A 37-year-old mechanic with multiple chemical sensitivities

A 37-year-old heating, ventilation, and air-conditioning mechanic developed respiratory, musculoskeletal, and central nervous system symptoms associat ed with a variety of odorous environmental chemicals. Organic disease was n ot evident, but the patient was distressed by these symptoms and was at ris k for becoming disabled by them. His symptoms fit broadly into the conditio n recognized as multiple chemical sensitivity Multiple chemical sensitivity is a diagnostic term for a group of symptoms without demonstrated organic basis. The symptoms are characteristic of dysfunction in multiple organ sys tems, they increase and decrease according to exposure to low levels of che mical agents in the patient's environment, and they sometimes occur after a distinct environmental change or insult such as an industrial accident or remodeling. Although traditional medical organizations have not agreed on a definition for this syndrome, it is being increasingly recognized and make s up an increasing percentage of the caseload at occupational and environme ntal medicine clinics. Although there is often dispute about whether the sy mptoms have a functional or organic basis, an informed approach to evaluati on, diagnosis, and management and a careful assessment of impairment, disab ility, and work relatedness are necessary. Careful exclusion of organic cau ses is critical, and this should be followed by a judicious approach to cop ing with symptoms.