Is it the building, the occupant, or both? Using the QEESI© to

investigate indoor air concerns.

June 7, 2011

Indoor Air 2011

Tatjana Walker, RD, MPH; Thomas J. Prihoda, PhD; Claudia S. Miller, M.D., M.S.

University of Texas School of Medicine at San Antonio

Chemical Intolerance

• About 5% of people report multiple chemical intolerances

• “Do you consider yourself sensitive to everyday chemicals like those in household cleaning supplies, paints, perfumes, soaps, garden sprays, or things like that?” (15%)

A New Theory of Disease—

Toxicant-Induced Loss of Tolerance or “TILT”

Evidence That We Are Dealing With a New Disease Mechanism

• Similar reports from more than a dozen countries—different languages, media

• YET they report similar new onset intolerances to structurally unrelated substances (foods, medications, alcoholic beverages, caffeine) and symptoms affecting multiple organ systems in response to these.

• This is what Kuhn called a “compelling anomaly”—observations that do not fit known theories of disease

• Compelling anomalies drive the search for new explanations, paradigms, theories

Common Indoor Conditions Linked to TILT (Stage 1)

• Remodeling—new carpets, glues, cleaners, and other VOC emitters

• Pesticides

• Mold

• Insufficient fresh make-up air

Solvents Glues Paints Gasoline Nail polish/remover

Pesticides Organophosphates Carbamates, pyridostigmine Pentachlorophenol Pyrethrins

Indoor Air Volatile Organic Compounds (VOCs) New carpet Plasticizers Formaldehyde Fragrances Mold VOCs

Combustion-related Products Engine exhaust Tobacco smoke Oil well fire smoke Natural gas Tar/asphalt

Drugs/Medical Devices Vaccines Anesthetics Implants Antibiotics Chemotherapy

Cleaning Agents Phenolic disinfectants Ammonia Bleach

TOXICANT-INDUCEDLOSS OF

TOLERANCE?

TOXICANT-INDUCEDLOSS OF

TOLERANCE?

Gastrointestinal irritable bowel refluxConnective Tissue/Musculoskeletal

fibromyalgia carpal tunnel syndrome temporomandibular joint dysfunction (TMJ) syndrome arthritis lupus and other auto-immune diseases

Respiratory asthma Reactive Airways Dysfunction Syndrome (RADS) toluene dlisocyanate (TDI) hypersensitivity

Skin eczema hives other rashes, eruptions

Miscellaneous Syndromes Chronic Fatigue Syndrome implant syndromes ''Gulf War Syndrome“ Post/other disaster syndromes

Cardiovascular arrhythmias hypertension hypotension Raynaud's phenomenon

Neuropsychological Attention Deficit Hyperactivity Disorder (ADHD) depression bipolar disorder panic disorder migraines and other headaches seizures autism

Ear, Nose and Throat sinusitis polyps tinnitus recurrent otitis

Identifying Toxicant-Induced Loss of Tolerance (TILT)?

The QEESI

• Validated, published questionnaire and screening tool

• 50 questions, self-administered

• 12-15 minutes to administer

• Research, clinical, building investigations

• Helps occupants understand their symptoms and intolerances

Available for download at:

QEESI Symptom Star Pre- and Post-Exposure

Before exposure eventSince exposure event

Courtesy of Carl E. Grimes

QEESI Symptom Stars for 4 People in Sick Buildings

How Can You Use This Information

Without “Practicing Medicine”?

• Provide link to QEESI for occupants to self-administer

• Invite affected occupants to take the results to their doctors

• Some occupants will share the results with you, but don’t ask them to

• In either case, those affected will self-identify and will begin to understand that they may be especially susceptible

• These are the people who need accommodation

• Look for physicians you can work with—QEESI will help them understand too

Tatjana Walker, RD, MPHUniversity of Texas School of Medicine at San Antonio

walkert2@uthscsa.edu

The QEESI is Available for Download at: