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We identified optimal cutoff scores for three questionnaire instruments that quantify environmental annoyance (affective reactions and behavioral disruptions) attributed to everyday environmental exposures of chemicals, electromagnetic fields and sounds, and applied these cutoff scores to estimate the prevalence of such reactions in two general populations. Data were used from 4941 participants from Swedish and Finnish population-based surveys. The identified optimal cutoff scores showed excellent diagnostic accuracy, and provided prevalence rates for these reactions of 28.8 and 27.0% for chemicals, 7.0 and 7.7% for electromagnetic fields, and 27.8 and 28.3% for sounds, for the Swedish and Finnish samples, respectively. The prevalence rates varied between age groups and sexes. The findings suggest that the cutoffs are useful for identifying individuals or groups with affective and behavioral reactions to everyday environmental exposures, and that the prevalence rate for these reactions vary depending on type of exposure, age and sex. [ABSTRACT FROM AUTHOR]

Abstract: The objective was to develop, metrically evaluate and establish normative data for the Environmental Symptom-Attribution Scale (ESAS), which is a questionnaire-based instrument for quantifying degree to which health symptoms are attributed to specific environmental exposures and sources. Data were used from 3406 individuals who took part in the Västerbotten Environmental Health Study in Sweden. The responders constitute a random sample, aged 18–79 years. They responded to the ESAS and to questions about physician-based diagnoses for evaluation of concurrent validity of the ESAS. Four dimensions of the ESAS were identified, constituting subscales: the Odorous/Pungent, Building-Related, Sound, and Electromagnetic Field Subscales. A Global Scale is available as well. In general, the distributions of the scores on the scales were positively skewed and leptokurtic in shape. The results demonstrate good reliability and concurrent validity of all five ESAS scales. Percentiles were obtained as normative data. Examples of use of the ESAS applied on individuals are provided. The favorable metric properties of the ESAS and its rapid administration suggest that it is useful for assessment in clinical and epidemiological settings. [Copyright &y& Elsevier]

A systematic review of provocation studies of persons reporting multiple chemical sensitivities (MCS) was conducted from databases searched from inception to May 2006. Thirty-seven studies were identified, testing 784 persons reporting MCS, 547 control subjects, and 180 individuals of whom a subset were chemically sensitive. Blinding was inadequate in most studies. In 21 studies odors of chemicals were probably apparent; 19 of these reported positive responses to provocations among chemically sensitive individuals, and 1 study demonstrated that negative expectations were significantly associated with increased symptom reporting after provocations. Seven studies used chemicals at or below odor thresholds, and 6 failed to show consistent responses among sensitive individuals after active provocation. Six studies used forced-choice discrimination and demonstrated that chemically sensitive individuals were not better at detecting odor thresholds than nonsensitive participants. Three studies tested individuals by using nose clips/face masks and confirmed response, possibly mediated through eye exposure. Three studies used olfactory masking agents to conceal stimuli, and none of these found associations between provocations and response. We conclude that persons with MCS do react to chemical challenges; however, these responses occur when they can discern differences between active and sham substances, suggesting that the mechanism of action is not specific to the chemical itself and might be related to expectations and prior beliefs. [Copyright &y& Elsevier]

Unproved methods and controversial theories in the diagnosis and management of allergy-immunology are those that lack scientific credibility. Some definitions are provided for perspective because in chronic medical conditions, frequently, nonscientifically based treatments are developed that can have a very positive psychological effect on the patients in the absence of objective physical benefit. Standard practice can be described as 'the methods of diagnosis and treatment used by reputable physicians in a particular subspecialty or primary care practice' with the understanding that diagnosis and treatment options are consistent with established mechanisms of conditions or diseases.3 Conventional medicine (Western or allopathic medicine) is that which is practiced by the majority of MDs, DOs, psychologists, RNs, and physical therapists. Complementary medicine uses the practice of conventional medicine with complementary and alternative medicine such as using acupuncture for pain relief in addition to opioids. Alternative medicine implies use of complementary and alternative practices in place of conventional medicine. Unproved and controversial methods and theories do not have supporting data, validation, and sufficient scientific scrutiny, and they should not be used in the practice of allergy-immunology. Some examples of unproven theories about allergic immunologic conditions include allergic toxemia, idiopathic environmental intolerance, association with childhood vaccinations, and adrenal fatigue. Unconventional (unproved) diagnostic methods for allergic-immunologic conditions include cytotoxic tests, provocation-neutralization, electrodermal diagnosis, applied kinesiology assessments, and serum IgG or IgG4 testing. Unproven treatments and intervention methods for allergic-immunologic conditions include acupuncture, homeopathy ('likes cure likes'), halotherapy, and autologous urine injections. [ABSTRACT FROM AUTHOR]