Biological interventions in the treatment of patients with multiple chemical sensitivities

The syndrome of multiple chemical sensitivities has many manifestations and undoubtedly many causes. Treatment must be individualized based on a thorough psychosocial and biological diagnostic evaluation. Careful listening, as is usually the case, not only results in a more complete history but also serves a critical therapeutic purpose in cementing a trusting, working partnership. Family dynamics, and larger social concerns, such as litigation, may figure importantly as obstacles to rehabilitation if they are ignored in treatment planning. In chronically disabled patients, the importance of psychosocial interventions is even greater but should not eclipse attention to relevant medical interventions. The most basic physiologic manipulation involves a program of environmental avoidance. Such a program should be applied with caution since it is not without risks of inadvertent exacerbation of medical and psychologic disabilities. Therefore, from a medical perspective, interventions should focus on improving chemical tolerance by the appropriate application of first aid, chronohygiene, nutrition, psychophysiology, and correction of microbiological disruptions. Thorough investigation for intercurrent disease and its appropriate management is paramount. Attempts to treat the entire problem by isolating attention to one area or based on a single theory are likely to fail.