BIOMARKERS of MCS and MUSES Syndrome
Oxygen Uptake: unlike people with chemical sensitivity alone, people with MUSES Syndrome have impaired oxygen uptake. Their arterial blood shows normal levels of oxygen going into their body, but they cannot absorb it well and so show higher than normal levels in their veins. This can be measured via non-invasive VO2max or VO2 resting, or via invasive arterial and venous blood gases. Our recommended threshold for considering oxygen therapy is when the gap between arterial and venous dissolved oxygen (PaO2-PvO2) is less than 60mmHg.
Listed below are the medical tests physical signs that have been found to be abnormal in some studies of MCS patients. They are listed alphabetically and the cited references are listed the below. Some of these biomarkers are used to confirm the diagnosis of other disorders that commonly overlap with MCS (such as methacholine challenge testing for asthma, punch biopsy for mast cell disorders, blood enzyme testing for porphyrin disorders).
No single one of these tests is considered "diagnostic" of MCS, but if abnormalities are reported or suspected in any of these areas, they should be fully evaluated and appropriately treated. Some of these biomarkers may be abnormal at all times while others wax and wane with exposure. Given that MCS by definition is a disease provoked by chemical exposure, physicians should evaluate MCS cases both before (at baseline) and after an offending chemical exposure Ð either accidentally encountered or deliberately arranged under a doctor's supervision, preferably as a "blinded' exposure to an odorless gas like CO2 if inhaled or a tasteless liquid if ingested. Subcutaneous injections and dermal patches may also be used to test "blinded" reactions to certain chemicals.
Allergy: increased risk of IgE allergies to mold, pollen, dust, dander, etc (Baldwin 1998b)
Blood: lhigh 2,3-DPG, low red blood cell mass, low plasma volume, high plasma lactate, some cases involve a genetic pyrvate kinase deficiency in which the carrier state is symptomatic (Wilcox 1996),
Breath: elevated carbon monoxide after standard 23 second breath hold, over 3ppm. This is a sensitive but not specific marker as elevated CO also has been reported in breath of smokers, 2nd hand smokers, people who live with gas appliances or attached garages, and people with chronic diseases of the heart, lungs, blood and brain.
Cardiac: tachycardia, other arrhythmia, mitral valve prolapse (Ziem 1997), abnormal echocardiogram (Bell 1998a, Baldwin 1998a)
Cerebral: reduced blood flow on SPECT (Callender 1993, Heuser 1994), increased resting alpha on qEEG (Bell 1998b)
Circulatory: small vessel vasculitis (punch biopsy of fingertip), nontraumatic thrombophlebitis (Rea 1976, Rea 1977), neurally mediated hypotension (in undifferentiated CFS patients)
Detoxification: impaired function of Phase I (cP450) and/or Phase II detox pathway (Ziem 1997); caffeine clearance, salicylic acid conversion, paracetamol conversion (Monro 1997); low sulphoxidation and low glutathione (Scadding 1988, McFadden 1996, Ziem 1997), low superoxide dismutase and glutathione peroxidase (Ziem, unpublished)
Ears: abnormal brain stem auditory evoked potentials (Cary 1997); tinnitus is commonly reported but not quantifiable
Endocrine: variable hyper or hypo function in thyroid, adrenals and HPA axis (Levin 1987)
Eyes: photophobia as measured by reaction time; dry eyes or weeping tear glands in response to exposure
Gastrointestinal: esophagitis, 'nutcracker' esophagus, increased intestinal permeability, lactose breath test, bacterial overgrowth breath test (Monro 1997)
Immune: chronic T-cell activation, impaired NK cell function, variable auto-immunity especially elevated ANA (McGovern 1983, Heuser 1992, Ziem 1997), reduced secretory IgA and other Ig (Ziem 1999)
Mast Cells: increased number on punch biopsy (Heuser 1996), increased sensitivity to stimuli seen with scratch test, variably abnormal serum tryptase during reactions (Schwartz 1987) Mast cell punch biopsy has 80% SENSITIVITY (second highest of any MCS report), SPECIFICITY > 99%
Minerals: numerous deficiencies, especially magnesium, molybdenum, manganese, zinc, selenium and copper. (Galland 1987, Ziem unpublished).
Musculoskeletal: fibromyalgia tender points (Donnay 1999)
Neurocognitive: impaired learning and/or retention in short-term memory (visual and verbal), attention span and reaction times (Ziem 1997). Abnormalities seen in PASAT, WAIS-R (Ziem 1997), computerized Divided Attention Test (Bell 1995), STROOP tests (Little 1999), Knox Cubes, and in non-dominant hand on Tactual Performance Test
Nose: degraded nasal epithelium, chronic inflammation, rhinitis and sinusitus (Meggs 1993b)
Oxygen Uptake: unlike people with multi-sensory sensitivity, aka MUSES Syndrome, people with MCS alone do not have abnormally low oxygen uptake (and they cannot be cured by oxygen therapy)
Porphyrin Metabolism: multiple blood enzyme deficiencies, especially ALA-D, PBG-D, UPG-D (Ziem 1997),
Porphyrin enzyme abnormalities have 86% SENSITIVITY (highest of any MCS report), SPECIFICITY > 99%
Respiratory: inflammation in larynx & trachea; abnormal methacholine challenge (Bell 1998a)
Sensory Nerves: altered somatosensory potentials (Hummel 1996), peripheral neuropathy (Ziem 1997)
Skin: rash in response to chemicals and irritants, hypersensitive to touch, vibration, and cold; "loose" skin if pinched
Sleep: frequently disrupted with abnormal EEG (Bell 1996)
Vestibular: impaired Romberg and other balance testing (Ziem 1997)
Vitamins: numerous deficiencies, especially in the B series (Galland 1987, Ziem 1997)
Xenobiotics: various markers of poisoning by heavy metals (lead, mercury, depleted uranium) and pesticides (chlorinated or organophosphate) may be detected in urine, stool, blood, hair and/or fat (Heuser 1992)
Compiled by Albert Donnay, 2/1999, rev'd 8/2000
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Baldwin CM, Bell IR, O'Rourke M, Nadella S, and Lebowitz MD. 1998b. Allergen risk ratios for a community sample with and without self-reports of multiple chemical sensitivity. Chem Senses 20: 661-662.
Bell I.R. Baldwin, C.M. and Schwartz, G.E. 1998a. Illness from low levels of environmental chemicals: relevance to chronic fatigue syndrome and fibromyalgia. Am J Med 105: 74S-82S.
Bell, I.R., Schwartz, G.E., Baldwin, C.M., Hardin, E.E. and Kline, J.P. 1998b. Differential resting quantitative electroencephalographic alpha patterns in women with environmental chemical intolerance, depressives, and normals. Biol Psychiatry 43: 376-388.
Bell, I.R., Bootzin, R.R., Ritenbaugh, C., Wyatt, J.K., DeGiovanni, G., Kulinovich, T., Anthony, J.L., Kuo, T.F., Rider, S.P., Peterson, J.M., Schwartz, G.E. and Johnson, K.A. 1996. A polysomnographic study of sleep disturbance in community elderly with self-reported environmental chemical odor intolerance. Biol Psychiatry 40: 123-133.
Bell, I.R., Wyatt, J.K., Bootzin, R.R. and Schwartz, G.E. 1995. Slowed reaction time performance on a divided attention task in elderly with environmental chemical odor intolerance. Int.J Neurosci. 84: 127-134.
Callender, T.J., Morrow, L.A. and Subramanian, K. 1993. Evaluation of chronic neurological sequelae after acute pesticide exposure using SPECT brain scans. J.Toxicol.Ind.Health 41: 275-284.
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Donnay A. and Ziem G. 1995. Protocol for diagnosing disorders of porphyrin metabolism in chemically sensitive patients. Baltimore, MD: MCS Referral & Resources
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Monro J.M. 1997. Laboratory tests found to be effective in the evaluation of chemical sensitivity: derived from 12,000 patient evaluations. 32nd Annual Meeting of the American Academy of Environmental Medicine, La Jolla CA, 24-27 October 1997 [abstract and presentation]
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Last Modified: 11/05/06