Environmental Sensitivities

Sex and Gender-based Analysis of this topic

Environmental sensitivities are adverse responses to agents in the environment (in air, dust, food, water, and consumer products) at exposure levels commonly tolerated by many people [1]. The responses may be to chemicals (multiple chemical sensitivities, sensitivity or intolerance(s)), to electromagnetic radiation (electrohypersensitivity), or to other environmental factors that collectively may be called environmental illness, sensitivity or intolerance, or sensitivity-related illness. 

Three stages in the development of sensitivity-related illness have been identified: 1) exposure to a harmful agent or agents; 2) stimulation of the body’s defence mechanisms and initiation of a state of sensitivity; and, 3) triggering of diverse symptoms on subsequent exposure to the same agents [2].  

Symptoms can be triggered in multiple body systems by low-dose exposures to a number of common chemicals, either individually or in combination [3].  The most prominent symptoms are having a stronger sense of smell than most people, feeling dazed, dull or groggy, and having difficulty concentrating [4]. Other symptoms may include muscle aches, fatigue, wheezing, digestive problems, and skin rashes. People affected by environmental sensitivities have reported that the most effective way to manage these adverse responses is the avoidance of chemicals, foods, inhalants and other agents such as electromagnetic radiation that trigger symptoms [5]. Clinicians working with chemically sensitive people have concurred on this point [6-7].

The underlying mechanisms of environmental sensitivities are not yet fully understood [6]. However, it is now recognized that there has been an increase in exposure to many environmental factors since the Second World War, and that environmental factors, interacting with genetic susceptibilities found in those with environmental sensitivities, may lead to toxicant-induced loss of tolerance in the population [7].

The Canadian Community Health Survey (CCHS) (2005) by Statistics Canada revealed that other chronic conditions co-occurred with environmental sensitivities, including myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia [8].  The 2005 CCHS also found that 1.2 million Canadians aged 12 or older, or 5% of the population, reported being diagnosed with at least one of these three conditions.  About 14% of the affected population had 2 of the 3 conditions. In the 2005 National Survey of the Work and Health of Nurses, 3.6% of Canadian nurses reported experiencing multiple chemical sensitivities, 1.9% fibromyalgia and 1.4% chronic fatigue syndrome [9].
Sex Issues
Environmental sensitivities are more prevalent in women than in men, with some estimates as high as 80% in women compared to 20% in men, with women reporting more severe symptoms [10].  Women may be more vulnerable because they have a higher body fat to muscle ratio than men, and so may have more body burden of toxicants accumulated in their fat.  Women’s use of cosmetics, their household cleaning activities, and their work in jobs such as in hair and nail salons could expose them to chemicals to which men are not as heavily exposed [11]. However, there is little research on the reasons for higher rates of environmental sensitivities in women, who are most frequently diagnosed between the ages of 30 and 40, the peak productive years for work and family [12]. 
Gender Issues
The symptoms of environmental sensitivities and the need to avoid chemical exposures have the potential to substantially limit women’s ability to perform daily activities.  Many women find it difficult to continue work because of chemical exposures in the workplace and a lack of understanding and accommodation by co-workers and administrators [13]. The Environmental Health Clinic of Women’s College Hospital in Toronto found that the majority of patients surveyed had stopped working on average three years after the onset of symptoms [12].  The inability to work can impose financial hardship on women and their families, and many women have reported obstacles to obtaining disability benefits or workers’ compensation [11]. 

Environmental sensitivities can also lead to social isolation and lack of access to medical care, education, and community services as women seek to minimize chemical exposure [14].  For some, it is difficult to find housing that does not trigger adverse responses. 
Since symptoms triggered by low level exposures to environmental agents vary among affected people and consistently abnormal laboratory tests are unavailable, researchers have investigated the possibility that these conditions have psychological origins [15].  Although people affected by environmental sensitivities are more likely than people without them to have anxiety and depression, recent research has found that few patients (1.4%) had such symptoms prior to the onset of their illness, but many (37.7%) developed them after their life-altering physical symptoms emerged [16]. Because women more frequently report environmental sensitivities, a gender bias has been suggested in the disproportionate focus on psychological and psychosocial factors [17].
Surveys show that environmental sensitivities affect all socio-economic classes [8,16]. However, residents in the lowest income households report environmental sensitivities at rates significantly higher than the national average; rates are also relatively high for people with less than high school graduation. 

Some groups in the population may be more exposed to hazardous environmental agents than others and are more likely to be diagnosed with environmental sensitivities [2].  These groups include industrial workers exposed to chemicals, occupants of “sick buildings”, Gulf War veterans, and people in communities where air or water is chemically contaminated. 

In Canada, environmental sensitivities were recognized in 2007 by the Canadian Human Rights Commission as a medical condition, and a disability [18].  As a result, people affected by environmental sensitivities are entitled to protection under the Canadian Human Rights Act, which prohibits discrimination on the basis of a disability. 
In spite of the large number of people affected by environmental sensitivities, there are significant gaps in access to medical care from knowledgeable health professionals, as well as a lack of appropriate housing, social supports and financial assistance [7]. Only two provinces, Ontario and Nova Scotia, have funded health clinics that assess patients, provide education about environmental health issues, and do clinical research.  At the Women’s College Hospital Environmental Health Clinic, waiting times can be 6 to 8 months, and services are only available to adult Ontario residents.  A Paediatric Environmental Health Specialty Unit, within an academically-affiliated paediatric clinic in Alberta, provides clinical services and conducts research on children’s environmental health.  In other provinces, affected individuals must seek out the few doctors with training in environmental medicine or consult family practitioners. 
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