Letter to the Editor
Dietary factors and endocrine consequences of multiple chemical sensitivity
Factores dietéticos y consecuencias endocrinas de la sensibilidad química múltiple
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"apellidos" => "Cardona Maya" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2530016419302678" "doi" => "10.1016/j.endinu.2019.10.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016419302678?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018020300639?idApp=UINPBA00004N" "url" => "/25300180/0000006700000005/v1_202008250845/S2530018020300639/v1_202008250845/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Dietary factors and endocrine consequences of multiple chemical sensitivity" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "353" "paginaFinal" => "354" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Paolo D. Pigatto, Valentina Rossi, Gianpaolo Guzzi" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Paolo D." "apellidos" => "Pigatto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Valentina" "apellidos" => "Rossi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Gianpaolo" "apellidos" => "Guzzi" "email" => array:1 [ 0 => "gianpaolo_guzzi@fastwebnet.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20161 Milan, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Milan, Italy" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores dietéticos y consecuencias endocrinas de la sensibilidad química múltiple" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In a recent cross-sectional study, Aguilar-Aguilar et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> found that patients with newly diagnosed of multiple chemical sensitivity (MCS) followed an exclusion diet in 57.7 percent.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> Similarly, it was estimated that approximately half of all cases (52.1 percent) were taking daily dietary antioxidants and/or supplements.<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.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1,2</span></a> As the investigators correctly state in the Discussion section, elimination diets may lead to a low muscle mass (sarcopenia),<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> along with frailty/fragility, weakness, and impair mobility.<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. We would like to share our perspective on MCS and metabolic abnormalities of micronutrients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the case series to which we refer,<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3–5</span></a> it has now been expanded to include more than 164 patients with MCS. Further analyses are now under way. Therefore, in our own clinical experience with MCS patients, 41.5 percent of patients (68 of 164) presented with hormonal disorders, a larger percentage than that reported in our previous retrospective MCS study,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> in which the overall prevalence of hormone-related disorders was 31.7 (13 of 41) percent.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The mean (±SD) age of MCS patients was 48.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12 years (range, 22–78). The female to male ratio is approximately 6:1. At this time, amongst 164 patients who received diagnosis of MCS between 2000 and 2019, 10 of 164 (6.1 percent) had adrenal gland dysfunction (8 had hyposurrenalism and 2 had Cushing's syndrome). As was seen in a previous trial of MCS,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> hyperprolactinemic disorders are recognized diagnostic entities that are associated with MCS.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> Amongst MCS patients, 11 of 38 (28.9 percent) had a diagnosis of hyperprolactinemia. Patients were not taking any anxiety medications.</p><p id="par0020" class="elsevierStylePara elsevierViewall">From a nutritional standpoint, in our clinical experience, zinc deficiency is one of the most important metabolic alterations with existing MCS syndrome.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> In fact, zinc is often displaced and/or replaced due to long term exposure to metal toxicants.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> Also, hypozinchemia may be a marker of other hormonal as well as metabolic abnormalities (i.e., adrenal gland dysfunction, liver metabolic response, and malabsorption syndrome).<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3,6,7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In patients with severe MCS (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>54), four patients had coexisting genetic and rare diseases (4 of 54, 7.4 percent): one patient received a diagnosis of porphyria, one patient had systemic mastocytosis, one had Ehlers–Danlos syndrome, and one had sickle cell anemia. Neuropathy (axonal) – predominantly related to small-fiber involvement – occurred in 39 (39 of 164, 23.8 percent) of the subjects in our MCS cohort.<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/or dysimmune reactions induced by toxic metals.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Metabolically, in patients with MCS caused by retention of toxic metals (long-term body burden of toxic metals)<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> there was an impairment of vitamins (mainly vitamins B) and trace elements activities, which in turn lead to destabilization of delicate hormonal balance.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3,8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Interesting, none had clinical manifestations of MCS originating from molds<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">9,10</span></a> to date. Currently, we have follow-up data on undesirable side effects relating to antioxidant supplements among individuals who have suffered with MCS. Combining acute and late adverse effects owing to antioxidant therapy (mainly reduced glutathione, GSH) had been reported in our initial study to account for about 60–70 percent.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> Now, the rate of patients with adverse effects to antioxidants was moderately increased to 72.7 percent (24 of 33).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Lastly, that 7 of 164 patients with MCS (4.3 percent) had anorexia nervosa emphasizes the high prevalence of anorexia and/or eating disorders in patients with chemical sensitivity.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> Physicians treating patients with multiple chemical sensitivity (also termed MCS) should monitor their patients’ hormone levels as well as micronutrients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0050" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0010" ] ] ] ] "multimedia" => array:2 [ 0 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 22472 ] ] 1 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc2.docx" "ficheroTamanyo" => 22602 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics and determinants of dietary intake and physical activity in a group of patients with multiple chemical sensitivity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. 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