Dear Friends and Supporters,
In 1858, when Lincoln was nominated for U.S. Senator, he said: “A house divided against itself cannot stand.”
In the 1970s this song became popular: “United we stand, divided we fall, and if our backs should ever be against the wall, we’ll be together, together, you and I.”
In 1996, Dr. Claudia Miller of UT Health San Antonio, writing in the journal Toxicology, proposed a unifying theory of disease called “Toxicant-Induced Loss of Tolerance” (TILT). TILT offered a new, understandable scientific framework for a host of “medically unexplained symptoms and syndromes” initiated by diverse toxic exposures. These exposures ranged from pesticides, volatile organic compounds (VOCs), breast implants, and Gulf War chemicals, combustion products, and more recently toxic molds and algae.
In 1999, recognizing the need for a systematic and quantitative approach for measuring chemical intolerance, Dr. Miller developed the “Quick Environmental Exposure and Sensitivity Inventory” (QEESI). This 50-item questionnaire has become the gold standard for diagnosing TILT. To date, researchers and clinicians from 17 countries have used the QEESI to publish more than 100 peer-reviewed papers.
In 2000, in the millennial edition of the journal Addiction, Miller described how exposures to petrochemicals appear to initiate addictions to formerly tolerated chemicals, foods, and drugs. This paper is built upon clinical observations first made by allergist Theron Randolph in the 1950s.
Fast forward to 2021. Dr. Miller and mast cell experts Lawrence Afrin and Tania Dempsey published a pivotal study in Environmental Sciences Europe, revealing that nearly two-thirds of patients diagnosed with mast cell activation syndrome (MCAS) met QEESI criteria for chemical intolerance. Since its publication, this paper has had more than 30,000 views!
In 2023, in a large population-based U.S. survey, Dr. Miller’s team used the QEESI to identify two broad classes of TILT initiators: 1) fossil fuel-related toxicants, that is, coal, oil or natural gas, their combustion products, and 2) synthetic chemical derivatives, including pesticides, implants, drugs/antibiotics, VOCs, and biogenic toxicants such as particles and VOCs from mold or algae.
Mast cells evolved more than 500 million years ago in early vertebrate fish to protect our internal milieu from the external chemical environment. Mast cells are our immune system’s “first responders” and are present in every tissue.
Although first described in 1877, our knowledge of what mast cells do is very recent. In fact, our 2021 paper first connected TILT with toxic exposures altering mast cells potentially epigenetically. Why has our knowledge of mast cells lagged so far behind? It is because they live in tiny numbers at the interface between all of our tissues—the olfactory-limbic tract (nose-to-brain pathway), our airways, our digestive tract, and skin—and the external chemical environment. Unlike antibodies, mast cells rarely circulate in the bloodstream. Finally, they are extraordinarily fragile and release tiny quantities of hundreds of mediators which are essential in coordinating the immune response to foreign substances (xenobiotics). Our discovery that toxic exposures alter mast cells provides an “understandable and researchable biomechanism” for all TILT- and MCAS-related conditions.
Please join our quest to stop chemical intolerance by supporting our work today!
In a 2024 paper published in the Journal of Xenobiotics’ special issue on autism, Miller’s team reported that parents whose chemical intolerance scores on the QEESI were in the top 10th percentile of U.S. adults, compared to the bottom 10th percentile, had 5.7 times the risk of having a child with autism and 2.1 times the risk of having one with ADHD.
Also in 2024, Dr. Miller’s team published the first paper demonstrating how “Environmental House Calls” involving trained inspection teams, indoor air testing, and occupant counseling can reduce symptom severity in primary care patients. This approach may also prevent illness in susceptible individuals, their children, and health problems resulting from altered genes causing neural tube defects, miscarriages, autism, and ADHD in succeeding generations. Most medical centers offer genetic counseling to parents at risk for particular diseases. We propose offering environmental testing and counseling to families to prevent environmentally related diseases such as asthma, autism, ADHD, autoimmune diseases, allergies, addictions, and affective disorders such as depression.
Professor Peter Spencer, internationally renowned neurotoxicologist of Oregon Health and Sciences University, recently wrote to his U.S. colleagues who teach toxicology, urging them to incorporate our tutorials into their research and training programs:
- TILT Tutorial for Autism/ADHD
- TILT Tutorial for Exposed Communities and Individuals, Their Doctors, and Public Health Professionals
- TILT Self-Assessment
As patients, health professionals, and researchers, together we stand at the forefront of these challenges.
I encourage you to contribute, whether through research, education, outreach, and especially with your donation.
Best regards,
Claudia S. Miller, MD, MS
Professor Emeritus
Allergy/Immunology and Environmental Health
UT Health San Antonio