こうやって、夏の花火を楽しめる現在の日本は、平和ボケと言われるかもしれませんが、つい70年前の日本に比べて、また今戦争に苦しんでいる世界の国々に比べて、何て幸せなんだろうと思いました。
1982年～1983年に私がノースカロライナ州立大学の毒性学プログラムで客員教授をしていた時に、ポストドク（博士研究員）として私のグループのセミナーに参加していたBuck Grissom 博士は、その後 CDC（Centers for Disease Control and Prevention 疾病対策予防センター）勤務を経てNIEHS（National Institute of Environmental Health Sciences 米国環境健康研究所）に長年勤務して退職し、現在はジョージア州に住んでいますが、私が化学物質過敏症に興味を持っていることを知っていて、時々面白そうな記事があると送ってくれます。
以下は今日届いた記事ですが、元々の質問者のHarold E. Hoffman, MD（医師）に対するDavid Hartman, PhD（博士）の回答に対して、Dorothy Wigmore, MS（修士）が根拠は何かと疑問を呈するとともにカナダのアルバータ州政府が採用している職場環境を健康に保つ対策を紹介し、それに対してDavid Hartmanが化学物質過敏症（MCS）患者20人を対象に行った二重盲検の研究論文を引用して詳しい反論をし、さらにRonald E. Gots, MD（医師）・Ph.D（博士）がコメントをしているという内容です。
これらは今年の3月から4月にかけてのやりとりですが、この頃あまり私の意識になかった化学物質過敏症についてあらためて考える機会になりました。
Ronald E. Gots の「中枢神経系の受容体が化学物資や匂い物質で直接活性化されても、恐怖心（危険の知覚）の結果として二次的に神経生理学的反応が起こるにしても違いはない。舞台負け（聴衆が見ている舞台の上で緊張してあがること）が起こると、付随して頻脈や手に汗をかき、気絶することもあり得る。これらは精神力学的過程を経て神経生理学的な反応が起こるということである。化学物質過敏症はそれと似たような現象に思える。」というコメントは簡単明瞭です。
これに関連して、イギリスやカナダやアメリカの医師たちが共著でJ. Can. Chiropr. Assoc. 2008 June : 52(2): 88-95 に発表した化学物質過敏症に関する総説 "Managing environmental sensitivity: an overview illustrated with a case report" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2391018/ は、最近の文献も引用されていて、Environmental Physician/Clinician（環境臨床医師）が行っている科学的に間違っている（根拠のない）治療法についても言及してあり、大変有用です。
化学物質過敏症のある女性患者は、著者らによる認知行動療法の治療を受ける前は、環境臨床医師によって2年間にわたっていわゆる"toxins"（毒物）から逃れることと、"purported triggers"（症状を起こす引き金と主張する物質）への感受性を下げるという治療を受けていました。具体的には、室内のカーペットを除去したり、各種献立の食事の輪用や、サプルメントやビタミン類の服用や、by-weekly （週2回又は隔週？）のいわゆる"enzyne potentiated desensitization therapy"（酵素で活性化される脱感作セラピー）注射を受けていました。"enzyme potentiated desensitization therapy"とは、BMJ. 2003 Aug 2: 327(7409): 251 に発表された"Enzyme potentiated desensitization in treatment of seasonal allergic rhinitis: double blind randomised controlled study" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC167158/ という論文に記述されているように、200 Fishman units の β glucuronidase、50pg の 1,3-cyclohexanediol、50ng の protamine sulphate、及び吸入される各種アレルゲン抽出物の混合物（樹木、草類、雑草類の花粉混合物 ; アレルゲンになる黴の胞子; 猫と犬のフケ; ホコリと貯蔵物に発生するダニ）を含んだ緩衝生理食塩水0.05mℓを間隔をおいて2回注射するという方法です。プラセボ（コントロール）には同様に緩衝生理食塩水0.05mℓを2回注射します。この論文では、18才から64才の深刻な夏の花粉症歴のある183人の患者を被験者としたが、プラセボと有意な差がなく効果はなかったという結論が報告されています。
日本でもそうですが、環境臨床医師の人たちの治療方法は、化学物質過敏症で苦しんでいる患者たちの化学物質に対する恐怖症（本当の原因）をいつまでも持続させる結果になって、逆に苦しめているのではないかという気がして仕方がありません。
・・・・・・・・・・・・・・・・・・・・・・・・・・・・
（Ronald E. Gotsのコメント）
From: bounce-36012335-6838494@listserv.unc.edu [mailto:bounce-36012335-6838494@listserv.unc.edu] On Behalf Of Ronald Gots
Sent: Thursday, April 02, 2015 9:23 AM
To: Occ-Env-Med-L
Cc: Occ-Env-Med-L@listserv.unc.edu; harold@drhoffman.ca
Subject: Re: [occ-env-med-l] Air purifiers for fragrance intolerance at work
Sent: Thursday, April 02, 2015 9:23 AM
To: Occ-Env-Med-L
Cc: Occ-Env-Med-L@listserv.unc.edu; harold@drhoffman.ca
Subject: Re: [occ-env-med-l] Air purifiers for fragrance intolerance at work
When we renamed MCS idiopathic environmental intolerances, IEI, at our WHO panel in Spandau Germany, it was largely to deal with these kinds of arguments. Whether a CNS receptor (lambic say) is activated directly by a chemical or other odorant or secondarily through a perception of a hazard and consequent neurophysiological response makes little difference. Stage fright with attendant tachycardia, sweaty palms and even syncope, begins with a psychodynamic process and ends with certain neurophysiological responses. MCS would appear to be similar.
Ronald E Gots MD, PhD, DABT
301 466-9858 cell
Sent from my iPad
（David Hartman からDorothyらへ）
On Apr 1, 2015, at 11:11 PM, David Hartman <drdavidhartman1@comcast.net> wrote:
On Apr 1, 2015, at 11:11 PM, David Hartman <drdavidhartman1@comcast.net> wrote:
Dorothy et al.Probably the seminal study is below, demonstrating essentially chance reactivity among patients who believed they chemically sensitive. No physiological basis has been demonstrated to account for extreme claims of odor sensitivity among patients who are not asthmatic or atopic. Environmental activists have inveighed against the toxicity of odorants, and such patients view themselves as canaries in the coal mine; more sensitive than others and bellwethers of our toxic environment. Most of the studies of this population have found very high rates of psychiatric disturbance in such individuals, with somatization, pathological narcissism and sometimes delusional disorders. Many use litigation to manipulate their environment for attention and compensation.This is not to discount actual allergy, asthma, sensitivity in immunosuppressed individuals, etc., Moreover, I am hardly a fan of the idea that you must pump complex flower-scented hydrocarbons into the air to have a pleasant home. I think we all benefit from living in non-polluted environments. I completely agree with those who would strengthen environmental regulations.On the other hand, we have to separate the real from the superstitious. Many of these “sensitive” patients demand accommodations down to the atomic level, and report symptoms caused from contact with individuals wearing polyester clothing, reading newspapers, etc. That’s ridiculous. They do not have limbic system neuropathology that renders them unfit to live anyplace but a clean room. They may have severe phobic, paranoid and anxiety disorders, where they attribute their symptoms to a “toxic world.” No filter will eliminate narcissistic, delusional and compensation related demands made by such individuals because their claim of chemical injury is central to their identity and their demands.Bottom line; we need to care for both groups of people, those with actual physical issues like asthma, and those with severe psychiatric disorders who believe they are being damaged by our industrial society. But helping the latter group does not mean trying to treat somatization, hypochondria, delusions and personality disorder by trying to validate their pathological view of reality. We will never succeed in such an enterprise because there is no physical damage to correct.David E. Hartman PhD MS ABN ABPPMedical & Forensic Neuropsychology
（David Hartmanが引用している二重盲検研究論文）Regul Toxicol Pharmacol. 1993 Aug;18(1):44-53.Double-blind provocation chamber challenges in 20 patients presenting with "multiple chemical sensitivity".
Abstract
A clinical algorithm was used to discriminate verifiable chemical sensitivity from psychological disorders in patients referred for evaluation of polysomatic symptoms attributed to hypersensitivity to workplace and domestic chemicals. These patients believed that they were reactive or hypersensitive to low-level exposure to multiple chemicals. Some had previously been evaluated and managed by the tenets of "clinical ecology" and diagnosed as having "multiple chemical sensitivity." Double-blind provocation challenges with an olfactory masker were performed in an environmental chamber on each of 20 patients. A variety of chemicals was employed, one or more per subject, dependent on individual clinical history. Clean air challenges with the olfactory masker were used as placebo or sham controls. As a group, probability analyses of patient symptom reports from 145 chemical and clean air challenges failed to show sensitivity (33.3%), specificity (64.7%), or efficiency (52.4%). Individually, none of these patients demonstrated a reliable response pattern across a series of challenges. Implications for future research in assessment methodology incorporating neurophysiologic and neurobehavioral measures are discussed.
（Dorothy WigmoreからDavidとHaroldへ）On Apr 1, 2015, at 8:46 PM, Dorothy Wigmore <dwigmore@worksafe.org> wrote:David:Not sure what your evidence is for "odour sensitivity" being a psychiatric disorder. There certainly is evidence in the literature that it is very real, related to the limbic system reacting to smells, as well as the hazards associated with chemicals used in fragrances.
Harold:
For an authoritative Canadian take on this topic, check out the Canadian Centre for Occupational Health and Safety's piece at http://www.ccohs.ca/oshanswers/hsprograms/scent_free.html, and related documents. For Alberta, see the government's guidance for health care facilities, at work.alberta.ca/documents/OHS-WSA-handbook-healtcare-admin-workers.pdf.And that's what I'd recommend as a public health approach: get rid of whatever is causing the smell. If it's people's products, go scent-free. If it's chemicals (e.g., cleaning products), use Ecologo or GreenSeal certified products at least (without the citrus smell chemical that is an asthmagen). If it's not clear what the source is, sounds like it's time for an investigation.Let us know what you do.Dorothy Wigmore
（David HartmanからHarold Hoffmanへ）
（Harold Hoffmanの元々の質問）On 31 March 2015 at 20:15, David Hartman <drdavidhartman1@comcast.net> wrote:Given that many such individuals who claim odor sensitivity actually have a psychiatric disorder, you are unlikely to find a filter capable of removing somaticized or delusional components from their perception.Best regards,David Hartman PhDMedical & Forensic Neuropsychology
Sent from my iPhone
On Mar 31, 2015, at 5:36 PM, Harold Hoffman <harold@drhoffman.ca> wrote:
（Dorothy Wigmore の所属）Are air purifiers effective in workplaces to control fragrances, odors, and scents?Do you have an employer policy regarding air purifiers to control fragrances?In a literature search, I found no information on this topic.
Harold E. Hoffman, MD, FRCPCOccupational & Environmental MedicineMeadowlark Place Professional Centre#410, 8708 - 155 St. Edmonton, Alberta T5R 1W2Telephone: (780) 439 - 9491Fax: (780) 439 - 9091Email: Harold@DrHoffman.ca
Dorothy Wigmore, MS
Occupational health and green chemistry specialistWorksafe55 Harrison St., Oakland, California 94607www.worksafe.org
Please note: I now am working half-time for Worksafe. This means I won't check e-mail every day. If you need to reach me quickly, please send a note to dwigmore@mymts.net.Follow Worksafe on Twitter @WorksafeCA and check us out on Facebook at https://www.facebook.com/Worksafe.California
