Idiopathic environmental intolerance (IEI)
Idiopathic environmental intolerance (IEI), formerly known as multiple chemical sensitivity, is the term used to describe a condition where people report a range of recurrent nonspecific physical and psychological symptoms and attribute them to exposure to low levels of a wide range of chemical, biological or physical agents in the everyday environment. The causes of IEI are unknown.
What triggers IEI?
Individuals with IEI identify a wide and diverse range of chemical, biological and physical factors as symptom triggers, including:
- carpeting, soft furnishings, printing ink, soft plastics, synthetic fabrics, cleaning products
- chlorinated and fluoridated water
- cigarette smoke
- electromagnetic field
- fragranced products such as perfumes, aftershave, and deodorants
- pesticides, pharmaceutical drugs and anaesthetics
- volatile organic compounds, paint, solvents.
The symptoms of IEI are reportedly triggered by exposure to very low levels of perceived triggers, for instance background levels of exposure, which do not cause concern for the vast majority of the population.
It is not known what causes the condition and how it develops. Despite extensive research over the past 50 years, there is little understanding of the causes and pathophysiological mechanisms of IEI. Several toxicological mechanisms have been proposed, but the scientific evidence is lacking.
What are the symptoms of IEI?
The individuals reporting IEI present with broad range of symptoms involving different organs and systems. There is no consistency in the reported symptoms from patient to patient. Individuals with IEI commonly report:
- headache
- fatigue
- confusion
- depression
- shortness of breath
- arthralgia
- myalgia
- nausea
- dizziness
- memory problems
- gastrointestinal symptoms
- various respiratory symptoms.
The symptoms of IEI are real to the person who reports them, despite the lack of medical explanation.
Some of the symptoms reported by IEI individuals may be debilitating and may take a significant toll on many aspects of their everyday life, including relationships, lifestyle, and work.
How is IEI diagnosed?
There are no universally accepted diagnostic criteria for IEI. There are no laboratory tests and no clinical guideline documents. IEI is not recognised as a medical condition in Australia and most countries.
Individuals with IEI symptoms who seek help from their GPs are frequently referred to various specialists. If following clinical investigations there is still no explanation for the symptoms, these patients are usually provided with explanation, reassurance, and guidance on trigger avoidance measures.
Can IEI be treated?
There are no clear evidence-based treatment options for IEI.
Individuals with IEI consider education, support and acknowledgement as the most beneficial interventions. Other effective treatments reported in the literature include psychotherapy and cognitive behavioural therapy.
Some groups promote a wide range of interventions, ranging from intravenous injections of vitamins and nutritional supplements to ‘detoxification therapies’ such as sauna, colonic irrigation and others. The efficacy of these interventions in the treatment of IEI has not been tested systematically and they are not supported by medical practitioners.
Does trigger avoidance help?
Trigger avoidance is a common approach to the management of IEI symptoms because many individuals with IEI report feeling better when they intentionally avoid the factors they report as triggers for their symptoms.
However, there is no conclusive scientific evidence that perceived trigger avoidance is effective in treating the condition. Several controlled exposure studies showed that individuals reporting IEI tend to develop symptoms only when they are aware of being exposed to a trigger. More research is needed in this area.
It is prudent at all times to strive to maintain a healthy environment in the home and at work.
Better air quality, particularly good building ventilation, helps to maintain good health and benefits people with many medical conditions, including those who report IEI.
It is also wise to minimise the use of household chemicals, such as pesticides, disinfectants, solvents and others. Use them only when needed, and always follow the label instructions.
At work and in public settings it is important to appreciate that for some individuals, exposure to certain chemical or physical agents may result in considerable distress. Workplaces and public settings should, therefore, endeavour to take reasonable steps to accommodate the needs of people reporting IEI whenever possible.
Considerations for health staff
While it may not be possible or practical to alter many aspects of the clinical environment, health staff are encouraged to work in partnership with people who report IEI triggers by considering the following strategies:
- Developing respectful partnerships with individual patients/carers
- Interacting with all patients/carers in a respectful and non-judgemental manner
- Acknowledging the distress expressed by people reporting IEI
- Communicating to people who express concerns that they are being taken seriously and modifications to the health care environment will be considered where it is possible and practical
- Whilst the nature and aetiology of IEI does not have current scientific consensus, it is inappropriate for staff to question the validity of IEI status with the individual concerned.
- Identifying triggers and communicating this information to other staff
- Documenting particular triggers of concern to the individual
- Recording potential triggers in the ‘Patient Alert’ or equivalent section of medical records
- Communicating concerns promptly to senior members of staff and undertaking appropriate mediation processes to address questions, concerns or complaints
- Considering the use of additional methods of communication about potential triggers to other staff (clinical and non-clinical) in consultation with the patient and their carer. For example, signs to be added to a door or at the end of a bed.
- Modifying the environment
- Whilst it is not always possible or practical to alter the clinical environment, health staff may endeavour to reduce the individual’s exposure to potential triggers
- Health staff may discuss ways of modifying the environment without compromising clinical safety
- Potential modification of the environment will depend on individual circumstances (including severity and acuteness of the clinical scenario) and availability of alternative arrangements, but may include:
- providing the individual with a separate room and bathroom
- locating an individual away from high traffic areas, freshly renovated or repainted areas
- minimising the use of scented personal products
- allowing people to supply their own linen.
- Using alternative cleaning products (where available) which may be more acceptable to individuals with IEI (i.e., unscented).
- Responding to concerns throughout a health service visit
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- People with IEI may report difficulties with additional triggers and the approaches described above may need to be reassessed throughout a health service visit.
Further information
For further information on IEI, contact Scientific Services on (08) 8226 7100.