Clinical ecology syndrome T78.4

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 28.09.2022

Synonym(s)

20th century disease; clinical ecology syndrome; Clinical Ecology Syndrome; Ecology syndrome clinical; Eco-syndrome; Eko Syndrome; Multiple chemical sensitivies syndrome; Total Allergy Syndrome

Definition
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Polysymptomatic complaint complex with allergy suspected by the patient or increased sensitivity to environmental substances, especially chemicals (see formaldehyde below). The triggers are suspected in the air, in water and in medicines. Routine allergy tests are negative for this clinical picture. The pathogenesis is to be understood as a complex interaction of psychogenic factors (see below somatoform disorders) mixed with atopic reactions.

Etiopathogenesis
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Behind the label "eco-syndrome" there can be hidden different diseases: allergies and pseudoallergies, but also hormonal disorders, autoimmune diseases or psychological or psychosomatic disorders. An interdisciplinary diagnosis is therefore absolutely necessary for this unspecific symptomatology.

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Clinical features
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Headaches, concentration disorders, nervousness, insomnia and fatigue.

According to Cullen, one speaks of ecosyndrome when the patient complains of symptoms that are triggered by detectable exposure to pollutants, affect more than one organ system, occur with predictable stimuli, are triggered by a wide variety of chemicals even at low concentrations, and cannot be detected by the usual organ function tests.

General therapy
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Therapeutically, a subtle allergological clarification is necessary to exclude relevant allergies, also by means of provocation testing, as well as further interdisciplinary psychiatric and allergological care.

Behavioral therapy: this includes desensitization through stimulus confrontation in combination with relaxation techniques, biofeedback, development of alternative behavior and cognitive restructuring.

Literature
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Bell IR et al (2001) Sensitization studies in chemically intolerant individuals: implications for individual difference research. Ann N Y Acad Sci 933: 38-47
Black DW et al (2001) The Iowa follow-up of chemically sensitive persons. Ann N Y Acad Sci 933: 48-56
Bornschein S et al (2002) Psychiatric aspects of multiple chemical sensitivity (MCS). Insurance medicine 54: 163-167
Caress SM et al (2002) Symptomatology and etiology of multiple chemical sensitivities in the southeastern United States. Arch Environ Health 57: 429-436
Haumann K et al (2003) Breathing and heart rate during experimental solvent exposure of young adults with self-reported multiple chemical sensitivity (sMCS). Neurotoxicology 24: 179-186
Eberlein-Konig B et al (2002) Multiple chemical sensitivity (MCS) and others: allergological, environmental and psychological investigations in individuals with indoor air related complaints. Int J Hyg Environ Health 205: 213-220
Ring J et al (1991) Clinical ecology syndrome (Eko syndrome) Psychology or allergy? In: Ring J, Przybilla B (ed.) New Trends in Allergy III Springer Verlag, S. 500-516
Schafer ML et al (2002) On the history of the concept neurasthenia and its modern variants chronic-fatigue-syndrome, fibromyalgia and multiple chemical sensitivities. Progress Neurol Psychiatrist 70: 570-582
Wiesmuller GA et al (2003) Are syndromes in environmental medicine variants of somatoform disorders? Med Hypotheses 61: 419-430