Environmental sensitivities (ES) describes a chronic condition whereby a person has symptoms when exposed to certain chemicals or other environmental agents at low levels tolerated by most people. The symptoms may range in severity from mild to debilitating.
ES has also been called multiple chemical sensitivity, chemical intolerance, environmental hypersensitivity, environmental illness, toxicant-induced loss of tolerance, and idiopathic environmental intolerance.
Approximately three percent of Canadians have been diagnosed with ES. It affects men, women and children of all ages, but the prevalence increases with age, and 60 to 80 percent of those diagnosed are women.
Last winter, Caroline and her husband renovated their home, installing new carpet, painting the walls, and varnishing the woodwork. They didn’t open the windows much as they didn’t want to waste energy. During the renovations, Caroline became ill with flu-like symptoms, headache and nausea. After the renovations were completed, she continued to feel tired all the time, and to experience headaches, nausea, and occasional joint and muscle pain.
A few weeks later, Caroline noticed she had a stronger sense of smell than others, and that her symptoms were worse whenever she smelled perfumes, odours from cleaning products and their new furniture. She also began to feel dull, groggy and “spacey” when she came into contact with these products.
She stopped using scented cleaning and personal care products at home. However, it became more difficult for her at work, as others in her office wore perfumes. She developed headaches, had difficulty concentrating and often had to leave her workspace to feel better. Her symptoms would improve once she stepped outside for at least 20 minutes. However, her boss started to complain about her frequent breaks and Caroline felt increasingly stressed, as she was now also worried about losing her job.
She sought help from her family doctor, who referred her to several specialists over the course of many months: a neurologist, a gastroenterologist and a rheumatologist. Each doctor noted a few abnormal results from her physical and laboratory tests, but none could diagnose the problem. One doctor wondered if it might be “her nerves.” Caroline was finding it more and more difficult to cope, was getting more and more frustrated with the lack of progress in addressing her health problem, and began to feel depressed.
People with environmental sensitivities (ES) often visit several doctors before being diagnosed with the condition.
There is no one test used to diagnose ES. Your doctor will start by taking a detailed medical and environmental history. You will be asked about environmental exposures in your community, your home, at work or school. You will also be asked about your hobbies, personal habits, diet and the medications you take. Your doctor will try to identify environmental exposures that may be triggering your symptoms.
She or he will do a careful physical exam and may order some tests. One of the challenges in diagnosing ES is that there are no consistently abnormal findings from physical exams or consistently abnormal results from lab tests. Your doctor will also want to rule out other conditions that could explain the signs and symptoms you are experiencing.
Your doctor will make sure that your symptoms meet the following diagnostic criteria:
- The symptoms are reproducible with repeated chemical exposure.
- The condition is chronic.
- Low levels of exposure (lower than previously or commonly tolerated) result in manifestations of the syndrome.
- The symptoms improve or resolve when the environmental factors that provoke the symptoms are removed.
- Responses occur to multiple substances that are chemically unrelated.
- Symptoms involve multiple organ systems.
Patients with ES are more likely to:
- feel dull or groggy
- have difficulty concentrating
- feel ‘spacey’
- have a heightened sense of smell
If you suspect that you have ES and are unable to find a doctor who has specific knowledge of this condition, try looking for a doctor who has a holistic approach, one who understands how ES can affect many areas of your life. A doctor who is aware of the connections between your environment and your health can help you make changes at home and at work, to avoid symptom-triggering exposures, and thereby improve your quality of life.
Your doctor may also suggest that you limit your exposure to other known environmental contaminants, to enable your body’s defense mechanisms to work better.
There is no specific exercise regimen for those with environmental sensitivities (ES); however, regular physical activity has several health benefits for people with ES. Cardiovascular exercise can increase your energy, and help your heart, lungs and circulatory system stay healthy. Healthy circulation may help your body’s natural detoxification systems to work more effectively, and get rid of toxins. Flexibility or stretching exercises help relax your muscles and keep your joints mobile. Strengthening exercises help strengthen your bones and muscles.
Canada’s Physical Activity Guide to Healthy Living recommends engaging in moderate activity, such as brisk walking, for at least 30 minutes four times a week, as well as regular stretching and strengthening exercises.
If you are unable to go outside because of high pollution levels, put on a favourite CD and dance or exercise to the music at home. There are also many exercise DVDs available.
If you also experience symptoms of fibromyalgia or chronic fatigue syndrome/myalgic encephalomyelitis, such as pain, fatigue or both, you will need to start slowly. Start doing as little as five minutes of light activity daily and increase by 10 percent weekly, or as tolerated without “crashing” (becoming incapacitated with a prolonged recovery time of more than 24 hours). Aim to gradually build up to doing 30 minutes of moderate activity four times a week or more.
Living with a chronic condition like environmental sensitivities can be stressful. Relaxation exercises can decrease your stress and help you sleep better. They may even help to relieve your symptoms, as our minds and bodies are intricately connected.
Relaxation can be accomplished in different ways: deep breathing exercises, meditation, visualization techniques, progressive relaxation and biofeedback. As little as 20 minutes of relaxation a day can have health benefits, including reduced anxiety and an increased sense of well-being.
Below is an example of an easy exercise to promote relaxation:
- Choose a place in your house that will be your “relaxation space,” preferably a place where you can close the door and be alone, uninterrupted, for at least 10 minutes at a time. You may need to let your family know that this is a time when you want to be left alone.
- Sit in a comfortable chair and close your eyes. Take a few breaths to settle in and still your mind. Tell yourself that this is your time. When you feel settled, as you breathe in through your nose, say “re” silently to yourself, and “lax” as you exhale through your mouth. Gradually increase the length of your inhale and exhale.
- Ideally, you would do this for about 10 minutes twice a day. However, this exercise can be done at any time of day, for a few minutes, whenever you first recognize your particular symptoms of stress. For example, if you are working and start to feel a headache or a stiff neck, take a couple of minutes to do this breathing exercise before you continue with your work.
If you find that these strategies do not work for you, your family physician may suggest trying non-prescription sleep aids, such as chamomile tea, warm milk, valerian or over-the-counter medications that cause drowsiness as a side effect, for example, diphenhydramine HCl (Benadryl), certain antihistamines and dimenhydrinate (Gravol), an anti-nauseant.
Discuss with your doctor any over-the-counter or natural remedy that you are considering, before trying it, to make sure that it is compatible with other treatments being used and that it is safe for you. Also, just because a product is labelled “natural” doesn’t mean that it is safe.
If these strategies are still insufficient, your doctor may prescribe medications, such as a muscle relaxant or pain reliever, or a low dose of a tricyclic medication. Tricyclics are used in higher doses as antidepressants, but are also used in low doses as sleep aids and pain relievers.
If you are suffering from environmental sensitivities, it is important that you get enough rest, relaxation and good-quality sleep. Keeping your bedroom as free as possible from substances that trigger your symptoms will likely improve your sleep. You may also want to try the following:
- Go to bed at the same time every night and get up at the same time in the morning.
- Do not wait until you’re exhausted before going to bed.
- Avoid being very hungry or very full at bedtime.
- Avoid caffeine, alcohol and nicotine, as they can impair sleep.
- Do quiet, relaxing activities before bedtime, such as taking a warm bath with ½ cup Epsom salts or listening to relaxing music.
- Make the bedroom a “worry-free zone.” Use your bed for sleeping and sex only, not eating or watching TV.
- Keep the room dark and quiet while sleeping. Use earplugs and an eye mask if necessary.
- You may benefit from having a low-noise air purifier in your bedroom.
It is important to eat a nutritious, well-balanced diet, while minimizing your exposure to chemicals added to foods, such as pesticides, artificial flavours, colourings and preservatives.
If possible, eat organic foods. This includes meat and dairy products as well as fruits and vegetables. Organic crops use no chemical pesticides or weed killers, no synthetic fertilizers and no seeds that originate from GMOs (genetically modified organisms). Organic meats contain no antibiotics or growth hormones and come from animals that were given organic feed and provided with adequate moving space, sunlight and fresh air. Processed foods that are marked organic contain no chemical dyes, artificial flavours, synthetic additives or preservatives.
If you cannot find or afford organic foods, try the following:
- Avoid protein foods most likely to be contaminated (with PCBs, dioxins, mercury), such as organ meats and the following fish
- Eat low on the food chain – more fruits, vegetables and grains, and less meat and dairy.
- Eat lean meat and low-fat dairy products. Pesticides, hormones, drugs and other additives are often concentrated in the fat of animals.
- Eat as wide a variety of foods as possible. The more kinds of food that you eat, the less likely you are to be exposed to any one contaminant.
- Eat at least five to 10 servings of vegetables and fruit daily.
- Wash all produce well under running water and use a scrub brush when possible. Take extra care when washing fruits and vegetables grown in tropical countries, as they may have higher levels of pesticide residue.
- Peel fruits and vegetables when possible, for example, squash, carrots, potatoes, bananas, apricots, apples and pears. Remove the outer leaves of lettuce and cabbage.
- Avoid or limit your intake of produce known to be the most heavily sprayed, or produce that doesn’t peel well
- Increase your intake of antioxidants (found in fruits and vegetables, nuts, grains, and some meats and fish). Foods especially rich in antioxidants include dried beans, blueberries, cranberries, broccoli, artichokes, apples, cherries, plums, cooked Russet potatoes, pecans and walnuts.
- Avoid or minimize your intake of caffeine, alcohol, artificial food colourings and additives.
- Read the labels on packaged, frozen and canned foods, and choose foods with the fewest additives (for example, artificial colours and flavours, such as MSG; preservatives, such as sulfites, BHA and BHT; and artificial sweeteners).
- Drink six to eight glasses of filtered or spring water daily.
- Microwave and store food and water in glass or ceramic containers, not plastic.
- Talk with your doctor or a dietitian, who can help you eliminate a suspected food (or family of foods) completely for a specified period (usually four to seven days), before reintroducing it, to see if it triggers symptoms. (Important note: This “elimination and re-ingestion test” must not be done if you have ever had any life-threatening reaction to a food.)
- Take a multivitamin/mineral supplement daily (without iron if you are post-menopausal).
The best thing you can do to manage your environmental sensitivities is to minimize your exposure to known triggers and to substances that could potentially be harmful. Do this work slowly, in stages, and, if possible, ask family or friends to help.
Thoroughly inspect your home, one room at a time. Start with the things you know trigger symptoms and are the easiest and least expensive to change. Here are some suggestions for making your home more environmentally safe:
Keep dust to a minimum:
- Consider wearing a mask when cleaning, to filter out dust particles.
- Dust with a damp cloth.
- Decrease the number of “dust collectors” in your home by removing knick-knacks, decorative pillows and stuffed animals.
- Reduce clutter, particularly paper and books, which collect dust. Keep papers in a desk and books in a cabinet with glass doors, if possible.
- If you do not have a central vacuum cleaner that vents outside, use a high efficiency particulate arresting (HEPA) vacuum cleaner, if possible.
Prevent mould growth:
- Repair any water leaks promptly (it takes less than 48 hours for mould to grow on wet materials).
- Reduce the humidity in your house to 30 to 50 percent to prevent mould growth. You can measure the humidity in various rooms in your home with a hygrometer from the hardware store. Use a fan or a dehumidifier if needed.
- Get rid of any mouldy items.
- Do not store items in cardboard boxes – use moisture-proof storage containers.
- Decrease the number of plants in your home as mould spores are released into your indoor air from the soil.
Reduce your exposure to volatile organic compounds (VOCs) in cleaning, laundry and personal care products:
- Make your own non-toxic cleaning products from items such as baking soda, vinegar and pure soap or buy cleaning products labelled “non-toxic” that do not have warning logos and contain no perfumes or dyes.
- Avoid using “air fresheners” or “air care” products, which do not remove odours, but merely mask them by adding potentially harmful VOCs to your indoor air.
- Air out new items and clothing before using them.
- Avoid dry cleaning, or at least air out dry-cleaned clothes before returning them to closets.
- Avoid using perfumes, laundry detergents, fabric softeners and chlorine bleach.
- Use unscented deodorant, lotion, shampoo, aftershave and other personal care products.
- Avoid wearing perfume or cologne, and ask family and friends to avoid wearing perfumed products around you.
Avoid pesticides and herbicides:
- Avoid pesticides and herbicides, both indoors and outdoors. Use baits and traps instead, and seal points where pests could potentially enter your home.
- If possible, eat organic foods.
Choose flooring, furnishings and renovation materials carefully:
- Consider replacing wall-to-wall carpets with hard surface flooring. If you want some kind of rug or carpet on top, use washable area rugs.
- Choose new furnishings that don’t have a strong odour. Be aware that pressed wood and particle or chipboard in furniture emits formaldehyde over a prolonged period. Formaldehyde is a known irritant, allergen and carcinogen.
- Use low-VOC, water-based paints.
- Contain renovation areas, and ventilate them well after completing the renovations and before returning to the space.
- Consider purchasing an air purifier with a HEPA filter and activated carbon to filter out both particulates and some VOCs.
Create an oasis
Ideally, you will want to eliminate pollutants from your entire home. But if this is not possible, create an “oasis” – one room in your home that is free from as many problem items as possible. Many people choose to make their bedroom an oasis, as this is the room where they spend the most time.
To turn your bedroom into an oasis, follow these steps:
- Empty the room completely.
- Clean the walls, floors and windows using non-toxic products.
- Wash the drapes, pillows, sheets, bed covers and throw rugs in hot water to kill dust mites. If these items are made from synthetic materials that bother you, replace them with products made from natural, untreated fibres (like cotton, linen, silk or wool).
- Wash your sheets and pillowcases in hot water regularly (at least once a week).
- Replace old pillows that cannot be washed in hot water, and cover new pillows with mite-proof cotton protectors. If you are sensitive to synthetic foam or feather pillows, try pillows filled with organic cotton, buckwheat, kapok or even cotton towels.
- Cover your mattress and box spring with cotton covers that dust mites cannot penetrate, and wash the covers in hot water as often as possible.
- Return to the room only the items that you can tolerate. Ask yourself: Does the item smell? Has it been painted recently? Has it been treated with chemicals, such as synthetic fragrances, waterproofing or mothballs? If the answer to any of these questions is yes, you may want to get rid of the item.
- Solid wood or metal furnishings are generally better tolerated than those made from fibreboard or chipboard, which off-gas formaldehyde.
- As new carpets can off-gas VOCs, and old carpets can retain dirt, dander, bacteria, mould and mites, consider not having carpet in the room. If desired, scatter rugs made from natural fibres that can be washed frequently, could be used.
- Keep toys, knick-knacks, books and magazines out of the room, as they collect dust.
- Keep the bedroom door closed during the day, and free from dry-cleaned goods, frequently worn shoes, sports equipment and dirty laundry.
- Clean the room regularly and thoroughly. Wear a mask while cleaning, to avoid inhaling dust.
- Keep pets out of the room.
- Keep the bedroom door open when sleeping, to prevent the build-up of carbon dioxide.
It may be more difficult to make changes within your workplace than at home. The types of exposures you encounter at work will depend upon the industry you work in and the type of work you do. The risk of being exposed to chemicals and other toxins is higher in some industries than others. These include:
- Dry cleaning
- Manufacturing (plastic products, textiles, fabricated metals, transport equipment, clothing, furniture and others)
- Printing and publishing
- Hotel industry
- Pest control
Other occupations that may not appear to put people at risk can also expose workers to environmental contaminants. For example, some teachers are exposed to mould in older, poorly maintained schools and portable classrooms, and many are also regularly exposed to chalk dust, markers and art supplies. Hairdressers are exposed to a number of VOCs and heavy metals in hair dyes, perm solutions and other treatments. Many office workers spend the day in poorly ventilated buildings. Several items commonly found in offices can contribute to poor indoor air quality, including:
- Photocopiers, which emit VOCs, particulates and ozone
- Liquid paper, glues, carbonless paper, toners for photocopy and fax machines
- Computers, which emit electromagnetic radiation, and may release ozone and VOCs
- Carpets, which can collect dust, mould, bacteria, pesticides and dirt
- Desks, partitions and other furniture made from particle-board, which off-gas formaldehyde and other VOCs
- Cleaning products that have warning logos or contain fragrances
- Perfumes and other scented personal care products on employees
If you are experiencing symptoms you think are related to environmental exposures at work, talk with your supervisor. In Canada, employers have a legal duty to accommodate people with disabilities, including people with ES. Employers have a duty to take every step available to them, to the point of “undue hardship,” to remove any discriminatory barriers and ensure that all their programs and activities are inclusive of the needs of a diverse workforce. Accommodations are your legal right. Accommodations for people with ES may make the work environment healthier for everyone who works in it.
Here are some examples of accommodations:
- purchasing a portable HEPA and charcoal-containing air filter
- providing a workstation that is near a window that opens and away from off-gassing equipment, such as the photocopier
- developing and enforcing a scent-free policy
- allowing employees to work from home when possible
- avoiding the spraying of chemicals or, if necessary, informing workers beforehand so that they can stay away during the spraying and for a period afterwards
Remove Yourself from the Problem
Sometimes it is not so easy to change your immediate environment, for example, at the mall where you shop or in your workplace. In these cases, it is best to get out of the building or room in which your symptoms are being triggered, as quickly as possible, leave the area and “get some air.”
If problems persist in an environment that you need to enter regularly (for example, your workplace, school or place of worship), you may need to work with others to improve the environment or make special accommodations.
As you “clean up” your environment and adopt healthier habits, your symptoms may be triggered less frequently. Your tolerance for problematic substances may gradually improve, although you may go through a period of a few weeks or months where symptoms, whenever they are triggered, are more noticeable. Although your tolerance may gradually improve, unfortunately, it probably won’t return to what it was, and you will likely remain more sensitive than others to these substances.
Canadian law prohibits discrimination against people with ES and other disabilities and requires that they be accommodated. As environmental illnesses become more widely recognized, there are more and more laws and policies that protect people from environmental contaminants, such as no-smoking laws, pesticide bans, policies that prohibit perfumes and reduced use of toxic chemicals.
Living with a chronic illness can make you feel fearful, angry, frustrated, down and even depressed. Living with environmental sensitivities (ES) can also make you feel like your life has been “turned upside down,” especially if you have lost your ability to work, can no longer socialize outside your home or perform routine tasks, like grocery shopping, due to triggering agents in the environment. Developing coping strategies and getting the emotional support you need and deserve will not only help lift your spirits but should help promote your physical well-being as well.
When you first develop ES, you may feel out of control, particularly if you aren’t sure what substances are triggering your symptoms. Consider keeping a diary in which you keep track of your activities and note your symptoms in relation to your exposure to various substances. This will help you determine which substances you need to avoid. It will help you make changes at home, at work, to your diet, etc., and will help you regain a sense of control.
If there are many things you need to change, it can seem overwhelming. Try to set priorities and realistic timeframes for making changes. If there are people around you who are willing to help, this will also help make the tasks seem less daunting.
Listening to Your Body
Think of your symptoms as early warning signals that let you know when your body is being overburdened by substances around you. If you can remove yourself from the triggering agents when the symptoms start, and stop and rest, you may be able to avoid developing further symptoms.
Isolation is often one of the most difficult aspects of having a chronic illness like ES. Your friends, family and colleagues may not understand what you are going through. Your sense of isolation may be compounded by health professionals who do not see your illness as “real” and may not be supportive because there are no consistently abnormal objective physical findings or laboratory tests that “prove” you have a “real” disease. Developing skills to deal with the reactions of others is also a crucial part of coping with ES.
The first step in helping others to understand your condition is to educate yourself, and then educate them. Explain how you’re feeling and be clear about what your limits are – what you can and can’t do at this time.
Many people find that joining a support group, to connect with others who have ES, is helpful. Building a group or community of people who understand and care can be energy well spent: a support group can provide you with emotional and moral support as well as useful information. If you cannot leave your home or find a tolerable space to meet, you may want to network with supportive others over the phone or online.
You can also join the Environmental Sensitivities, CFS, Fibromyalgia discussion group on this website.
When socializing, you may wish to have family and friends come to your home, rather than going to their homes, as it is easier to control your own environment. Ask visitors, in advance, not to wear scented personal care products, freshly dry-cleaned clothes or clothes freshly laundered with scented detergent or fabric softener.
If you have severe symptoms, when you do go out, it may help to have someone accompany you in case your symptoms are triggered when you’re shopping, at the movies or on another outing.
Some women find that engaging in activities that cultivate their spiritual growth, such as prayer, yoga, religious services or meditation, is helpful.
Once you start to feel better, you might choose to become active in making environmental changes in your community to prevent others from becoming ill or to help others who have ES. Find out what groups are working in your community to create safer, healthier environments.