Psychologists and Psychiatrists: How to Recognize Chemical Intolerance in Patients

Psychologists, psychiatrists, and social workers need to understand chemical intolerance and be able to rule it out in their patients and make appropriate referrals, said Dr. Claudia Miller, allergist/immunologist, professor emeritus, and leader of the Hoffman TILT Program at UT Health San Antonio.

Chemical Intolerance, also known as TILT (Toxicant Induced Loss of Tolerance), is a two-stage disease process initiated by a major exposure, or a series of low-level exposures, to chemicals in previously tolerable household products, foods, and drugs, which often cause symptoms in illnesses such as fibromyalgia, chronic fatigue syndrome, brain fog, and more.

How can mental healthcare providers recognize chemical intolerance?

Ask their patients, at intake, these three questions from the Hoffman TILT Program’s Brief Environmental Exposure and Sensitivity Inventory (BREESI):

  1. 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.
  2. 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?
  3. 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)?

A patient’s answers will produce diagnostic clues that mental healthcare providers should not miss, Miller said.

“For example, patients/clients who feel great outdoors but have symptoms (anxiety attacks, brain fog, confusion, wheezing, headaches, etc.) inside stores or in other indoor environments; around fragrances; in the detergent aisle of a grocery; inside a new car or a taxi with fragranced hanger tags; while driving in heavy traffic; staying in a room with gas heaters; in restaurants or residences with gas cooking; around fireplaces, etc., suffer from chemical intolerance until proven otherwise,” Miller said. “Individuals with chemical, food, and/or drug intolerances—and especially those who have all three—should be approached differently. They often do not tolerate usual medications.”

TILT and chemical intolerance go hand in hand with mast cell activation syndrome (MCAS), according to a study by Miller and colleagues Dr. Tania T. Dempsey and Lawrence B. Afrin of the AIM Center in New York.

More than half of MCAS patients in the study met the international criteria for chemical intolerance.

“Immediately following the Gulf War, the VA hired me to take detailed exposure histories on the first 60 or so veterans referred for complex, ‘unexplained’ illnesses,” Miller said. “Some said they felt much better outdoors, e.g., when they spent a long holiday weekend in the north woods of Wisconsin or on the high mesas of Colorado, only to feel sick again when they drove in heavy holiday traffic back to their homes laden with fragrances, pesticides, mothballs, cleaning chemicals, new carpet, and in some cases mold. Or they returned to work, housework, or hobbies which exposed them to chemical inhalants—mowing the lawn, working on cars, glues, solvents, fragrances, candle-making, etc.”

Psychiatrists, psychologists, social workers, and any other healthcare or mental healthcare giver who sees complex patients, especially those with neurological or psychological manifestations, should be able to take a rudimentary exposure history and understand just how polluted indoor air environments, especially in the absence of sufficient fresh air ventilation, can be, Miller said.

“Psychological symptoms are not necessarily psychogenic. Practitioners of every stripe need to learn about and consider exposures that can initiate TILT/MCAS (pesticides, implants, a major chemical spill or fire) and thereafter trigger their patients’ symptoms (fragrances, cleaning chemicals, traffics exhaust) before they invoke psychological explanations,” Miller said.

Understanding chemical intolerance and MCAS could help mental healthcare workers better diagnose and care for their patients, Miller said.

“All psychiatrists, psychologists and social workers need to be able to rule out chemical intolerance and MCAS,” Miller said. “The BREESI and QEESI can help them understand how mast cells in the olfactory-limbic tract (brain fog, anxiety attacks), airways, GI and GU tracts, skin, etc., can be sensitized and subsequently triggered by a seemingly minor exposure to chemical inhalants (also foods and drugs) that never bothered the person previously and do not bother most people.”

Healthcare workers also should be trained on MCAS, TILT, and chemical intolerance.

“Health and mental health care professionals who suffer from these conditions themselves—and there are many—will be grateful and receptive [ for this training],” Miller said. “This is how we can help prevent our patients from being gaslighted, how we prevent Munchausen’s by proxy, how we can expand understanding of both MCAS and TILT.”

Are you chemically intolerant?

Take the Quick Environmental Exposure and Sensitivity Inventory (QEESI) and share the results with your doctor!