Multiple Chemical Sensitivity
... or MUSES Syndrome ?
Presented to the Environmental Law Centre’s
International MCS Conference
8 April 2002, Conway Hall, London
(c) 2002 by Albert Donnay, MHS
MCS Referral & Resources, Inc
www.mcsrr.org
adonnay@jhu.edu
(c) 2002 by ALBERT DONNAY
What is Multiple Chemical Sensitivity?


1999 Consensus Definition (Arch Env Health 1999;54:147-9)
[1] MCS is a chronic condition
[2] marked by multiple symptoms in multiple organs
[3] that recur reproducibly
[4] in response to low levels of exposure
[5] to multiple unrelated chemicals and
[6] improve or resolve when incitants are removed.
Best of 7 MCS Definitions at identifying MCS cases
(McKeown-Eyssen et al, Arch Env Health 2001;56:406-12)
(c) 2002 by ALBERT DONNAY
How Many MCS Symptoms Have Been Reported ?
List compiled by JHU Multi-Center Study of MCS Immunology
 CARDIOVASCULAR
9
 DIGESTIVE
18
 EARS // HEARING
7
 EYES // VISION
12
 GENITO-URINARY 10
 HEAD
6
 MOUTH // TASTE
14
 MUSCULOSKEL.
14
 NECK
3
 NERVOUS
SYSTEM 43
 NOSE // SMELL
10
 SYSTEMIC // OTHER 17
 VASCULAR
5
 REPRODUCTIVE
17
 RESPIRATORY
6
 SKIN // TOUCH
7
 THROAT
5
TOTAL # SYMPTOMS = 203
(c) 2002 by ALBERT DONNAY
What Objective Findings Are Reported in MCS ?
 Abnormal
Blood & Plasma
 Impaired Circulation
 Impaired Heart Function
 Impaired Detox Pathways
 Ear & Hearing Abnormalities
 Endocrine Deficiencies
 Eye & Vision Abnormalities
 Gastrointestinal Impairment
 Immune System Activation
 Increased Mast Cells
 Mineral Deficiencies
Musculoskeletal Abnormalities
 Neurocognitive Deficiencies
 Nose & Smell Abnormalitites
 Porphyrin Enzyme Abnorm.
 Respiratory Impairment
 Sensory Nerve Impairment
 Skin Tone Abnormalities
 Vestibular Impairment
 Vitamin Deficiencies
 Xenobiotics in Fat, Blood,
Urine and Hair
Refs online at www.mcsrr.org

(c) 2002 by ALBERT DONNAY
Who is Funding This MCS Research?
 Most MCS-related
papers do not acknowledge any funding !
 But 10 US federal agencies fund over $25M per year: ATSDR,
CDC, DOD, DOE, DVA, EPA, NIDCD, NIEHS, NIH & NIOSH
 US Dept of Defense also funds MCS studies of UK veterans
 State governments in California, Maryland, Missouri, New
Jersey, New Mexico & Washington have funded MCS studies
 Both patient support groups (eg. CIIN) and chemical industry
front groups (eg. ESRI) have funded MCS conferences and
pilot studies, which usually have a strong bias.
(c) 2002 by ALBERT DONNAY
What View Predominates: Physical or Psychiatric?
Overlaps:
Only 11% of
First Authors
and 30% of
Publishers
have ever
supported
more than
one view
(c) 2002 by ALBERT DONNAY
On What Do All Agree? Prevalence is Very High !
5
US studies find 28% - 37% of adults say they are
“especially sensitive” to common chemical exposures
 4 US studies find 15% - 17% say they’re “unusually sensitive”
 6.3% in CA and 1.9% in NM say they have been diagnosed
by a medical professional with MCS or “environmental illness”
 US, Canadian and UK studies of Gulf War veterans all find
an increased prevalence of (still undiagnosed) MCS with a
relative risk of 2 to 4 compared with undeployed era controls
 So whatever cause, must be very common & moreso in war.
(c) 2002 by ALBERT DONNAY
But is MCS Only a Disorder of Chemical Sensitivity?


Not just ODOURS: LIGHT & SOUND HYPERSENSITIVITY
are very strongly associated with MCS: p < 0.00001
(Miller, Tox Ind Health, 1999;15:370-85)
When asked, MCS patients also report hypersensitivity to:
TASTES // FOODS
In an audience poll conducted
at this point, approx. 75 people
TOUCH // PRESSURE // PAIN
reported having all these sensory
HOT or COLD WEATHER
sensitivities since ill. Only one
(an American) reported having just
ELECTROMAGNETIC FIELDS
chemical sensitivity, aka pure MCS.
HEAVY METALS
MENTAL or PHYSICAL EFFORT STRESS OF ANY KIND
(c) 2002 by ALBERT DONNAY
Might MCS Be Something Else as Critics Claim?
 Not
New or Unique in English or French Medical Literature
 At Least 133 Similar Syndromes “Discovered” Before & Since
 Few acknowledge any relation to any others, past or current
 Few propose any specific cause, etiology or biomarkers
 Hence most never widely adopted or eventually abandoned
 But some are still in use and many MCS case are still being
diagnosed by one or more of them depending on the doctor
 History reveals both consistency of underlying syndrome and
great inconsistency of evolving medical awareness, proving
doctors rarely ever discover anything new, just things they
forgot, were never taught or did not bother to look up first !
(c) 2002 by ALBERT DONNAY
First Described in 1733 by Dr. George Cheyne
as the English Malady (EM!), aka The Vapours
 “To enumerate all
the almost infinite Symptoms, Degrees and Kinds
of Vapours is impossible, and perhaps very little to the Purpose.
 In general … the symptoms are many, various, changeable, shifting
from one Place to another, and imitating the Symptoms of almost
every other Distemper described.”
 “Those who suffer … are all of weak Nerves, have a great degree of
sensibility; are quick Thinkers, feel Pleasure or Pain the most readily,
and are of most lively imagination.”
 “Not withstanding all this, the Disease is as much a bodily Distemper
as the Small-Pox or a Fever.”
 Worst in winter & cities. Blamed on bad air, bad diet & bad habits.
(c) 2002 by ALBERT DONNAY
Some Symptoms of E.M. Cited by Dr Cheyne
“Sometimes there is an Inflation, and an actual visible Swelling, to a
very considerable Bigness, in the Stomach to be seen, especially in
the Sex [women]; a Coldness or Chilliness upon the Extremities, and
sometimes Flushing and Burning in the Hands and Feet, Cold Damp
Sweats, Faintings, and Sickness … Head-aches either behind or over
the Eyes, … Flies and Atoms dancing before the Eyes, a Noise like
the dying Sounds of Bells, or a Fall of Water, in the Ears; Yawning,
and Stretching, and sometimes a Drowsiness or Lethargy, at other
times Watching and Restlessness, and several other Symptoms,
which it is impossible to enumerate. Some have but a few of these
Symptoms, and some all of them, and a great many more…”
(c) 2002 by ALBERT DONNAY
36 Focus on Allergy, Sensitivity, Neurology or Toxins
1733 The English Malady
aka The Vapours
1769 Dysesthesia
1837 Neuropathy of
Nervousness
1849 Nervosisme
1861 Ménière's Disease
1869 Neurasthenia >1K*
1892 Hyperaesthesia
1894 Autointoxication
1921 Chronic CO Poisoning
1930 Heat, Cold and & Effort
Sensitiveness
1930 Allergic Toxemia
1945 Allergic Fatigue
and Weakness
1945 Hyperventilation Asthma
1952 Allergy of Nervous System
1954 Cerebral Allergy
1956 Specific Adaptation Syn.
1957 Familial Dysautonomia >9K
1965 Minimal Brain Dysfunction
1965 Delayed Hypersensitivity
Reaction >4K
1973 Sensory Integrative
Dysfunction
* 1K = 1000 references
on PubMed
(c) 2002 by ALBERT DONNAY
Allergy, Sensitivity, Neurology or Toxins continued …
1990 Chronic Habitual
1978 Chemical
Hyperventilation Syn.
Hypersusceptibility
1994 Gulf War Syndrome
1979 Perinatal Hypoxic1996
Multi-Organ
Dysesthesia
Ischemic Cerebral Syn.
1998 Toxicant Induced Loss
1982 Total Allergy Syndrome
of Tolerance
1983 Sick Building Syndrome 1999 Eco-Syndrome
1985 20th Century Syndrome
1999 Multi-Sensory Sensitivity,
1985 Allergic Irritability Syn.
aka MUSES Syndrome
1985 Environmental Hypersensitivities
1986 Hypersensitivity Syndrome
1987 Darkroom Disease
1987 Multiple Chemical Sensitivity <700
(c) 2002 by ALBERT DONNAY
30 Focus on Variations of 1869 Neurasthenia:
1875
1881
1886
1887
1889
1890
1891
1893
1895
1897
1898
Spinal Neurasthenia
American Nervousness
Sexual Neurasthenia
Gastric Neurasthenia
Neurasthenia
Praecox (aka Male N.)
Psychosomatic
Neurasthenia
Female Neurasthenia
Syphilitic Neurasthenia
Senile Neurasthenia
Traumatic Neurasthenia
Encephalasthenia
1903
1906
1907
1907
1908
1909
1968
Disease of the Century
Tropical Neurasthenia
Endocrine Neurasthenia
Ocular Neurasthenia
Digestive Neurasthenia
Battleship Neurasthenia
Pseudoneurasthenic
Syndrome
1976 Organic Neurasthenia
1976 Neurasthenic
Musculoskeletal
Pain Syndrome
(c) 2002 by ALBERT DONNAY
Variations of Neurasthenia continued …
1980 Neurasthenic Neurosis
1988 Neurasthenic Fatigue
Types of Unknown Origin & Date Cited by Secondary Sources
Angiopathic Neurasthenia
Cardiac Neurasthenia
Cardiovascular Neurasthenia
Insania Neurasthenia
Neurasthenia Chemicorum
Neurasthenia Gravis
Post-viral Neurasthenia
Pulsating Neurasthenia
(c) 2002 by ALBERT DONNAY
42 Focus on Psychiatry or Behaviour
1765 Nervous, Hypochondriac
or Hysteric
1766 Hypochondriasis,
aka Hyp or Hypo
1859 Briquet’s Syndrome
1871 Hebephrenia
1895 Anxiety Neurosis >28K
1904 Phrenasthenia
1906 Psychasthenia
1912 Autism >6K
1914 Shell Shock Syndrome
1916 Battle Fatigue Syndrome
1918 War Neurosis
1930 Generalized Anxiety>1.5K
1938
1944
1947
1951
1957
1957
1965
1965
1966
1966
1966
1967
1968
Suburban Neurosis
Asperger’s Syndrome
Old Sergeant Syndrome
Munchausen’s Syn >1K
Psychogenic Dyspnea
and Hyperventilation
Traumatic Neurosis
Asthenic Neurosis
Psychogenic Pain Syn
Psychovegetative Syn
Accident neurosis
Hyperactive Child Syn
Post Accident Anxiety Syn
Chronic Factitious Illness
(c) 2002 by ALBERT DONNAY
Psychiatry or Behaviour continued …
1968
1968
1973
1973
1974
1977
1978
1978
1980
Pseudo Combat Fatigue
Hyperkinetic Behavior Syn
Ecologic Mental Illness
Psychalgia
Epidemic or Mass Hysteria
Pinocchio Syndrome
Mass Psychogenic Illness
Psychic Possession
Post Traumatic Stress
Disorder >6.5K (count
incl. Traumatic Neurosis)
1981 Attention Deficit Disorder,
aka ADD
1981 Pervasive Developmental
Disorder >7K
1981 Somatization Dis. >7K
1988 Attention Deficit
Hyperactivity Disorder,
aka ADHD, >6K (count
includes ADD & HCS)
1995 Environmental
Somatization Syndrome
1996 Iatrogenic
Hypochondriasis
1996 Idiopathic Environmental
Intolerances (not WHO)
1999 Functional Somatic
Syndromes
(c) 2002 by ALBERT DONNAY
28 Focus on Infection, Trauma, Fatigue or Pain
1857 Remittent Fever,
aka Crimea Fever
1866 Railway Spine
1871 Irritable Heart,
aka DaCosta’s Syndrome
1887 Undulating Fever,
aka Malta Fever
aka Mediterranean Fever
1904 Fibrositis
1934 Chronic Brucellosis
1936 Morbid Industrial Fatigue
1938 Neurocirculatory
Asthenia,
aka Effort Syndrome
1941 Chronic Fatigue
1950 Epidemic Neuromyasthenia
aka Icelandic Disease,
aka Akureyri Fever
1956 Encephalomyelitis
simulating Poliomyelitis,
aka Royal Free Hospital
1956 Benign ME, aka Myalgic
Encephalomyelitis <100
1957 Epidemic Postinfectious
Neuromyasthenia
1958 Irritable Colon Syn
1959 Irritable Bowel Syn >3.5K
(c) 2002 by ALBERT DONNAY
And Not Just Described By Doctors -First Reported in USA by Edgar Allan Poe
 1832: 1st
Report of Symptoms in Loss of Breath
 1838: Most Detailed Symptoms in Fall of House of Usher
 1839: 1st Report of Facial Sign in The Man Who Was Used Up
 1840: 1st Report of Cause in Philosophy of Furniture
 1843: 1st Report of Medical Debate in The Tell Tale Heart
“Now have I not told you that what you mistake for madness
is but overacuteness of the senses?”
 1844: 1st Report of Successful Therapy in Premature Burial
 1849: Dies as he predicted of “Congestion of the Brain”
(c) 2002 by ALBERT DONNAY
But Only Charles Baudelaire Recognized
Gas Lighting as the Cause of Poe’s Symptoms
 "All
the documents I have read led me to the conviction that
for Poe the United States was nothing more than a vast prison
which he traversed with the feverish agitation
of a being made to breathe a sweeter air
--nothing more than a great gas lighted nightmare—
and that his inner, spiritual life, as a poet or even as a drunkard,
was nothing but a perpetual effort to escape the influence
of this unfriendly atmosphere."
 Gas made from coal contained 5 % - 50 % carbon monoxide (CO)
 CO exposure limits today= 0.0009 % outdoors, 0.005% occupational
(c) 2002 by ALBERT DONNAY
“Do you know why I so patiently translated Poe?
It was because he was like me.”
REVERSE IMAGE
EDGAR ALLAN POE
TRUE IMAGE
CHARLES BAUDELAIRE
“And there
was
perceptible
about them,
ever and anon,
just that
amount of
interesting
obliquity…”
EA Poe, 1839
(c) 2002 by ALBERT DONNAY
Many Great English Writers
Also Apparently Poisoned by Carbon Monoxide
George Bernard Shaw
Oscar Wilde
(c) 2002 by ALBERT DONNAY
Of Course, Not Just Men and Not Just Then
Jane Austen
J.K. Rowling
(c) 2002 by ALBERT DONNAY
Tell Tale Face Noted in “Certain Nervous Disorders”
Even Before Introduction of Gas Lighting
“Her left eyelid
remained permanently
half closed and
the right angle
of her mouth
was considerably
drawn aside.”
Edward Percival, 1813
(c) 2002 by ALBERT DONNAY
England’s Most Famous Unrecognized Case ?
King George III
1738 – 1820
Presumed now to have
inherited porphyria:
gas poisoning was never
considered since his
illness began decades
before gas lighting.
(c) 2002 by ALBERT DONNAY
Most Likely Cause
Prior to Gas Lighting
Coal bed warmer on display
in bedroom of his grandmother
Queen Caroline, Hampton Court
(c) 2002 by ALBERT DONNAY
CO Role in “MCS etc” Not Yet Widely Recognized:
Excluding Literature on Chronic CO Poisoning,
CO is mentioned in only 11 of 90,000 other articles
Fibromyalgia Syndrome
Chronic Fatigue Syndrome
Generalized Anxiety
MCS / MUSES Syndrome
Post Traumatic Stress Disorder
Somatization Disorder
2 (both note “not CO”)
2 (1 notes “from CO”
the other “not CO”)
1 (notes “not CO”)
1 (notes “from CO”)
2 (both note “not CO”)
3 (all 3 note “not CO”)
Even most MCS patients fail to recognize the connection,
perhaps because CO is odourless, tasteless and invisible.
(c) 2002 by ALBERT DONNAY
First & Only Paper Proposing Connections
Between MCS, CO and Poe
Donnay, A.
International Journal
of Toxicology
1999;18(6):383-392
“On the recognition
of multiple chemical
sensitivity in medical
literature and
government policy.”
But CO is Well Known as “The Great Imitator” and
Already Well Documented to Cause or Worsen:
 Anemia
 Depression
 Angina
 Diabetes
 Anosmia (loss of
 Asthma
 Birth Defects
 Blindness
 Deafness
smell)
 Hallucinations of
all kinds
 Heart
Disease
 Mental Retardation
 Parkinson’s
 Psychoses
(c) 2002 by ALBERT DONNAY
Why So Many Syndromes? CO is Both
Ubiquitous Neurotoxin & Ubiquitous Neurotransmitter
 CO
is #1 Cause of Unintentional Toxic Deaths in USA
 CO is #1 Cause of Unintentional Toxic Poisonings
 CO is #1 Air Pollutant: more tons/year than any other,
primarily from industry, vehicles, fires, combustion appliances
 CO is also made systemically by all mammals from heme
breakdown by Heme Oxygenase, the Universal Stress Enzyme.
 HO-1 is greatly induced by exposure to any type of stress :
heat, bright light, noise, odors, drugs, alcohol and other
chemicals, trauma, infection, electro magnetic fields, etc.
 CO is not just bound to Hb but bioactive in over 90 pathways
(c) 2002 by ALBERT DONNAY
Increased endogenous production of CO
from heme breakdown is documented in:
Allergy
Diabetes
Altitude Sickness
Heart Attack
Alzheimer’s
Heat
Anemia
Asthma
Bronchiectasis
Cystic Fibrosis
Stress / Stroke
Methylene Chloride Poisoning
Parkinson’s
Pre-Menstrual Syndrome
Upper Respiratory Tract Infections
(c) 2002 by ALBERT DONNAY
All CO-Related Disorders Share Biomarker:
Elevated Level of CO in End-Tidal Breath
 Normal
bCO (maximum after holding breath 20 to 25 seconds)
Healthy Relaxed Non-Smokers
= 0-2 ppm
 Mildly Elevated bCO
Borderline Abnormal for Non-Smokers
= 3-4 ppm
 Moderately Elevated bCO
Smokers and People with CO Disorders = 5-24 ppm
 Highly Elevated bCO
Recently Smoked or CO Poisoned
= 25-999+ppm
All healthy adults have approx. noon peak and midnight trough
Higher after suppl. oxygen & if standing vs. sitting vs. supine.
(c) 2002 by ALBERT DONNAY
How CO Causes MUSES Syndrome
 CO
controls sensitization and habituation to stressors of all kinds
 Chronic repeated exposures to any stressor induces habituation,
so that higher doses are tolerated with less or no sensory awareness.
 Isolated acute exposures (and de-habituation) induce sensitization,
so that lower doses are less tolerated with more sensory awareness.
 While exogenous stressors (heat, drugs, alcohol) may be avoided,
endogenous CO produced by HO in response to ANY stressor cannot.
 So if/once sensitized to CO via exogenous poisoning or dehabituation,
increased sensory awareness may be provoked by ANY stressor
 Result is multi-sensory sensitivity to odours, lights, sounds, foods, etc
aka MUSES Syndrome (aka MCS in adults or autism in children).
(c) 2002 by ALBERT DONNAY
Curing MUSES Syndrome: The Treatments
Proposed by Cheyne and Poe are Still Best
 Dr.
George Cheyne in The English Malady, 1733:
“Seldom any lasting or solid cure is perform’d … till they have sucked in
and incorporated the sweet balmy clear Air of the Country.
… Diet will do infinitely more than Exercise and have more lasting Effects,
but both should be joined.
… Certainly the best of all is where Amusement or Entertainment of the
Mind is joined with Bodily Labour and Constant Change of Air.”
 Edgar Allan
Poe in The Premature Burial, 1844:
“I took vigorous exercise. I breathed the free air of Heaven.
I thought upon other subjects than Death. I discarded my medical books.”
(c) 2002 by ALBERT DONNAY
Where to Look for Evidence of CO Poisoning Today
• Test CO in end tidal breath after holding breath for 20 seconds
(healthy relaxed non-smoker should be 0 to 2 ppm).
• Monitor indoor CO levels with a digital detector near combustion
appliances, especially unvented ones like gas ovens and gas logs.
• Monitor CO levels in homes with attached garages after vehicles
are started and driven out.
• Monitor CO levels in motor vehicles while idling and driving.
• Look for the asymetrically drooping eye and mouth that mark the
Tell Tale Face of CO Poisoning and ask about any multi-sensory
sensitivity to lights, odors, noises, tastes, touch and heat or cold.
(c) 2002 by ALBERT DONNAY