MCS is one of the least understood co-morbidities associated with FM. MCS previously has been termed toxic injury, chemical injury syndrome, twentieth century syndrome, sick building syndrome, idiopathic environmental intolerance, and toxic-induced loss of tolerance. Due to alterations in the central nervous system, all people diagnosed with FM are more sensitive to light, noise, smell, and pain. MCS, however, is a more pronounced, debilitating chronic sensitivity to low levels of chemicals or other substances in industrialized society. The most common offenders include smoke, pesticides, plastics, synthetics, petroleum products, and paints. Symptoms are multisystem and can include runny nose, itchy eyes, scratchy throat and scalp, headaches or earaches, sleep disturbance, GI symptoms, cognitive dysfunction, difficulty breathing, and skin rash. A cause for suspicion of MCS occurs when an individual is exposed to a sensitizing agent and improves or resolves completely when the triggering chemicals are removed. The clinician will then diagnose MCS based on history and physical exam. It is important to rule out illnesses with similar symptoms such as panic disorder, dysautonomia, allergies, and thyroid dysfunction. Treatments include eliminating all offending substances from the surrounding environment. This often takes years, since the following are often found to be the offending agent or agents: food dyes, petroleum products, smoke, agricultural chemicals, cleaning fluids, volatile organic compounds, glues, paints, bleach, fabric softeners, laundry detergents, perfumes, air fresheners, scented candles, hair-care products, and even highlighter markers. Fortunately, there is no evidence of a long-term buildup of toxic chemicals in the body or an increased early mortality associated with MCS. No medications have been consistently demonstrated to be effective for most people with MCS.
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