Schwenk Michael
State Public Health Department, Stuttgart, Germany.
GMS Curr Top Otorhinolaryngol Head Neck Surg. 2004;3:Doc05. Epub 2004 Dec 28.
Multiple Chemical Sensitivity (MCS) is a phenomenon which the ENT-doctor should be familiar with. It has its roots in the description of a syndrome in 1987. A worker spilled chemicals at his workplace and from then on he reacted highly sensitive to chemicals. Today, there are many people who explain their complaints with self-suspected MCS. Various pathopysiological models have been proposed, including toxicological, immunological or behaviorial models. But no-one could be proved so far. Since controlled provocation tests have also provided unclear results, an increasing number of doctors assumes today, that MCS reflects a psychic condition. In 1996, an expert team of the WHO has suggested the renaming of MCS to "idiopathic environmental illness" (IEI). However, other doctors still assume a chemical cause. Since there are neither straightforward diagnostic methods to proof MCS, nor reliable therapeutic concepts, treatment of MCS-patients is usually difficult. The MCS-debate (somatic vs psychic causes) seems to reflect the dilemma of the medical profession today, that somatic disorders of known origin can be well treated, whereas the increasing number of psychosomatic/ somatoform disorders is often resistant to medical help. The ENT-doctor should pay attention to changes of the nasal mucous membrane, nasal resistance and the sense of smell. Moreover he should know about the peculiarities of MCS-patients. The manuscript describes the present knowledge and state of discussion with special regard to the situation in Germany.
多重化学物质敏感症（MCS）是一种耳鼻喉科医生应该熟悉的现象。它起源于1987年对一种综合征的描述。一名工人在工作场所洒出了化学品，从那时起，他对化学品产生了高度敏感的反应。如今，有许多人将自己的不适症状归因于自我怀疑的多重化学物质敏感症。人们已经提出了各种病理生理模型，包括毒理学、免疫学或行为学模型。但到目前为止，还没有一个模型得到证实。由于控制性激发试验也给出了不明确的结果，如今越来越多的医生认为，多重化学物质敏感症反映的是一种心理状况。1996年，世界卫生组织的一个专家小组建议将多重化学物质敏感症重新命名为“特发性环境疾病”（IEI）。然而，其他医生仍然认为是化学原因所致。由于既没有直接的诊断方法来证明多重化学物质敏感症，也没有可靠的治疗理念，对多重化学物质敏感症患者的治疗通常很困难。关于多重化学物质敏感症的争论（躯体原因与心理原因）似乎反映了当今医学界的困境，即已知病因的躯体疾病可以得到很好的治疗，而越来越多的心身疾病/躯体形式障碍往往对医疗帮助有抵抗性。耳鼻喉科医生应该注意鼻黏膜、鼻阻力和嗅觉的变化。此外，他应该了解多重化学物质敏感症患者的特点。本文稿特别结合德国的情况描述了目前的知识和讨论状况。
