Development and validation of the Exercise-Induced Laryngeal Obstruction Dyspnea Index (EILODI).

Background: Exercise-induced laryngeal obstruction (EILO) causes exertional dyspnea and is important for its effect on quality of life, diagnostic confusion with exercise-induced asthma, and health care resource utilization. There is no validated patient-reported outcome measure specific to EILO.

Objective: We sought to develop, validate, and define a minimal clinically important difference for a patient-reported outcome measure to be used with adolescents and young adults with EILO.

Inducible laryngeal obstruction during exercise: moving beyond vocal cords with new insights.

Exercise as an important part of life for the health and wellness of children and adults. Inducible laryngeal obstruction (ILO) is a consensus term used to describe a group of disorders previously called vocal cord dysfunction, paradoxical vocal fold motion, and numerous other terms. Exercise-ILO can impair one's ability to exercise, can be confused with asthma, leading to unnecessary prescription of asthma controller and rescue medication, and results in increased healthcare resource utilization including (rarely) emergency care.

Mass psychogenic illness: psychological predisposition and iatrogenic pseudo-vocal cord dysfunction and pseudo-reactive airways disease syndrome.

A multidisciplinary team assessed five patients who alleged chronic medically unexplained multiorgan system symptoms described by idiopathic environmental intolerance allegedly triggered by exposure to solvents used in membrane roofing repair work on an office building. The event precipitated an incident of mass psychogenic illness (MPI). Treating physicians diagnosed irritant-associated vocal cord dysfunction (IVCD) and reactive airways disease syndrome (RADS) resulting from exposure.

[Development of a screening tool for migraine prophylaxis].

The aim of the present study was to develop a screening tool to aid non-headache specialists, like general practitioners, in deciding whether migraine prophylaxis in the individual migraine patient is useful or not. The first step was the development of a questionnaire, consisting of 10 items, which was filled in by 132 migraineurs who called on neurologists or headache experts. Independently, the physicians filled in another questionnaire to answer the question of whether they decided to prescribe migraine prophylaxis and if they had, to give their reasons for doing so.

MMPI-2 validity, clinical and content scales, and the Fake Bad Scale for personal injury litigants claiming idiopathic environmental intolerance.

Background: Idiopathic environmental intolerance (IEI) is a descriptor for nonspecific complaints that are attributed to environmental exposure.

Methods: The Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was administered to 50 female and 20 male personal injury litigants alleging IEI.

Results: The validity scales indicated no overreporting of psychopathology.

Idiopathic environmental intolerance: Part 2: A causation analysis applying Bradford Hill's criteria to the psychogenic theory.

Toxicogenic and psychogenic theories have been proposed to explain idiopathic environmental intolerance (IEI). Part 2 of this article is an evidence-based causality analysis of the psychogenic theory using an extended version of Bradford Hill's criteria. The psychogenic theory meets all of the criteria directly or indirectly and is characterised by a progressive research programme including double-blind, placebo-controlled provocation challenge studies.

Idiopathic environmental intolerance: Part 1: A causation analysis applying Bradford Hill's criteria to the toxicogenic theory.

Idiopathic environmental intolerance (IEI) is a descriptor for a phenomenon that has many names including environmental illness, multiple chemical sensitivity and chemical intolerance. Toxicogenic and psychogenic theories have been proposed to explain IEI. This paper presents a causality analysis of the toxicogenic theory using Bradford Hill's nine criteria (strength, consistency, specificity, temporality, biological gradient, biological plausibility, coherence, experimental intervention and analogy) and an additional criteria (reversibility) and reviews critically the scientific literature on the topic.

Idiopathic environmental intolerances (IEI): myth and reality.

The psychogenic theory presupposes that idiopathic environmental intolerance (IEI) is an overvalued idea explained by psychological and psychosocial processes. The polysomatic symptoms are amplifications of complaints common to the general population, psychophysiological manifestations of stress and the stress-response, or symptoms of psychiatric clinical syndromes. The psychogenic theory is supported by provocation challenge studies which demonstrate that appraisals of 'reactions' are unreliable and cognitively mediated.

Psychological treatment of psychogenic idiopathic environmental intolerance.

This chapter focuses on the psychotherapy of individuals who suffer distress from functional somatic syndromes; specifically, idiopathic environmental intolerance (IEI). While patients believe environmental intolerances cause their distress, its origin is treated as psychological, mediated through psychophysiological systems and mechanisms associated with the stress response. Factors considered include stress and trauma premorbid to the alleged onset of IEI; somatization and its expression through affective, anxiety, and somatoform disorders; personality disorders and associated psychological defenses; motivation for the sick role; and iatrogenic suggestion and reinforcement of unsubstantiated toxicogenic theories and treatments.

Psychogenic chemical sensitivity: psychogenic pseudoseizures elicited by provocation challenges with fragrances.

A middle-aged woman with a 10-year history of disability attributed to chemical sensitivities complained that exposure to specific fragrances immediately elicited seizures. Video-EEG monitoring was performed in a hospital neurodiagnostic laboratory during provocative challenge studies employing fragrances identified by the patient as reliably inducing symptoms. The baseline clinical EEG was normal.

Clinical consequences of the EI/MCS "diagnosis": two paths.

There are two distinct paths down which patients "diagnosed" with environmental illness/multiple chemical sensitivities (EI/MCS) can travel. Along the first path, beliefs about low-level, multiple chemical sensitivities as the cause of physical and psychological symptoms are instilled and reinforced by a host of factors including toxicogenic speculation, iatrogenic influence mediated by unsubstantiated diagnostic and treatment practices, patient support/advocacy networks, and social contagion. Intrapsychic factors also reinforce this path through the motivational mechanism of factitious malingering, or unconscious primary and secondary gain, mediated through psychological defenses, particularly projection of cause of illness onto the physical environment.

Assessing Beliefs about 'Environmental Illness/Multiple Chemical Sensitivity'.

Knowledge representation was used to characterize beliefs in patients with Environmental Illness/Multiple Chemical Sensitivity (EI/MCS). EI/MCS patients, allergy and asthma patients, doctors and controls made relatedness judgments on concepts relevant to EI/MCS. Associative networks showed that EI/MCS patients viewed these concepts differently from others.

Failure to assess psychopathology in patients presenting with chemical sensitivities.

Mediating processes can be inferred from self-report data only if it can be assumed that the patient has a valid capacity for introspection. That assumption is invalid when beliefs can be shown to influence sensory perception and symptom reports. Another serious limitation of self-reporting is that the individual has only a limited awareness of his or her psychological state.

Adult sequelae of childhood abuse presenting as environmental illness.

Sixty-three patients with polysomatic complaints attributed to sensitivity to environmental chemicals had detailed clinical assessments and diagnostic psychologic evaluations. Objective medical parameters failed to substantiate their beliefs that multiple chemicals were the cause of their problems. A group of 64 patients with chronic medical conditions and defined psychologic disorders not attributed to chemical exposure served as controls.

Double-blind provocation chamber challenges in 20 patients presenting with "multiple chemical sensitivity".

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.

Assessment of nasal patency by rhinoscopic measurement of cross sectional nasal airway area: correlation with subjective nasal symptoms.

Assessment of nasal patency by the recording of nasal symptom scores was compared with an objective method of determining nasal airway area using a fiberoptic rhinoscope. Sixty patients with active allergic rhinitis and nasal congestion requiring treatment were studied. Nasal symptoms were recorded and nasal airway area was measured before and at fixed time intervals after administration of either pseudoephedrine or oxymetazoline.

Neuropsychophysiology during relaxation in generalized, universal 'allergic' reactivity to the environment: a comparison study.

Comparisons were made among a group of patients presenting with universal 'allergic' intolerance to environmental chemicals (universal reactor, n = 58), a group of control subjects without psychologic symptoms (control, n = 55) and a group of outpatients from a psychology practice (psychologic, n = 89) on neuropsychophysiological measures during relaxation. The measures were electroencephalographic (EEG) spectral category for frequencies below 15 Hz, EEG beta activity, scalp electromyography (EMG), peripheral temperature (TEMP), and skin resistance level (SRL). The distributions of subjects in each group across eight EEG spectral categories were significantly different, with the distribution for universal reactors the same as that of the psychologic patients (p = 0.

Vocal cord dysfunction: the importance of psychologic factors and provocation challenge testing.

We present three case reports involving patients with vocal cord dysfunction. The onset of symptoms in one case was coincident with a generalized cutaneous reaction to penicillin with laryngeal involvement. The other cases had been misdiagnosed as food allergy and chemical sensitivity.

The practical approach to the evaluation of suspected environmental exposures: chemical intolerance.

The purpose of this article is to encourage allergists to expand their interest in environmental intolerance to include chemicals found in everyday exposure. By incorporating controlled challenge procedures into outpatient practice capabilities, the practicing allergist can expand both clinical interest and practice potential. By merging scientific principles of toxicology and psychology with the traditional investigative skills of the well-trained clinical allergist, we believe that discipline of allergy/immunology can realize a rather remarkable new dimension.

Inhaled metabisulfite sensitivity.

Sensitivity to an inhaled sulfite-containing solution was evaluated in 13 asthmatics and ten nonasthmatic controls. Three of the 13 asthma patients were known to be sensitive to ingested sulfite and ten were not sensitive. All three sulfite-sensitive patients developed bronchospasm following sulfite inhalation challenges.