Multiple chemical sensitivity syndrome: clinical manifestations, triggers and prevention Section: Revisión How to quote Sancho Sinisterra P, Soriano García M. Síndrome de la sensibilidad química múltiple: manifestaciones clínicas, factores desencadenantes y prevención. RIdEC 2024; 17(2):46-56. Authors1 Pablo Sancho Sinisterra, 2 Marta Soriano García Position 1 Enfermero. Escuela Universitaria de Enfermería de Teruel. Hospital Obispo Polanco. Teruel (España).2 Enfermera de Quirófano. Hospital Obispo Polanco. Teruel (España). Contact email: psynisterra@gmail.com Abstract Introduction: multiple chemical sensitivity (MCS) is a chronic disorder in which exposure to low concentrations of chemicals results in the development of various symptoms. The aim of this review is to determine the main clinical manifestations, risk factors or triggers and preventive measures for MCS.Method: narrative literature review. The search was conducted in SciELO, Pubmed, Scopus, Web of Science and Google Scholar. Original and review articles were selected, published from 2014 onwards, in English or Spanish, and with information on MCS. Documentary quality and levels of evidence were assessed using CASPe templates and CEBM classification.Results: the general profile obtained corresponds to that of a woman aged between 40 and 50 years with a history of asthma and allergy. The most frequent triggers were cleaning products, perfumes, formaldehyde and VOCs. The main clinical manifestations were respiratory and neurological, followed by gastrointestinal and cognitive. Avoidance of triggers and space conditioning were the main preventive measures. Psychotherapy and symptomatic treatment were effective in some cases. The creation of a personal emergency kit has been proposed.Conclusions: MCS is a chronic disorder that may require complete isolation. The main manifestations are respiratory and neurological. Currently, prevention of MCS is aimed at space conditioning and avoidance of triggers. It may be beneficial to include psychotherapy in the management of the condition, as well as educating people in the patient’s close environment. Keywords: multiple chemical sensitivity; risk factors; idiopathic environmental intolerance; prevention; signs and symptoms. Versión en Español Título: Síndrome de la sensibilidad química múltiple: manifestaciones clínicas, factores desencadenantes y prevención Artículo completo no disponible en este idioma / Full article is not available in this language Bibliography 1. De Ben S, Spontón F, Chaves E, Medina F, Tomasina F. Sensibilidad química múltiple: un desafío para la salud ocupacional. Rev. Méd. Urug. [internet] 2014 [citado 1 dic 2024]; 30(2):123-7. Disponible en: http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-03902014000200007&lang=pt2. Zucco GM, Doty RL. Multiple Chemical Sensitivity. Brain Sciences. 2022; 12(1):46. doi: https://doi.org/10.3390/brainsci120100463. Vico Garcerán MB, Moya Ayza M. Sensibilidad química múltiple y trabajo, descripción de un caso sospechoso. Rev Asoc Esp Espec Med Trab. [internet] 2017 [citado 1 dic 2024]; 26(4):271-4. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S3020-11602017000400271&lng=es&nrm=iso4. Paredes Rizo ML. Sensibilidad Química Múltiple: análisis de un caso registrado en un hospital de referencia. Med. segur. trab. [internet] 2018 [citado 1 dic 2024]; 64(251):217-40. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0465-546X2018000200217&lng=es&nrm=iso5. Valderrama Rodríguez M, Revilla López MC, Blas Díez MP, Vázquez Fernández del Pozo S, Martín Sánchez JI. Actualización de la Evidencia Científica sobre Sensibilidad Química Múltiple (SQM) [internet]. Ministerio de Sanidad, Servicios Sociales e Igualdad. Instituto Aragonés de Ciencias de la Salud; 2015. [citado 1 dic 2024]. Disponible en: https://www.sergas.es/Asistencia-sanitaria/Documents/953/Actualizaci%C3%B3n%20de%20la%20evidencia%20cient%C3%ADfica%20sobre%20sensibilidad%20qu%C3%ADmica%20m%C3%BAltiple.pdf6. Dennison Busby L. A Comparison of Multiple Chemical Sensitivity with Other Hypersensitivity Illnesses Suggests Evidence and a Path to Answers. Ecopsychology. 2017; 9(2):90-8. doi: https://doi.org/10.1089/eco.2017.00037. Wardly D. Multiple Chemical Sensitivity as A Variant of Idiopathic Intracranial Hypertension: A Case Report. Jacobs Journal of Neurology and Neuroscience. [internet] 2018 [citado 1 dic 2024]; 5(2):39. Disponible en: https://www.researchgate.net/profile/Deborah-Wardly/publication/329588911_Multiple_Chemical_Sensitivity_as_A_Variant_of_Idiopathic_Intracranial_Hypertension_A_Case_Report/links/5c1127f04585157ac1bce350/Multiple-Chemical-Sensitivity-as-A-Variant-of-Idiopathic-Intracranial-Hypertension-A-Case-Report.pdf8. García Serna I, Bernardo Vega R, Arnal Burró AM, Moreno Reviriego A, Martín Medrano EM, González Blanco IA. Síndrome de sensibilidad química múltiple y gestación: cómo actuar. Clin Invest Ginecol Obstet. 2020; 47(4):164-7. doi: doi.org/10.1016/j.gine.2020.06.0029. SFC-SQM Madrid [internet]. Qué es la Sensibilidad Química Múltiple. [citado 1 dic 2024]. Disponible en: https://www.sfcsqm.com/sqm10. Associació Catalana d’Afectades i Afectats de Fibromiàlgia i d’altres Síndromes de Sensibilització Central (ACAF) [internet]. Sensibilidad Química Múltiple (SQM). [citado 1 dic 2024]. Disponible en: https://www.fibromialgia.cat/cast/sqm.htm11. Programa de Habilidades en Lectura Crítica Español (CASPe) [internet]. 2022 [citado 1 dic 2024]. Disponible en: https://redcaspe.org/materiales/12. Manterola C, Asenjo-Lobos C, Otzen T. Jerarquización de la evidencia: Niveles de evidencia y grados de recomendación de uso actual. Revista chilena de infectología. 2014; 31(6):705-18. doi: http://dx.doi.org/10.4067/S0716-1018201400060001113. Hutton B, Catalá-López F, Moher D. La extensión de la declaración PRISMA para revisiones sistemáticas que incorporan metaanálisis en red: PRISMA-NMA. Med. Clin. [internet] 2016 [citado 1 dic 2024]; 147(6):262-6. Disponible en: https://www-sciencedirect-com.cuarzo.unizar.es:9443/science/article/pii/S0025775316001512?via%3Dihub14. Storino V, Muñoz-Ortiz J, Villabona-Martínez V, Villamizar-Sanjuán JD, Rojas-Carabali W, de-la-Torre A. An Unusual Case of Multiple Food Allergies Comorbid with Multiple Chemical Sensitivity: A Case Report. J Asthma Allergy 2021; 14:317-23. doi: https://doi.org/10.2147/JAA.S29324815. Fares Medina S, Díaz Caro I, García Montes R, Corral Liria I, García Gómez-Heras S. Multiple Chemical Sensitivity Syndrome: First Symptoms and Evolution of the Clinical Picture: Case-Control Study/Epidemiological Case-Control Study. Int. J. Environ. Res. Public Health. 2022; 19(23):15891. doi: https://doi.org/10.3390/ijerph19231589116. Watai K, Fukutomi Y, Hayashi H, Kamide Y, Sekiya K, Taniguchi M. Epidemiological association between multiple chemical sensitivity and birth by caesarean section: A nationwide case-control study. Environmental Health: A Global Access Science Source. 2018; 17(1). doi: https://doi.org/10.1186/s12940-018-0438-217. Steinemann A. Prevalence and effects of multiple chemical sensitivities in Australia. Prev Med Rep. 2018; 10:191-4. doi: https://doi.org/10.1016/j.pmedr.2018.03.00718. Suzuki T, Bai Y, Ohno Y. Prevalence and Factors Related to High Risk of Multiple Chemical Sensitivity among Japanese High School Students. Int. J. Environ. Res. Public Health. 2024; 21(7). doi: https://doi.org/10.3390/ijerph2107093419. Dantoft TM, Nordin S, Andersson L, Petersen MW, Skovbjerg S, Jørgensen T. Multiple chemical sensitivity described in the Danish general population: Cohort characteristics and the importance of screening for functional somatic syndrome comorbidity-The DanFunD study. PLoS ONE. 2021; 16(2). doi: https://doi.org/10.1371/journal.pone.024646120. Ahrendt Bjerregaard A, Schovsbo SU, Gormsen LK, Skovbjerg S, Eplov LF, Linneberg A, et al. Social economic factors and the risk of multiple chemical sensitivity in a Danish population-based cross-sectional study: Danish Study of Functional Disorders (DanFunD). BMJ Open. 2023; 13(3). doi: https://doi.org/10.1136/bmjopen-2022-06461821. Azuma K, Ohyama M, Azuma E, Nakajima T. Background factors of chemical intolerance and parent-child relationships. EHOM. 2018; 23(1). doi: https://doi.org/10.1186/s12199-018-0743-y22. Miller CS, Palmer RF, Kattari D, Masri S, Ashford NA, Rincon R, et al. What initiates chemical intolerance? Findings from a large population-based survey of U.S. adults. Environ Sci Eur. 2023; 35(65). doi: https://doi.org/10.1186/s12302-023-00772-x23. Molot J, Sears M, Anisman H. Multiple chemical sensitivity: It’s time to catch up to the science. Neuroscience & Biobehavioral Reviews. 2023; 151:105227. doi: https://doi.org/10.1016/j.neubiorev.2023.10522724. Damiani G, Alessandrini M, Caccamo D, Cormano A, Guzzi G, Mazzatenta A, et al. Italian Expert Consensus on Clinical and Therapeutic Management of Multiple Chemical Sensitivity (MCS). Int. J. Environ. Res. Public Health. 2021; 18(21):11294. doi: https://doi.org/10.3390/ijerph18211129425. Azuma K, Uchiyama I, Kunugita N. Potential factors affecting chronic chemical intolerance associated with constitutional predisposition or lifestyle and environment during childhood: From a six-year follow-up study. J. Psychosom. Res. 2021; 151. doi: https://doi.org/10.1016/j.jpsychores.2021.11066526. Engström J, Bjurström R. Exposure to methylene chloride. Content in subcutaneous adipose tissue. Scandinavian Journal of Work, Environment & Health. 1977; 3(4):215-24. doi: https://doi.org/10.5271/sjweh.277127. Pérez Crespo J, Lobato Cañón JR, Solanes Puchol Á, Pérez Crespo J, Lobato Cañón JR, Solanes Puchol Á. Relación de la sensibilidad química múltiple con alergias y piel atópica en trabajadores de laboratorios químicos universitarios. Med. seg. trab. [internet] 2018 [citado 1 dic 2024]; 64(250):5-16. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0465-546X2018000100005&lng=es&nrm=iso28. McKeown-Eyssen G, Baines C, Cole DE, Riley N, Tyndale RF, Marshall L, et al. Case-control study of genotypes in multiple chemical sensitivity: CYP2D6, NAT1, NAT2, PON1, PON2 and MTHFR. International J. Epidemiol. 2004; 33(5):971-8. doi: https://doi.org/10.1093/ije/dyh25129. Johnson D, Colman I. The association between multiple chemical sensitivity and mental illness: Evidence from a nationally representative sample of Canadians. J. Psychosom. Res. [internet] 2017 [citado 1 dic 2024]; 99:40-4. Disponible en: https://www-sciencedirect-com.cuarzo.unizar.es:9443/science/article/pii/S0022399917301770?via%3Dihub30. Poletti S, Mazza MG, Benedetti F. Inflammatory mediators in major depression and bipolar disorder. Transl Psychiatry. 2024; 14(1):1-13. doi: https://doi.org/10.1038/s41398-024-02921-z31. Sani H, Kubota T, Surahman U. Factors affecting multiple chemical sensitivity (MCS) in newly constructed apartments of Indonesia. Building and Environment. 2023; 241. doi: https://doi.org/10.1016/j.buildenv.2023.11048232. Miller CS, Prihoda TJ. The Environmental Exposure and Sensitivity Inventory (EESI): a standardized approach for measuring chemical intolerances for research and clinical applications. Toxicol Ind Health. 1999; 15(3-4):370-85. doi: https://doi.org/10.1177/07482337990150031133. Driesen L, Patton R, John M. The impact of multiple chemical sensitivity on people’s social and occupational functioning; a systematic review of qualitative research studies. J. Psychosom. Res. [internet] 2020 [citado 1 dic 2024]; 132:109964. Disponible en: https://www-sciencedirect-com.cuarzo.unizar.es:9443/science/article/pii/S002239991930976634. García-Sierra R, Álvarez-Moleiro M. Evaluación del sufrimiento en personas que tienen sensibilidad química múltiple. Clínica y Salud. [internet] 2014 [citado 1 dic 2024]; 25(2):95-103. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-52742014000200002&lng=es&nrm=iso