Is it the building, the occupant, or
both? Using the QEESI© to
investigate indoor air concerns.
June 7, 2011
Indoor Air 2011
Tatjana Walker, RD, MPH; Thomas J. Prihoda, PhD;
Claudia S. Miller, M.D., M.S.
University of Texas School of Medicine at San Antonio
Chemical Intolerance
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About 5% of people report multiple chemical
intolerances
“Do you consider yourself sensitive to
everyday chemicals like those in household
cleaning supplies, paints, perfumes, soaps,
garden sprays, or things like that?” (15%)
A New Theory of Disease—
Toxicant-Induced
Loss of Tolerance or “TILT”
Evidence That We Are Dealing
With a New Disease Mechanism
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Similar reports from more than a dozen countries—
different languages, media
YET they report similar new onset intolerances to
structurally unrelated substances (foods, medications,
alcoholic beverages, caffeine) and symptoms affecting
multiple organ systems in response to these.
This is what Kuhn called a “compelling anomaly”—
observations that do not fit known theories of disease
Compelling anomalies drive the search for new
explanations, paradigms, theories
Common Indoor Conditions
Linked to TILT (Stage 1)
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Remodeling—new carpets, glues, cleaners,
and other VOC emitters
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Pesticides
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Mold
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Insufficient fresh make-up air
Solvents
Indoor Air Volatile Organic
Compounds (VOCs)
New carpet
Plasticizers
Formaldehyde
Fragrances
Mold VOCs
Glues
Paints
Gasoline
Nail polish/remover
Drugs/Medical Devices
Vaccines
Anesthetics
Implants
Antibiotics
Chemotherapy
TOXICANT-INDUCED
LOSS OF
TOLERANCE
?
Combustion-related Products
Engine exhaust
Tobacco smoke
Oil well fire smoke
Natural gas
Tar/asphalt
Cleaning Agents
Pesticides
Organophosphates
Carbamates, pyridostigmine
Pentachlorophenol
Pyrethrins
Phenolic disinfectants
Ammonia
Bleach
Neuropsychological
Ear, Nose and Throat
sinusitis
polyps
tinnitus
recurrent otitis
Attention Deficit Hyperactivity
Disorder (ADHD)
depression
bipolar disorder
panic disorder
migraines and other headaches
seizures
autism
Cardiovascular
arrhythmias
hypertension
hypotension
Raynaud's phenomenon
Miscellaneous Syndromes
Chronic Fatigue Syndrome
implant syndromes
''Gulf War Syndrome“
Post/other disaster
syndromes
TOXICANT-INDUCED
LOSS OF
TOLERANCE
?
Respiratory
asthma
Reactive Airways Dysfunction
Syndrome (RADS)
toluene dlisocyanate
(TDI) hypersensitivity
Skin
eczema
hives
other rashes,
eruptions
Gastrointestinal
Connective Tissue/Musculoskeletal
fibromyalgia
carpal tunnel syndrome
temporomandibular joint
dysfunction (TMJ) syndrome
arthritis
lupus and other auto-immune diseases
irritable bowel
reflux
Identifying Toxicant-Induced
Loss of Tolerance (TILT)?
The QEESI
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Validated, published questionnaire and
screening tool
50 questions, self-administered
12-15 minutes to administer
Research, clinical, building investigations
Helps occupants understand their symptoms
and intolerances
Available for download at:
QEESI Symptom Star
Pre- and Post-Exposure
Before exposure event
Since exposure event
QEESI Symptom Stars
for 4 People in Sick Buildings
Courtesy of Carl E. Grimes
How Can You Use This Information
Without “Practicing Medicine”?
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Provide link to QEESI for occupants to self-administer
Invite affected occupants to take the results to their
doctors
Some occupants will share the results with you, but
don’t ask them to
In either case, those affected will self-identify and will
begin to understand that they may be especially
susceptible
These are the people who need accommodation
Look for physicians you can work with—QEESI will
help them understand too
Tatjana Walker, RD, MPH
University of Texas School of Medicine at San Antonio
walkert2@uthscsa.edu
The QEESI is Available for Download at: