From WIRED: The Next Thing You Smell Could Ruin Your Life

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

“The Next Thing You Smell Could Ruin Your Life” by Lexi Pandell of WIRED.

The article features Dr. Claudia Miller, allergist/immunologist, professor emeritus, and leader of the TILT Program at UT Health San Antonio. It shares how Dr. Miller has been working for decades to understand the reason why millions of people get sick amid certain scents, chemicals, foods, and drugs.

“In 1997, Miller proposed a career-defining theory of how people succumb to this condition. It came with a technical-sounding name, toxicant-induced loss of tolerance, and a convenient acronym, TILT. You can lose tolerance after one severe exposure, Miller says, or after a series of smaller exposures over time. In either case, a switch is flipped: Suddenly, people are triggered by even tiny amounts of everyday substances—cigarette smoke, antibiotics, gas from their stoves—that never bothered them before. These people become, in a word, TILT-ed,” Pandell wrote for WIRED.

Read the full article on WIRED.

The Progression of TILT Over the Years

In 1996, Dr. Miller, writing in the journal Toxicology, proposed a unifying theory of disease called 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 18 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.

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.

Educating People about TILT

Dr. Miller is also leading the charge in educating people about TILT.

The team aims to raise awareness of TILT and chemical intolerance among environmental health professionals, public health emergency response leaders, researchers, teachers, architects, parents and more.

Start with the TILT Tutorials:

TILT Tutorial for Chemical Intolerance, Autism/ADHD

TILT Tutorial for Exposed Communities and Individuals, Their Doctors, and Public Health Professionals

Find Out If You Are TILT’ed

Answer these three questions:

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)?

If you answer YES to any question, take the TILT Self Assessment and share the results with your doctor!

Email us at tilt@uthscsa.edu. Sign up for TILT e-news.