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Letter to the Editor
Dietary factors and endocrine consequences of multiple chemical sensitivity
Factores dietéticos y consecuencias endocrinas de la sensibilidad química múltiple
Paolo D. Pigattoa, Valentina Rossib, Gianpaolo Guzzic,
Corresponding author
gianpaolo_guzzi@fastwebnet.it

Corresponding author.
a Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20161 Milan, Italy
b IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
c Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Milan, Italy
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In a recent cross-sectional study&#44; Aguilar-Aguilar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> found that patients with newly diagnosed of multiple chemical sensitivity &#40;MCS&#41; followed an exclusion diet in 57&#46;7 percent&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> Similarly&#44; it was estimated that approximately half of all cases &#40;52&#46;1 percent&#41; were taking daily dietary antioxidants and&#47;or supplements&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> Aguilar-Aguilar and colleagues<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> should be congratulated for providing new nutritional clinical data among patients with MCS&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#44;2</span></a> As the investigators correctly state in the Discussion section&#44; elimination diets may lead to a low muscle mass &#40;sarcopenia&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> along with frailty&#47;fragility&#44; weakness&#44; and impair mobility&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> The interesting study by Aguilar-Aguilar and colleagues<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> helps further the connection between low micronutrient consumption and MCS&#46; We would like to share our perspective on MCS and metabolic abnormalities of micronutrients&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the case series to which we refer&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3&#8211;5</span></a> it has now been expanded to include more than 164 patients with MCS&#46; Further analyses are now under way&#46; Therefore&#44; in our own clinical experience with MCS patients&#44; 41&#46;5 percent of patients &#40;68 of 164&#41; presented with hormonal disorders&#44; a larger percentage than that reported in our previous retrospective MCS study&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> in which the overall prevalence of hormone-related disorders was 31&#46;7 &#40;13 of 41&#41; percent&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The mean &#40;&#177;SD&#41; age of MCS patients was 48&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 years &#40;range&#44; 22&#8211;78&#41;&#46; The female to male ratio is approximately 6&#58;1&#46; At this time&#44; amongst 164 patients who received diagnosis of MCS between 2000 and 2019&#44; 10 of 164 &#40;6&#46;1 percent&#41; had adrenal gland dysfunction &#40;8 had hyposurrenalism and 2 had Cushing&#39;s syndrome&#41;&#46; As was seen in a previous trial of MCS&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> hyperprolactinemic disorders are recognized diagnostic entities that are associated with MCS&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> Amongst MCS patients&#44; 11 of 38 &#40;28&#46;9 percent&#41; had a diagnosis of hyperprolactinemia&#46; Patients were not taking any anxiety medications&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">From a nutritional standpoint&#44; in our clinical experience&#44; zinc deficiency is one of the most important metabolic alterations with existing MCS syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> In fact&#44; zinc is often displaced and&#47;or replaced due to long term exposure to metal toxicants&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> Also&#44; hypozinchemia may be a marker of other hormonal as well as metabolic abnormalities &#40;i&#46;e&#46;&#44; adrenal gland dysfunction&#44; liver metabolic response&#44; and malabsorption syndrome&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3&#44;6&#44;7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In patients with severe MCS &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>54&#41;&#44; four patients had coexisting genetic and rare diseases &#40;4 of 54&#44; 7&#46;4 percent&#41;&#58; one patient received a diagnosis of porphyria&#44; one patient had systemic mastocytosis&#44; one had Ehlers&#8211;Danlos syndrome&#44; and one had sickle cell anemia&#46; Neuropathy &#40;axonal&#41; &#8211; predominantly related to small-fiber involvement &#8211; occurred in 39 &#40;39 of 164&#44; 23&#46;8 percent&#41; of the subjects in our MCS cohort&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> Small-fiber neuropathy is a well-recognized entity and may be associated with auto- and&#47;or dysimmune reactions induced by toxic metals&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Metabolically&#44; in patients with MCS caused by retention of toxic metals &#40;long-term body burden of toxic metals&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> there was an impairment of vitamins &#40;mainly vitamins B&#41; and trace elements activities&#44; which in turn lead to destabilization of delicate hormonal balance&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3&#44;8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Interesting&#44; none had clinical manifestations of MCS originating from molds<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">9&#44;10</span></a> to date&#46; Currently&#44; we have follow-up data on undesirable side effects relating to antioxidant supplements among individuals who have suffered with MCS&#46; Combining acute and late adverse effects owing to antioxidant therapy &#40;mainly reduced glutathione&#44; GSH&#41; had been reported in our initial study to account for about 60&#8211;70 percent&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> Now&#44; the rate of patients with adverse effects to antioxidants was moderately increased to 72&#46;7 percent &#40;24 of 33&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Lastly&#44; that 7 of 164 patients with MCS &#40;4&#46;3 percent&#41; had anorexia nervosa emphasizes the high prevalence of anorexia and&#47;or eating disorders in patients with chemical sensitivity&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> Physicians treating patients with multiple chemical sensitivity &#40;also termed MCS&#41; should monitor their patients&#8217; hormone levels as well as micronutrients&#46;</p></span>"
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ISSN: 25300164
Original language: English
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