BACKGROUND:Despite advances in pharmacologic therapy, a subset of patients with bronchial asthma (BA) experience persistent symptoms. Multiple chemical sensitivity (MCS), a non-allergic condition triggered by low-level chemical exposures, may be responsible for asthma-like symptoms. Although epidemiological studies have reported a high co-prevalence of MCS and BA, clinical comparisons among patients with BA between those with and without MCS are limited. We aimed to characterize the clinical and symptomatic profiles of patients with BA and comorbid MCS. METHODS:This cross-sectional study included 100 patients with BA treated at Sagamihara Hospital. MCS-related symptoms were evaluated using the Quick Environmental Exposure and Sensitivity Inventory (QEESI). Clinical data including serum total Immunoglobulin E (IgE) levels, eosinophil counts, pulmonary function, hospitalization frequency, comorbidities, and medications were collected by attending physicians. Fifteen patients who exceeded the QEESI MCS cut-off value (BA-MCS group) were compared with 30 age- and sex-matched controls without MCS (BA-control group). RESULTS:Compared to BA-controls, the BA-MCS group had strong symptoms in multiple organs other than the respiratory system (p = 0.000), exhibited significantly higher percentage forced expiratory volume (%FEV1) (p = 0.047), lower serum IgE levels (p = 0.028), more frequent hospitalizations (p = 0.002), and higher incidence of atopic dermatitis history (p = 0.001). CONCLUSIONS:The BA-MCS group had a distinct phenotype characterized by preserved lung function, low IgE levels, systemic symptoms, and high disease burden. For these patients, a multidisciplinary approach addressing BA and MCS may be more effective than intensifying asthma pharmacotherapy alone.

BACKGROUND:In Japan, there are currently no definitive conclusions regarding the characteristics of multiple chemical sensitivity (MCS) and electromagnetic hypersensitivity (EHS). This study aimed to determine the prevalence and correlation of MCS and EHS with age, sex, and depression in the Japanese population.METHODS:An anonymous self-report questionnaire was distributed to 2,007 participants. Variables such as MCS, EHS, depression score, and demographic characteristics were individually evaluated using the U-test, chi-squared test, and correlation analyses. Moreover, we performed a covariance structure analysis to build a structural equation model.RESULTS:Older individuals and women were more likely to exhibit MCS and EHS symptoms. Moreover, depression was correlated with MCS and EHS.CONCLUSIONS:Although MCS and EHS are strongly correlated, they exhibit distinct characteristics and symptoms, indicating that they can be regarded as separate conditions.

Background Environmental hypersensitivity/intolerance is considered closely related to allergic diseases. To understand these conditions, the environmental intolerances and symptoms of patients with multiple chemical sensitivity (MCS), subjects with self-reported electromagnetic hypersensitivity (EHS), patients with bronchial asthma (BA), and the general population were compared using universal questionnaires. Methods A survey was conducted from 2012 to 2015. The subjects were categorized in four groups: 111 patients with physician-diagnosed MCS, 119 subjects with self-reported EHS, patients with 98 physician-diagnosed BA, and 619 controls from general population. The Quick Environmental Exposure and Sensitivity Inventory and EHS questionnaire were used. The differences between the questionnaire scores among the four groups were tested using logistic regression analyses adjusted for age and gender as covariates. Results The MCS and EHS groups had significantly high scores of intolerances to multiple environmental factors, life impact, and multiple symptoms than the BA and control groups. Although the differences between most of these scores of the MCS and EHS groups were not significant, the electromagnetic hypersensitivity reaction was significantly higher in the EHS group than in the MCS group. In addition, the scores for intolerances to chemicals and other compounds, life impact, and several symptoms of the BA group were significantly higher than those of the control group. Conclusions This study clarified the similarities and differences of the environmental intolerances and symptoms between the four groups.

Objectives: To investigate age and sex differences in multiple chemical sensitivity (MCS) and electromagnetic hypersensitivity (EHS), as well as their relationship with depression in the Japanese population.Methods: An anonymous self-report questionnaire was distributed to 2,007 participants. Variables such as MCS, EHS, Total Health Index-Depression, and demographic characteristics were individually evaluated using the U-test, chi-squared test, and correlation analyses. Moreover, we performed a covariance structure analysis to build a structural equation model.Results: Older individuals and women were more likely to exhibit MCS and EHS symptoms. Moreover, depression was correlated with MCS and EHS.Conclusion: Although MCS and EHS are strongly correlated, they present different characteristics and symptoms. Keywords: Multiple chemical sensitivity; Electromagnetic hypersensitivity; Depression; Sex differences; Japanese population

Context . Multiple chemical sensitivity (MCS) is a chronic disorder in which minimal but sustained exposure to particular chemicals causes headaches, vertigo, and multiple othersymptoms. Up to 10%of casesare clinically unresponsive to treatment. Kampo medicines include multiple crude components with many applications for organ disorders. Objective . The research team aimed to assess the efficacy of goreisan, a Japanese Kampo medicine, for 2 patients diagnosed with intractable cases of MCS. Design . The research team conducted case studies with 2 female patients. Setting . The study took place at the Kampo clinic in the Department of Gynecology and Obstetrics at the Japanese Red Cross Maebashi Hospital in Maebashi, Gunma, Japan. Participants . The participants were patients at the clinic. Intervention . The first participant received the Kampo formula goreisan for her headaches and keigairengyoto for her mucosal discomfort; the second received goreisan for her headaches and kakkonto to reduce her shoulder-muscle stiffness. The participants received Kampo treatments for one month. Outcome measures . The first participant's MCS symptoms were evaluated with the Quick Environment Exposure Sensitivity Inventory questionnaire (QEESI); the second using a numeric rating scale (NRS). Results . After the Kampo treatments, the first participant's QEESI scores for chemical intolerance, symptom severity, and life impact were reduced from 47, 92, and 76 to 37, 39, and 55 points, respectively. The second participant's NRS scores were likewise reduced from 6, 8, and 8 out of 10 to 1, 2, and 1 out of 10. Symptoms were relieved in both patients, and didn't recur. Conclusions . These results highlight the potential benefits of Kampo medicine for the treatment of intractable MCS. Further investigations will be needed to confirm the mechanism of action, thereby improving the understanding of the effectiveness of Kampo medicine for MCS therapy.

Background & objectives The Quick Environmental Exposure and Sensitivity Inventory (QEESI) developed by Miller and Prihoda in the USA is used as a questionnaire for patients with multiple chemical sensitivity (MCS) in >10 countries. We developed a Japanese version of QEESI, assessed its reliability and validity, and defined original cut-off values for screening Japanese patients with MCS in 2003. Our recent study revealed that opportunities for exposure to various chemicals had increased for people in Japan, while subjective symptoms of MCS in patients had increased in severity. In this study, we considered new cut-off values that combined QEESI subscale scores based on the current situation in Japan. Methods The questionnaire used was a Japanese version of QEESI. The survey was conducted from 2012 to 2015. Participants were 111 patients with MCS (mean age: 46 ± 20, 81% female) initially diagnosed by physicians, and 444 age- and gender-matched controls not diagnosed with MCS by doctors. The discriminatory validity of QEESI scores of patients and controls were evaluated by logistic regression and receiver operating characteristic analyses when considering interactions of the Masking Index (ongoing chemical exposure). New combined cut-off values were then set. Results New combined cut-off values (meeting conditions of Chemical Intolerances ≥ 30, Symptom Severity ≥ 13, and Life Impacts ≥ 17) showed high sensitivity (82.0%) and specificity (94.4%). Using new criteria when considering ongoing chemical exposure, study participants were categorized as: Very suggestive, Somewhat suggestive, Problematic, and Not suggestive. Participants classified as Very suggestive included 25 (5.6%) controls. Conclusions We have set new criteria with combined cut-off values based on current Japanese conditions. Such new criteria can be used for screening and as a diagnostic aid for Japanese patients with MCS and suggest approximately 6% of the Japanese general population may be classified as “Very suggestive people with MCS”.

BACKGROUND:Recently, with rapid changes in the Japanese lifestyle, the clinical condition of patients with multiple chemical sensitivity (MCS) may also have undergone change. Thus, we conducted a new survey for subjective symptoms, ongoing chemical exposures, the prevalence of allergic diseases, and presumed onset/trigger factors in patients with MCS and compared results with those of an old survey from ten years ago.METHODS:The new survey was conducted from 2012 to 2015 and the old survey was independently conducted from 1999 to 2003, meaning it was not a follow-up study. Patients were initially diagnosed by physicians at five medical institutions with MCS specialty outpatient services, with 111 and 103 patients participating in the new and old surveys, respectively. The controls were a general population living in Japan, with 1313 and 2382 participants in the new and old surveys, respectively. Subjective symptoms and ongoing chemical exposure were evaluated using a quick environmental exposure sensitivity inventory. Additionally, from clinical findings recorded by an attending physician, the prevalence of allergic diseases and presumed onset/trigger factors were evaluated. Differences between new and old surveys were analyzed using logistic regression analyses and significance tests.RESULTS:Compared with ten years ago: (1) Regarding factors affecting patients with ongoing chemical exposures, the proportion of patients affected decreased significantly for two items only (insecticides and second-hand smoke). The proportion of controls showing ongoing exposure to 8 out of 10 items changed significantly. (2) In patients, scores for chemical intolerances, other intolerances, and life impacts increased significantly. (3) In terms of the prevalence of allergic diseases among patients with MCS, bronchial asthma (adjusted odds ratio [AOR]: 5.19), atopic dermatitis (AOR: 3.77), allergic rhinitis (AOR: 5.34), and food allergies (AOR: 2.63) increased significantly, while hay fever (AOR: 0.38) and drug allergies (AOR: 0.40) decreased significantly. (4) With regard to construction and renovation, which was the presumed predominant onset/trigger factor for MCS 10 years ago, this decreased from 68.9% to 35.1%; in contrast, electromagnetic fields (0.0%-26.1%), perfume (0.0%-20.7%), and medical treatment (1.9%-7.2%) increased significantly, confirming the diversification of onset/trigger factors.CONCLUSION:Compared to ten years ago, for patients with MCS, an increase in avoidance behavior toward chemical substance exposures, which were presumed to be aggravating factors for symptoms, was confirmed. It has been suggested that the ongoing chemical exposure of the general population in Japan has largely changed. In addition, for patients with MCS, chemical intolerances and life impacts have become severe, the prevalence of the main allergic diseases has increased, and onset/trigger factors have become diversified.

The purpose of the present study was to evaluate the validity and reliability of a Japanese version of an electromagnetic hypersensitivity (EHS) questionnaire, originally developed by Eltiti et al. in the United Kingdom. Using this Japanese EHS questionnaire, surveys were conducted on 1306 controls and 127 self-selected EHS subjects in Japan. Principal component analysis of controls revealed eight principal symptom groups, namely, nervous, skin-related, head-related, auditory and vestibular, musculoskeletal, allergy-related, sensory, and heart/chest-related. The reliability of the Japanese EHS questionnaire was confirmed by high to moderate intraclass correlation coefficients in a test-retest analysis, and high Cronbach's α coefficients (0.853-0.953) from each subscale. A comparison of scores of each subscale between self-selected EHS subjects and age- and sex-matched controls using bivariate logistic regression analysis, Mann-Whitney U- and χ(2) tests, verified the validity of the questionnaire. This study demonstrated that the Japanese EHS questionnaire is reliable and valid, and can be used for surveillance of EHS individuals in Japan. Furthermore, based on multiple logistic regression and receiver operating characteristic analyses, we propose specific preliminary criteria for screening EHS individuals in Japan. Bioelectromagnetics. 37:353-372, 2016. © 2016 The Authors. Bioelectromagnetics Published by Wiley Periodicals, Inc.

The Indoor Air Quality Management Act in Taiwan formally came into effect in November 2012 to protect public health. Studies have reported that public and private buildings in Taiwan currently have been facing pollution problems regarding indoor air quality (IAQ), which threatens the health of occupants. 1), 2)To clarify the correlation between the indoor air environment and influences on human health by using an economical and efficient method, the United States, Japan, and other countries use screening tools first to understand the health effects on building occupants, and, subsequently, adopt appropriate examination methods once primary influential factors are identified. To enable the integration of research results from Taiwan with those from abroad, this study introduced the quick environmental exposure and sensitivity inventory (QEESI) questionnaire, which the United States, Japan, and other countries have implemented for many years. In this study, the applicability of the QEESI questionnaire in screening sick building syndrome (SBS) in Taiwan was examined by observing the association between the QEESI score and IAQ survey results. The results from Taiwan were compared with those from the United States and Japan. A questionnaire concerning personal and residential environmental factors was also incorporated to identify factors with significant predictive power for the QEESI score.The following conclusions were derived from this study.1. The correlation between the IAQ survey values and the QEESI score indicates the capability of the QEESI questionnaire to identify problems related to sick buildings and to serve as a screening tool for SBS in Taiwan.2. Currently, using the cutoff points proposed by Japanese researchers(3-5)) to judge the QEESI score can optimally enhance the correlation between the IAQ survey results and the QEESI scores for people in Taiwan.3. Eight factors with significant predictively power for the QEESI score include gender, age, an understanding of the mechanism of SBS occurrence, allergy history, building type, air ventilation, the use of deodorants and fragrances, and smoking. These factors can serve as key points when performing on-site examinations.

Taiwan and Japan are similar in life style and customs. Taiwan is geographically situated in a subtropical climate zone which is deemed as a future model of Japanese climate if global warming continues. It is therefore advantageous for Japanese to know the present IAQ (Indoor Air Quality) situations in Taiwan.The research was carried out in two phases. The first phase used questionnaire surveys to collect the relevant information of the occupants and their living environments, and QEESI questionnaires (Chinese version) for information regarding their health conditions. In the second phase, IAQ measurements were conducted in the 40 houses which were selected among volunteers of the first survey. Measurement items were temperature, humidity and concentrations of carbonyl compounds and VOCs (Volatile Organic Compounds). Verification measurements were conducted to investigate the hypothesis in the two houses, A and B, selected from 40 measured houses. The amount of furnishing materials in the two houses was quite different.Finally, the questionnaire results, QEESI (Quick Exposure Sensitivity Inventory) scores, and IAQ data were compared accordingly to determine the factors that cause SHS (Sick House Syndrome).The results are as follows.1. For areas deficient in SHS and/or MCS (Multiple Chemical Sensitivity) diagnoses, combining QEESI investigations and IAQ measurements in the surveys is successful in screening SH and discovering SHS.2. To reduce indoor air pollution effectively, it is insufficient just to regulate the materials and the quantity of interior furnishings. Construction process, ventilation rate, airflow path, and an overall plan with strict assessment should all be included in the regulations.

In order to make clear the relationship between the chemical substances concentration and symptom of sick house syndrome, an investigation of 30 sick houses in Japan has been done for 8 years. Chemical substance concentrations show a decrease as the building age increases. However, there are some houses where concentrations increase due to low air change rate, use of moth crystals for clothes and new furniture. Because there was the case where the improvement of indoor air quality has relieved occupant's symptoms, it must be important to take measures such as ventilation frequently, non use of chemical products or use of low chemical products in the long term to treat “SHS”.

The Quick Environment Exposure Sensitivity Inventory (QEESI©) has been used as a questionnaire to evaluate subjective symptoms of patients with multiple chemical sensitivity (MCS), also known as idiopathic environmental intolerance, in Japan. However, no cutoff value for Japanese subjects has yet been established. We designed this study to establish a cutoff value for Japanese subjects using QEESI© for screening of MCS patients.

In order to make clear the relationship the chemical substances concentration and symptom of sick house syndrome, an investigation of 62 houses in Japan has been done for 9 years. The results showed that the indoor air of many sick houses was polluted with high carbonyl compounds and Volatile Organic Compounds (VOC) concentrations exceeded the criterions of Japan Standard. In addition, high concentration was found not only in the houses which were just built or renovated, but also in the houses with well-air-tightened and low air change rate.

Multiple chemical sensitivity (MCS), a syndrome in which multiple symptoms occur with low-level chemical exposure, has not been clarified in detail. The aim of our study was to clarify the clinical characteristics of physician-diagnosed MCS patients in Japan. We analyzed patient characteristics based on the medical records of 106 patients diagnosed with MCS according to the 1999 Consensus and the Japanese diagnostic criteria for MCS. We evaluated subjective symptoms using the Quick Environment Exposure Sensitivity Inventory (QEESI) and compared the QEESI scores with those of four MCS patient groups in the US reported by Miller and Prihoda [Miller, C.S., Prihoda, T.J., 1999b. A controlled comparison of symptoms and chemical intolerances reported by Gulf War veterans, implant recipients, and persons with multiple chemical sensitivity. Toxicol Ind Health 15, 386-397]. Female patients accounted for 74.0%. Most male patients were in their 30s, whereas female ages ranged widely from 10 to 65 years. Among estimated onset factors, those seen in males tended to be workplace related, while female patients showed a variety of factors. Co-morbid allergic disease was present in 84.0% of patients. A significant difference in the QEESI score between male and female patients was found in only one item out of 10 in symptom severity and life impact. However, all 10 items in chemical intolerance were significantly higher in females than in males. The mean QEESI score in the patient group in our study was lower than those in any of the four self-reported patient groups in the US.