Article of Interest: Gearing Up for Expanded Veteran Benefits Tied to Toxic Exposure


Our team at the Toxicant-Induced Loss of Tolerance (TILT) Program at UT Health San Antonio wanted to share this important external article:

San Antonio-area VA services gearing up for expanded veteran benefits tied to toxic exposure” from the San Antonio Report.

Mari, who requested her last name be withheld, first deployed to Iraq in 2005 and also attended the PACT Act open house, one of 90 happening nationwide, to check on the claim she filed as the COVID-19 pandemic began. While serving, she said she lived and worked adjacent to a burn pit the size of a football field that spewed smoke day and night. The six-year Army veteran said she didn’t experience breathing problems while overseas, but decided to submit a claim after noting breathing problems beginning five years ago.
“I think my lungs are affected by the toxins that I was exposed to,” said the 38-year old San Antonio native, who served on two year-long tours in Iraq. “Now, it’s hard to breathe. I always feel tightness in my chest with anything like smoke, aerosol or fragrance. I feel like I’m always choking.”

This is important because veterans’ intolerances for smoke and fragrances are pathognomonic of Toxicant-induced Loss of Tolerance (TILT), said Dr. Claudia Miller, allergist/immunologist, professor emeritus, and leader of the TILT Program at UT Health San Antonio.

“The VA and DoD have not yet recognized this two-step disease mechanism, which is initiated by toxic exposures,” Miller said.

TILT begins with one major exposure, or repeated lower level exposures, to smoke, pesticides or other chemicals which sensitize the immune systems’ first responders—mast cells.

Once sensitized, the mast cells become “twitchy” and will react to everyday chemical inhalants, foods and drugs—exposures that never bothered the person before and do not bother most people.

Thereafter, everyday exposures to fragrances, cleaning chemicals, engine/traffic exhaust, foods/food additives, and structurally diverse chemicals can trigger sensitized mast cells to release thousands of mediators including histamine and other molecules that inflame the tissues and perpetuate illness. Mast cell degranulation can also affect the olfactory-limbic tract resulting in memory, mood and concentration difficulties, often described as “brain fog.”

“As long as doctors remain unaware of this important biomechanism, our armed forces will find It difficult to ‘maintain the fighting forces’ and recruit new soldiers,” Miller said. “The burn pit victims, which included President [Joe] Biden’s own son, are yet another group of disabled veterans who need to be assessed and treated for TILT.”

“New-onset intolerances for chemical inhalants, foods/food additives, and drugs are characteristic (pathognomonic) of TILT, much as fever is the hallmark of infection. Not all infected persons have fevers, nor are all fevers are due to infection. Nevertheless, if a patient has a fever, doctors must look for and treat an underlying infection. Likewise, patients with brain fog or other medically unexplained symptoms/syndromes need to be assessed for TILT.”

How chemically sensitive are you?

Answer these three questions from Hoffman TILT’s Brief Environmental Exposure and Sensitivity Inventory (BREESI):

  • Do you feel sick when you are exposed to tobacco smoke, certain fragrances, nail polish/remover, engine exhaust, gasoline, air fresheners, pesticides, paint/thinner, fresh tar/asphalt, cleaning supplies, new carpet or furnishings? By sick, we mean: headache, difficulty thinking, difficulty breathing, weakness, dizziness, upset stomach, etc.
  • Are you unable to tolerate or do you have adverse or allergic reactions to any drugs or medications (such as antibiotics, anesthetics, pain relievers, X-ray contrast dye, vaccines or birth control pills), or to an implant, prosthesis, contraceptive chemical or device, or other medical/surgical/dental material or procedure?
  • Are you unable to tolerate or do you have adverse reactions to any foods such as dairy products, wheat, corn, eggs, caffeine, alcoholic beverages, or food additives (e.g., MSG, food dye)?

If you answer YES to any of these three questions, take the Quick Environmental Exposure and Sensitivity Inventory (QEESI) and share the results with your doctor!

Editor’s Note: Burn pit image via the U.S. Department of Veteran Affairs here.

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