Environmental House Calls Can Reduce Symptoms of Chemical Intolerance: A Demonstration of Personalized Exposure Medicine

Aim: The goal of this investigation was to 1) identify exposure sources in the home, 2) teach occupants how to remove or replace them, and 3) determine whether measured levels and reported symptoms could be reduced by these changes. Background: Chemical intolerance (CI) is an international public health and clinical concern, but few resources are available to address patients’ often disabling symptoms. Numerous studies show that levels of indoor air pollutants can be two-to-five (or more) times higher than outdoor levels. Fragranced consumer products, including cleaning supplies, air fresheners, and personal care products are symptom triggers commonly reported by susceptible individuals. Methods: A team of professionals trained and led by a physician/industrial hygienist and two certified indoor air quality specialists conducted a series of five structured Environmental House Calls (EHCs) in 37 homes of patients reporting chemical intolerances. Results: We report three case studies demonstrating that an appropriately structured home intervention can teach occupants how to reduce indoor air exposures and associated symptoms. Symptom improvement, documented using the QEESI Symptom Star, corresponded with reduction of indoor air volatile organic compounds, most notably fragrances. Discussion: We address the long-standing dilemma that worldwide reports of fragrance sensitivity have not previously been confirmed by human or animal challenge studies. Our ancient immune systems’ “first responders,” mast cells, which evolved 500 million years ago, can be sensitized by synthetic organic chemicals whose production and use has grown exponentially since WWII. We propose that these chemicals, which include now-ubiquitous fragrances, trigger mast cell degranulation and inflammatory mediator release in the olfactory-limbic tract, thus altering cerebral blood flow and impairing mood, memory, and concentration (so-called “brain fog”). The time has come to translate these research findings into clinical and public health practice.