Q. Do you recommend any doctors who specialize in treating chemical intolerance?
A. We do not recommend particular doctors. Choosing a doctor is a very personal matter. In part, it depends on your specific health problems. Any doctor can be helpful if he or she listens to you and takes your symptoms and intolerances seriously.
Q. Is there any help for people with chemical intolerances?
A. Yes. People who are chemically intolerant often feel better once they learn to avoid substances (chemicals, food, and drugs) that make them feel ill. Family support is essential. Patients often take the time to research and reduce exposures to volatile organic chemicals (e.g., cleaning agents, fragrances, gasoline). This may require the help of a patient’s family and co-workers. Initially, individuals may go through “withdrawal,” during which they commonly feel worse for several days. After about a week of avoiding their problem exposures, patients become “unmasked” and report a heightened ability to recognize exposures that trigger their symptoms. The best recoveries are when patients also take the time to identify food intolerances. However, elimination diets need to be done under medical guidance.
Q. I noticed you used the words chemical intolerance. Is that the same as chemical sensitivity?
A. We no longer use the term “chemical sensitivity”—chemical intolerance more accurately describes the responses to chemicals, foods, and drugs that we see with TILT. When patients experience adverse reactions that are immunologically (Ig-E) mediated, these reactions are considered “allergic” in nature, and we say patients are “sensitive” to the substance that causes the allergic reaction. Responses that are non-Ig-E-mediated are termed “intolerances.” Allergists use skin tests and blood tests (RAST) to identify classical allergies (e.g., to dust mites, pet dander and some foods). While helpful, these methods only identify a subset of the exposures that may be making patients ill. TILT specifically addresses intolerances, rather than allergies/sensitivities, although many patients have both. In addition, the term “intolerance” is readily understood and accepted by most doctors, and translates meaningfully to other languages.
Q. Is there a treatment facility for people who are chemically intolerant?
A. Unfortunately, no academic medical center has built an Environmental Medical Unit (EMU). An EMU is an environmentally controlled in-patient hospital unit designed to isolate patients from exposures that trigger their symptoms. It is widely accepted that such a unit is an essential tool for diagnosis, research and treatment of conditions suspected of having environmental origins. This goes far beyond the study of chemical intolerances, with potential benefits for understanding conditions as diverse as asthma, AD/HD, autism, autoimmune diseases.
Q. How is chemical intolerance diagnosed?
A. Chemical intolerance is not a diagnosis per se. Intolerances can be associated with a variety of medical diagnoses (e.g., migraine, asthma, depression). These diagnoses are labels based upon recognized constellations of signs and symptoms, but they do not indicate what made the patient sick. Doctors need to explore environmental exposures that may have initiated TILT, and try to identify exposures that are triggering current symptoms (e.g., headache, difficulty breathing, cognitive changes). The QEESI is the only validated screening tool for assessing intolerances, triggers and life impact.
Q. Is there a special diet you recommend for TILT?
A. About 90 percent of chemically intolerant patients that we’ve studied also report food intolerances. A rotary elimination diet can reveal which foods are provoking symptoms. These diets are very challenging, but without eliminating problem foods patients continue to have symptoms. Inhalants (airborne chemicals) and ingestants (foods, medications, alcohol, caffeine) need to be explored simultaneously.
Q. What is the Personal Precautionary Principle?
A. The Personal Precautionary Principle recognizes that not every exposure will be regulated at the levels needed to protect the most vulnerable individuals—children, pregnant women, or the chemically susceptible. However, many exposures cannot be avoided at the personal level (vehicle emissions, community-wide exposures), so strong protections for our air and water are vital. Unfortunately, the price of a safer environment may be out of reach for those who need it most. Nevertheless, informed consumer choices (e.g., cleaning and personal care products, pest control, foods) can improve individual health and influence the marketplace.
Q. What is the TILT test and where can I find it?
A. The TILT test is a validated assessment tool also known as the Quick Environmental Exposure and Sensitivity Inventory, or the QEESI. The QEESI screens for symptoms, common chemical and food intolerances, life impact of intolerances, and masking. Doctors should use the QEESI in their practice to get a one-time baseline on every patient and to measure changes over time, either pre-and post-exposure, or pre-and post-treatment.
Q. Why doesn’t my doctor recognize TILT or chemical intolerances as a diagnosis?
A. There is no insurance billing code for chemical intolerance. Doctors can only diagnose and bill for conditions resulting from TILT such as migraine, asthma and depression.
Q. Do you consult on worker’s comp and disability claims?
A. Although we don’t do any legal work, publications by Dr. Claudia Miller may be helpful, and most are available free-of-charge.
Q. Do you see patients?
A. Although Dr. Miller no longer sees patients, people who are TILTed are encouraged to participate in the Hoffman TILT Program. It is the goal of the Hoffman TILT Program to advance research related to TILT. TILT represents a new class of diseases, involving a two-stage disease process not previously recognized. We feel we can best help patients by focusing our efforts on research.
Q. Are there treatments that you recommend other than avoidance?
A. There are no validated treatments for chemical intolerance. Most patients improve by avoiding chemical and food triggers, although this can be an arduous task. Clearly, we need more research, and specifically, we need an Environmental Medical Unit (EMU) in every major academic medical center.
Q. Can TILT result from multiple exposures over time? You describe a single exposure, like pesticides, as an initiating event.
A. In the case of a single exposure, the initiating event is much clearer. For multiple exposures that occur over months or years, it is more difficult to determine the underlying cause(s) for illness. However, the presence of multi-system symptoms and adverse reactions to low-level exposures, foods and drugs, may point to TILT.