The "eco-syndrome" ("multiple chemical sensitivity"): Allergological and environmental-medical management

For the group of patients suffering from polysomatic complaints with a subj ective feeling of allergy against or other disease from environmental noxio us agents we have suggested the term "Eco-Syndrome". Other names include "m ultiple chemical sensitivity" (MCS) or "idiopathic environmental intoleranc e" (IEI). Etiologic hypotheses have focused on immunological disorders, olf actory and limbic system involvement and psychiatric abnormalities. However all of the suggested theories to date are of hypothetic character and lack compelling evidence. For the practical management of patients who possibly suffer from an environmentally, induced disease we suggest a four step pro cedure of clinical diagnostic assessment in form of a check list. Eco-syndr ome patients need a careful allergological investigation. In general, no im munologically mediated (allergic) reactions have been found earlier, theref ore the existence of a possible non immunologic hypersensitivty reaction (i diosyncrasy, intolerance or pseudo-allergic reaction) has to be excluded. T he oral provocation test for idiosyncrasy (OPTI) is a valid test method to evaluate food additive or drug hypersensitivity. Furthermore, a psychosomat ic-psychiatric orientated diagnostic and therapeutic concept has been estab lished. The question in how far psychiatric or psychosomatic factors play a role in the chronic disorder is evaluated by using a detailed questionnair e.