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

For the group of patients suffering from polysomatic complaints with a subjective feeling of allergy against or other disease from environmental noxious agents we have suggested the term "Eco-Syndrome". Other names include "multiple chemical sensitivity" (MCS) or "idiopathic environmental intolerance" (IEI). Etiologic hypotheses have focused on immunological disorders, olfactory 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 procedure of clinical diagnostic assessment in form of a check list. Eco-syndrome patients need a careful allergological investigation. In general, no immunologically mediated (allergic) reactions have been found earlier, therefore the existence of a possible non immunologic hypersensitivty reaction (idiosyncrasy, intolerance or pseudo-allergic reaction) has to be excluded. The oral provocation test for idiosyncrasy (OPTI) is a valid test method to evaluate food additive or drug hypersensitivity. Furthermore, a psychosomatic-psychiatric orientated diagnostic and therapeutic concept has been established. The question in how far psychiatric or psychosomatic factors play a role in the chronic disorder is evaluated by using a detailed questionnaire.