveys 2 percent to 6 percent reported that they have been diagnosed as having multiple chemical sensitivities. Ref: IEQ Indoor Environmental Quality (2005, National Institute of Building Sciences)

5. Fragrances a major problem According to a 1986 U.S. House of Representatives Report: "In 1986, the National Academy of Sciences targeted fragrances as one of the six categories of chemicals that should be given high priority for neurotoxicity testing. The other groups include insecticides, heavy metals, solvents, food additives and certain air pollutants. The report states that 95 percent of chemicals used in fragrances are synthetic compounds derived from petroleum. They include benzene derivatives, aldehydes, and many other known toxics and sensitizers, which are capable of causing cancer, birth defects, central nervous system disorders and allergic reactions "

6. 2008 - The superosmic phenomenon discovered Olfaction studies in the Department of Otorhinolaryngology at Leicester Royal Infirmary have detected a previously unreported, variable phenomenon – ‘superosmia’ – in which subjects' olfaction threshold concentrations are up to 100,000 smaller than the average value. Two per cent of subjects demonstrated the superosmic phenomenon on single testing, and 10 per cent demonstrated this phenomenon on variable occasions during repeated testing. C M Philpotta, P Goonetillek, P C Goodenough, A Clark and G E Murty The Journal of Laryngology & Otology (2008), 122:805-809 Cambridge University Press

7. Hypersensitivity • The correct name for Multiple Chemical Sensitivity (MCS) • Caused by possibly only a single exposure • Essentially an allergic reaction • Improves when source removed • Can appear many years after exposure – e.g. Beryllium • Very low levels enough e.g. Formaldehyde at 0.5 ppm

8. Australian Pharmacy Regulation MIMS Reference Hypersensitivity “Important information for prescribers: Hypersensitivity to a product or to related compounds is an absolute contraindication.”

9. Sensitizers – Examples emitted from Alumina Plants • Beryllium – Alcoa have not published the figure • Nickel – 5 ppm in red mud dust • Cobalt – 7ppm in red mud dust • Chromium – red mud dust is 269 ppm Cr • Mercury • Methacrylates • Formaldehyde • 1,2-benzisothiazolin-3-one • Chlorocresol • 5-chloro-2-methyl-4-isothiazoline-2-one • 2-methyl-4-isothiazoline-3-one • Bromo compounds • Dichloromethane (methylene chloride)

10. Wagerup emissions – narrow plume approaches Yarloop

11. Wagerup pollution blanket

12. CSIRO modelling power demonstrated

13. Very short peaks in emissions strike from narrow plume

14. Example of lifetime sensitization- Formaldehyde U.S. Department of Labor Occupational Safety & Health Administration (OSHA) regulations 1910.1048(l)(8)(v) • If the physician finds that significant irritation of the mucosa of the eyes or of the upper airways, respiratory sensitization, dermal irritation, or dermal sensitization result from workplace formaldehyde exposure and recommends restrictions or removal, the employer shall promptly comply with the restrictions or recommendation of removal. In the event of a recommendation of removal, the employer shall remove the affected employee from the current formaldehyde exposure and if possible, transfer the employee to work having no or significantly less exposure to formaldehyde.

15. A recent Japanese study of formaldehyde A Case of Sick House Syndrome in Which the Main Symptom Was Allergy to Formaldehyde Masanori OGAWA 1, Shuta NISHINAKAGAWA 2, Fumiko YOKOSAWA 2, Hiroyuki GOTO 3, Toshihiro KAWAMOTO 4 and Yoko ENDO 1 1Occupational Poisoning Center, 2Environmental Health Research Center, Tokyo Rosai Hospital, 3Environmental Health Research Center, Kansai Rosai Hospital and 4Department of Environmental Health, University of Occupational and Environmental Health, Japan

16. Clues to long term formaldehyde exposure – impact on hormone production Sari DK, Kuwahara S, Tsukamoto Y, et al. Effect of prolonged exposure to low concentrations of formaldehyde on the corticotropin releasing hormone neurons in the hypothalamus and adrenocorticotropic hormone cells in the pituitary gland in female mice. Brain Res 2004; 1013:107–116.

17. Chronic beryllium disease Chronic beryllium disease results from hypersensitivity to beryllium and may occur at much lower exposures than acute beryllium pneumonitis. A small number of the cases occurred among people living near the plants but who were not occupationally exposed. People with beryllium-induced contact dermatitis react to patch testing (Curtis, 1951; DeNardi et al., 1952). Patch testing may cause a flare of the dermatitis in sensitized people; it may also induce beryllium sensitivity (Curtis, 1951) Susceptibility to chronic beryllium disease varies between individuals, and the disease may develop after low environmental exposures in some people. (ref IARC monograph)

18. Patch testing not completely understood Allergenic extracts for scratch or prick testing produce erythema or erythema and weal reactions in patients with significant IgE mediated sensitivity to the relevant allergen. This allergic inflammatory response, although not completely understood, is thought to begin with reaction of antigen with IgE on the surface of basophils or mast cells, which initiates a series of biochemical events resulting in the production of histamine and other mediators. These, in turn, produce the immediate-type 'weal and flare' skin reaction. (ref MIMS)

19. Allergy Testing has its risks Allergenic extracts may potentially elicit a severe life threatening systemic reaction, rarely resulting in death. Therefore, emergency measures and personnel trained in their use should be available immediately in the event of such a reaction. Patients should be instructed to recognise adverse reaction symptoms and cautioned to contact the doctor if symptoms occur. (ref MIMS) “it must be remembered that allergenic extracts are highly potent in sensitive individuals and overdose could result in anaphylactic symptoms.”

20. anaphylactic reaction • Adverse reaction frequency data for allergenic extract administration are not available. Inherent difficulties in establishing such data are the wide variations in clinical allergy types, patient sensitivity, treatment schedules used by allergists, potency of extracts from various sources, etc. • It cannot be overemphasised that, under certain unpredictable combinations of circumstances, anaphylactic shock is always a possibility. Other possible systemic reaction symptoms are, in varying degrees of severity, fainting, pallor, bradycardia, hypotension, angioedema, cough, wheezing, conjunctivitis, rhinitis and urticaria. • If a systemic or anaphylactic reaction does occur, apply a tourniquet above the site of injection and inject intramuscularly or subcutaneously 0.3 to 0.5 mL of 1:1,000 adrenaline hydrochloride into the opposite arm. (ref MIMS) • Well-known example – death from exposure to peanuts

21. Hypersensitivity – can be measured with blood tests • 5-chloro-2-methyl-4-isothiazoline-2-one • 2-methyl-4-isothiazoline-3-one Used by Alcoa in cooling towers, banned in some countries (e.g. German Biocide Act) Lymphocyte Transformation test for Diagnosis of Isothiazoline Allergy in Man Stejskal VDM et al The Journal of Investigative Dermatology 1990 94 798-802

22. Alumina effects in the body Small particles of Alumina generate reactive oxygen metabolites in human Leukocytes Ref: Nagase M, Nishaya H, Takeuchi H, Scandinavian Journal of Rheumatology 1995, 24, 102-7 Alumina gel injections into the temporal lobe of rhesus monkeys cause complex partial seizures and morphological changes found in human temporal lobe epilepsy Ref: Ribak et al Journal of Comparative Neurology 1998, 401, 266-90

23. Hypersensitivity (MCS) Victims

24. Some Scientific work on measurement of hypersensitivity: Evaluation of Several Variations of the Mouse Ear Swelling Test (MEST) for Detection of Weak and Moderate Contact Sensitizers. Sailstad DM; Tepper JS; Doerfler DL; Selgrade MK Govt Reports Announcements & Index (GRA&I), Issue 09, 1994 [NTIS] 20 Validation Of A Minimal Transcript Biomarker Set To Differentiate Between Sensitizers And Irritants In The Local Lymph Node Assay. Foster WR; Ladics GS; Glatt CM Toxicologist 2004 Mar;78(1-S):43 [MTGABS]

25. Something to ponder A survey of suppression of public health information by Australian governments Boshra Yazahmeidi and C . D .Arcy J . Holman School of Population Health, The University of Western Australia “Conclusion: The suppression of public health information is widely practised by Australian governments. Implications : Systemic interventions are necessary to preserve the integrity of public health research conducted with government involvement.” (Aust N Z J Public Health. 2007 ;31 :551-7 )