August 14, 2017

Chemical Allergies Were Proven to Exist Long Ago

Stephen Barrett "MD" is an outspoken individual who retired from
psychiatry in 1993 and then proclaimed himself  "the media" in 2001.
He was never board-certified in psychiatry, and he was never board
certified in any other discipline.   He has zero experience as a practit-
ioner in every form of internal, dermatological, and dental medicine.
He was not a researcher in any capacity, either.   Neither was he a
biochemist nor a vaccinologist nor a pharmacologist nor a medical
technologist nor anything similar.  He spent inordinate amounts of
time suing people, including a disabled woman to whom he lost.

In the late 1980s he wrote an article titled, "Unproven Allergies."  Big
problem with that title, though.  Those allergies were proven to exist,
in the world of Occupational & Environmental Medicine, even during
the writing of the deceptive text.  Take note of the following:

       * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
       The testing for IgE-mediated chemical allergies has been con-
       ducted via mainstream medical RAST testing.   The specific
       chemicals tested are found in the OCCUPATIONAL PANEL
       of a  RAST TEST order form.   This means that mainstream
       medical science recognizes the existence of chemical allergies.
       Case closed.  
        * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

An Allegation of  Stephen Barrett that Calls for a Response:

Stephen Barrett alleged, throughout his anti-MCS literature, that
a primary test for chemical sensitivities consists in ...

(I)   ... a very subjective and non-quantitative form of testing ...

(II)  ... by which a diluted chemical solution is placed under ...
           the tongue of a patient (or injected through his skin), ...

(III) followed by nothing more than the patient reporting if whether or
       not he experiences any symptom from the administered chemical
       solution.

       This allegation, in combination with numerous omissions of  fact,
       can easily deceive a beginner into assuming that there has never
       been a test to prove the existence of chemical sensitivities.  This
       allegation, therefore, calls for a response.

The Response:


(1)  The testing for chemical sensitivities has included, but has not been
       limited to, ...

(I) ... the traditional skin prick test, otherwise known as the SPT.

(II)  In skin prick testing, a test-subject is regarded as having  tested
       positive when a visible and measurable wheal, equal to or larger
       than a designated size, appears as a result of the skin test.

(III) The size of  the wheal is then recorded in numerical form, and
        numerical measurement constitutes objectivity.       

IgE-mediated Chemicals, via the Process of Haptenation

(2)  The purpose for the SPT is to test for immediate onset hyperreac-
       tivity.  This is a Type I reaction, and such a reaction occurs within
       one hour of  exposure.

(I)   IgE stands for Immunoglobulin E, and an immunoglobulin is a pro-
       tein produced by plasma cells & lymphocytes, serving the function
       of  an antibody.

(II)  A number of chemicals have been found to trigger immediate on-
       set reactions, and a subset of  those have been discovered to be
       IgE-mediated, via a process known as "haptenation."

(III) Haptein is a greek word which means "to fasten," and a hapten is
        a low weighted molecular agent that reacts with an antibody, but
        cannot induce the formation of an antibody until it is fastened to
        either a carrier protein or to a large antigenic molecule.  Chemi-
        cals happen to be agents of  low molecular weight.     

Type IV Hypersensitivity Reactions


(3)  In addition, there are a significant number of chemicals that have
       been found to induce the Type IV, cell-mediated hyperreactivity.
       This is known as "delayed allergic reactivity," and this type hyper-
       sensitivity results in dermatitis or anaphylaxis.

(I)  Concerning the Type I and Type IV hyper-reactivity, the Practice
      Parameter for Allergy Diagnostic Testing, as is issued by the Joint
      Council of Allergy Asthma and Immunology, states:          

       "Many chemicals (e.g., sulfonechloramides, azo dyes, par-
        abens, fragrances) used as additives in foods, drugs, and
        cosmetics may induce either IgE-mediated reactions or
        contact dermatitis, or both." Ann Allergy 1995; 75:543-625      

Non-immunological Chemical Sensitivity Reactions,      
Including Anaphylaxis


(4)   In addition, a number of chemicals have been identified as irritants,
        being that they trigger "nonimmunological" responses.  There is ev-
        en a nonimmunolgical form of  anaphylaxis, known as the "anaphy-
        lactoid reaction."   Such a reaction produces the same final result
        as doe an immunologic anaphylactic reaction.  The only difference
        between the two types of  reactions is in the triggering mechanism
        of them.  That is to say:             

      "An anaphylactoid reaction is another type of immediate 
       reaction that mimics anaphylaxis.  While symptoms and 
       treatments are the same the reason for the reaction is not.  
       An anaphylactoid reaction doesn't involve IgE antibodies' 
       immune system and is not considered a true allergic reac-
       tion.  Even so, the reaction can be just as serious."  [Amer-
       ican College of Allergy, Asthma & Immunology]  See:

       http://www.acaai.org/public/advice/anaph.htm

(I)    Thus, there is Allergic Asthma, and then there is Irritant-induced
        Asthma. One type of asthma is immunologic, while the other type
        is not. You are not inclined to run a 26 mile marathon whenever
        you are exposed to your asthma triggers.      

Allergic Sensitization, Direct Irritation, 

and Pharmacological Reactions

(5)  Hypersensitivity reactions can be triggered via:

(a)  Allergic Sensitization.   This is induced by repeated exposure to
       a sensitizing agent such as formaldehyde, glutaraldehyde, or phenyl
       isocyanate.  Then, upon becoming sensitized, further exposure to
       the same agent results in an antibody release or an inflammatory
       chemical release.

(b)   Direct Irritation.   This is induced in those who are "atopic," in
        person who possess chronic vulnerabilities aand/or pre-existent
        conditions.   Such persons develop "symptoms immediately af-
        ter exposure to substances such as chlorine, ammonia, sul-
        fur dioxide, and environmental smoke."

(c)   Pharmacological Reaction.   This comes as a result of the fact
        that some chemicals and nonchemical agents elevate the produc-
        tion of chemicals that naturally exist in the body.  An example of
        a naturally existent chemical in the body, able to have its level ele-
        vated by nontoxic chemical exposure, is acetylcholine.   A case
        in point is the organophosphate/carbamate class of pesticide.  At
        nontoxic levels, it can elevate the level of acetylcholine in the lungs,
        because that class of  pesticide inhibits acetylcholinesterase, the
        enzyme which displaces/dissolves acetylcholine.

        For further understanding on this, see the Mayo Clinic's teaching
        on Occupational Asthma.   It is found at:

http://www.mayoclinic.com/health/occupational-asthma /DS00591/DSECTION=3&

A Sample of IgE-mediated Chemicals


(6)   For confirmation purposes, examples of IgE-mediated chemicals
        which can be involved in skin testing, include the following:

(a)   The disinfectant Ortho-phthalaldehyde.        

        It has even resulted in anaphylaxis, via "Cidex OPA." See:

<>  Nine episodes of anaphylaxis following cystoscopy caused by 
       Cidex OPA (ortho-phthalaldehyde) high-level disinfectant in 
       4 patients after cystoscopy.  {J Allergy Clin Immunol. 2004 Aug;
       114(2): 392-7}

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd= Retrieve&db=PubMed&list_uids=15316522&dopt=Citation

(b)  Formaldehyde.

        It is masked behind a number of aliases, and it outgases from the
        shampoo and liquid soap ingredients, imidazolidinyl urea, DMDM
        hydantoin, diazolidinyl urea, and quaternium-15.   See:

<>   IgE-mediated urticaria from formaldehyde in a dental root 
        canal compound.  (The full text describes 28 cases of Formalde-
        hyde Sensitivity.  {J Investig Allergol Clin Immunol., 2002;12(2):
        130-3}

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=12371530&dopt=Abstract

<>   Exposure to gaseous formaldehyde induces IgE-mediated 
        sensitization to formaldehyde in school children. {Clin Exp
        Allergy, 1996 Mar;26(3): 276-80}

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=8729664&dopt=Abstract

<>   IgE allergy due to formaldehyde paste during endodontic
        treatment.  Apropos of 4 cases:  2 with anaphylactic shock 
        and 2 with generalized urticaria. {Rev Stomatol Chir Maxillofac.
        2000 Oct;101(4):169-74}

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=11103423&dopt=Abstract

(c) Vinyl Sulphone Reactive Dyes.

       They are also known as fiber-reactive dyes, as well as azo dyes.
       They include Remazol Black B.   See:

<>   Roll of skin prick test and serological measurement of  
        specific IgE diagnosis of  occupational asthma resulting 
        from exposure to vinyl sulphone reactive dyes.  {Occup
        Environ Med. 2001 Jun;58 (6):411-6}

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=11351058&dopt=Citation

<>   Asthma, rhinitis, and dermatitis in workers exposed to re-
        active dyes.
{Br J Ind Med. 1993 Jan;50(1):65-70}

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=8431393&dopt=Abstract

(d)  Cyanuric Chloride.

     It is used in the production of  plastics, herbicides, pharmaceuticals,
     and fiber-reactive dyes.  It is also a structural component of mono-
     chlorotriazine and dichlorotriazine dyes. See:<>   Immunologic cross-reactivity between respiratory chemical
       sensitizers: reactive dyes and cyanuric chloride
.    {J Allergy
       Clin Immunol. 1998 Nov;102(5): 835-40}

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=pubmed&dopt=Abstract&list_uids=9819302&query_hl=9

(e)  The disinfectant Chlorhexidine.  It even triggered anaphylaxis:<>   
       FDA Public Health Notice:  Potential Hypersensitivity Re-
        actions to Chlorhexidine-Impregnated Medical Devices

         http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm062306.htm

<>   Immediate hypersensitivity to chlorhexidine: literaure re-
        view. {Allerg Immunol (Paris) 2004.  Apr;36(4):123-6}

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=pubmed&dopt=Abstract&list_uids=15180352&query_hl=16

(f)   Phthalic Anhydride.

       Nail polish ingredient, ingredient in specific spray paints, and
       an agent used in the making of  unsaturated polyester resins,
       alkyd resins, polyester polyols, and insect repellents.     

<>   Detection of specific IgE in isocyanate and phthalic anhy-
        dride exposed workers:  comparison of RAST RIA, Im-
        muno CAP System FEIA, Magic Lite SQ.  {Allergy. 1993
        Nov;48(8);627-30}

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=8116862&dopt=Abstract

<>   In vitro demonstration of  specific IgE in phthalic anhydride 
        hypersensitivity.  Am Rev Respir Dis, 1976 May;113(5):701-4

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=1267268&dopt=Abstract

(7)  The test which Barrett condemns in his anti-MCS literature is the
       provocation-neutralization test.  In fact, the only type of medical
       practitioner that he mentions in the same literature is the so-called
       clinical ecologist.  Barrett inaccurately explained the provocation-
       neutralization test, in his omitting of pivotal fact, and he additional-
       ly gave the illusion that the only people on earth who test for chem-
       ical sensitivity are the so-called clinical ecologists.

(I)   Firstly, the diagnosing of  the various forms of chemical sensitivity
       has been occurring in the worlds of the Nose, Throat, & Allergy
       Specialist, the Occupational and Environmental Health Specialist,
       the Dermatologist, and even the Chest Physician.   In fact, from
       the world of  the chest physician came the golden rule for diag-
       nosing Irritant-associated Vocal Cord Dysfunction.  In addition,
       two pivotal papers on chemical sensitivity were produced by the
       head of  the department of  emergency medicine of an American
       university.  Yes, Emergency Medicine.      

(II)  Secondly, Stephen Barrett failed to mention that the provocation-
       neutralization test has included the measuring of objective skin
       wheals, and it was also used to detect allergies to insect stings.

Barrett Failed to Mention that it is an Offshoot
of  the Serial Endpoint Titration Skin Testing
Procedure, Covered by Aetna Insurance


(8)   The provocation-neutralization test is actually an offshoot of the
        serial endpoint titration skin testing procedure, covered by Aetna
        Insurance.  This is pertinent to note in light of the observation that
        Stephen Barrett has repeatedly stated what Aetna covers, as if
        Aetna alone is the ultimate benchmark in diagnostic testing.

(I)    Now, the Skin Endpoint Titration seeks to first identify a patient's
        allergens or hymenoptera venom hypersensitivities (such as to that
        of hornets, bees, wasps, fire ants, and/or yellow jackets.)   That is
        to say, the Skin Endpoint Titration first seeks to find the triggering
        dose of  a hypersensitivity reaction.

(II)   The same testing then seeks to find the neutralizing dose of the
         same allergen or venom.  Now, this is done for immunotherapy
         purposes and the neutralizing dose is found in a series of skin
         prick tests.  The dose at which a patient no longer experiences
         a hypersensitivity reaction is the "endpoint."   It constitutes the
         neutralizing dose.    It then becomes the "safe starting dose" for
         immunotherapy.   Thus originates the name "neutralization" in the
         provocation-neutralization test.  The set goal of a provocation-
         neutralization test is to identify the "neutral dose."

(III)   In summary, the provocation-neutralization test looks for 
         objective skin wheals, while simultaneously asking the pa-
         tient how he/she feels when, of  course, such testing involves
         skin prick testing.  The appearance of wheals have been docu-
         mented in such testing.

(IV)  The diagnostic parameters become exceeded when the testing is
         considered positive on an either/or basis; on the basis of either
         the appearance of an objective skin wheal or the subjective re-
         porting of a symptom.  However, this is test concerns itself with
         prognostic parameters, also.

(V)   Nonetheless, to consider a test positive exclusively on the merits
         of an objective skin wheal is to keep the diagnostic part of skin
         prick testing within acceptable parameters.  It's the sublingual
         drops version of such testing which raises eyebrows.

Wheal Reactions Showed a Distinct Pattern


(9)   Objective skin whealing was consistently documented
        during a research undertaking that tested the reliability
        of the provocation-neutralization test.   The result of
         the research goes as follows:            

       "Reaction by symptoms to foods, chemicals, and normal sa-
        line solution showed a random pattern, although wheal
        reactions showed a distinct pattern."

(I)   Thus, in the skin test version of the provocation-neutralization
       test, "wheal reactions showed a distinct pattern."

(II)   The conclusion of that research undertaking goes as follows         

         "Skin response alone may be a more reliable indicator
          and require cross-validation with other tests, such as
          oral and inhalation challenges and comparison with 
          a control population." See:

<>    Intradermal skin testing for food and chemical sensitivities:  
         a double-blind controlled study.  J Allergy Clin Immunol. 1999
         May;103(5 Pt 1): 907-11}

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd= Retrieve&db=PubMed&list_uids=10329827&dopt=Abstract

(III)  Concerning the prognostic aspect of the provocation-
         neutralization test, the Aetna Insurance Company states:

        "Since provocation-neutralization requires the provoking 
         and neutralizing of symptoms to a single item at a time, 
         a patient could be required to undergo hundreds of indi-
        idual tests requiring weeks or months of full-day testing."
         (Well, this is what Aetna states and its bottom line is money.)

(IV)   The bottom line is that skin testing has been used to identify indi-
          vidual chemical sensitivities to chemicals such as formaldehyde
          and phenyl isocyanate, and phthalic anhydride.  Tested patients
          produced the objective medical finding of visible and measurable
          wheals.  This has included forms of testing other than that of the
          neutralization-provocation test.  In fact, this has included RAST
          Testing.

(V)   Chemically sensitive patients have tested positive in inhalation
         challenge testing, as well as in patch testing (the testing which
         seeks to detect delayed hypersensitivity responses.)  Chemical-
         ly sensitive patients were also documented as having objective
         medical findings via the fiberoptic rhinolaryngoscopy and even
         the fine needle biopsy.  Some chemically sensitive patients were
         found to have inflamed air sacs of the lungs, while other patients
         were found to have hepatic injury in the absence of viral infection.
         Other ones were found to have upper-respiratory erythema and
         swelling.

         Chemical Sensitivity exists in a number of forms.   It's very real,
         and it can be quite brutal.   It has been repeatedly documented
         that chemicals, at ambient (nontoxic) levels, are not universally
         harmless.
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