Tag: Gulf War Illness

Multiple chemical sensitivity and chronic fatigue syndrome in British Gulf War veterans

Abstract:

The objective of this study was to measure the prevalence of multiple chemical sensitivity (MCS) and chronic fatigue syndrome (CFS) in British Gulf War veterans and to investigate their association with reported exposures and psychologic morbidity. In 1997–1998, the authors undertook a cross-sectional survey of three cohorts of British military personnel comprising Gulf veterans (n = 3,531), those who had served in Bosnia (n = 2,050), and those serving during the Gulf War but not deployed there (Era cohort, n = 2,614). MCS and CFS were defined according to operational criteria.

The prevalence of MCS in the Gulf, Bosnia, and Era cohorts was 1.3%, 0.3%, and 0.2%, respectively. For CFS, the prevalence was 2.1% (Gulf cohort), 0.7% (Bosnia cohort), and 1.8% (Era cohort). In Gulf veterans, MCS was strongly associated with exposure to pesticides (adjusted odds ratio = 12.3, 95% confidence interval: 5.1, 30.0). Both syndromes were associated with high levels of psychologic morbidity.

These findings suggest that CFS and MCS account for some of the medically unexplained illnesses reported by veterans after deployment to the Gulf. MCS was particularly associated with Gulf deployment and self-reported exposure to pesticides, findings that merit further exploration given the controversial status of this diagnosis and the potential for recall bias in a questionnaire survey.

 

Source: Reid S, Hotopf M, Hull L, Ismail K, Unwin C, Wessely S. Multiple chemical sensitivity and chronic fatigue syndrome in British Gulf War veterans. Am J Epidemiol. 2001 Mar 15;153(6):604-9. http://aje.oxfordjournals.org/content/153/6/604.long (Full article)

 

Toxicant-induced loss of tolerance

Abstract:

Drug addiction and multiple chemical intolerance (abdiction) appear to be polar opposites–the former characterized by craving and dependency, the latter by aversion. However, when the two are viewed in juxtaposition similarities emerge, revealing a common underlying dynamic, one which appears to be a new paradigm of disease. TILT, or toxicant-induced loss of tolerance, bridges the gap between addiction and abduction and has the potential to explain a variety of illnesses, including certain cases of asthma, migraine headaches and depression, as well as chronic fatigue syndrome, fibromyalgia and “Gulf War syndrome”.

This paper argues that both addiction and chemical intolerance involve a fundamental breakdown in innate tolerance, resulting in an amplification of various biological effects, particularly withdrawal symptoms. While addicts seek further exposures so as to avoid unpleasant withdrawal symptoms, chemically intolerant individuals shun their problem exposures, but for the same reason–to avoid unpleasant withdrawal symptoms.

These observations raise critical questions: do addictive drugs and environmental pollutants initiate an identical disease process? Once this process begins, can both addictants and pollutants trigger symptoms and cravings? TILT opens a new window between the fields of addiction and environmental medicine, one that has the potential to transform neighboring realms of medicine, psychology, psychiatry and toxicology.

 

Source: Miller CS. Toxicant-induced loss of tolerance. Addiction. 2001 Jan;96(1):115-37. http://www.ncbi.nlm.nih.gov/pubmed/11177524

 

Stressors, personality traits, and coping of Gulf War veterans with chronic fatigue

Abstract:

OBJECTIVES: preliminary surveys of Persian Gulf veterans revealed a significant prevalence of self-reported symptoms consistent with chronic fatigue syndrome (CFS). The purpose of this study was to compare self-reported life stressors, combat, and chemical exposures, personality and coping between Gulf War veterans with CFS and healthy veterans.

METHODS: following a complete physical, psychiatric, and neuropsychological evaluation, 45 healthy veterans, 35 veterans with CFS and co-morbid psychiatric disorder, and 23 veterans with CFS and no co-morbid psychiatric disorder completed questionnaires assessing war and non-war-related life stressors, self-reports of environmental exposure (e.g. oil well fires, pesticides), personality, and coping.

RESULTS: measures of personality, self-reported combat and chemical exposures, and negative coping strategies significantly differentiated healthy veterans from those with CFS.

CONCLUSION: a biopsychosocial model of veterans’ illness was supported by the fact that personality, negative coping strategies, life stress after the war, and environmental exposures during the war were significant predictors of veterans’ current physical function.

 

Source: Fiedler N, Lange G, Tiersky L, DeLuca J, Policastro T, Kelly-McNeil K, McWilliams R, Korn L, Natelson B. Stressors, personality traits, and coping of Gulf War veterans with chronic fatigue. J Psychosom Res. 2000 Jun;48(6):525-35. http://www.ncbi.nlm.nih.gov/pubmed/11033371

 

Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome

Abstract:

Fibromyalgia and widespread pain were common in Gulf War veterans with unexplained illness referred to a rheumatology clinic. Increased tenderness was demonstrated in the postmenstrual phase of the cycle compared with the intermenstrual phase in normally cycling women but not in users of oral contraceptives. Patients with fibromyalgia had high levels of symptoms that have been used to define silicone implant-associated syndrome. Tender points were found to be a common transient finding associated with acute infectious mononucleosis, but fibromyalgia was an unusual long-term outcome. The common association of fibromyalgia with other rheumatic and systemic illnesses was further explored. A preliminary study revealed a possible linkage of fibromyalgia to the HLA region. Patients with fibromyalgia were found to have an impaired ability to activate the hypothalamic pituitary portion of the hypothalamic pituitary adrenal axis as well as the sympathoadrenal system, leading to reduced corticotropin and epinephrine response to hypoglycemia. Much interest has been expressed in the literature on the possible role of autonomic dysfunction in the development or exacerbation of fatigue and other symptoms in chronic fatigue syndrome. Mycoplasma genus and mycoplasma fermentans were detected by polymerase chain reaction in patients with chronic fatigue syndrome. It was reported that myofascial temporomandibular disorder does not run in families. No major therapeutic trials in fibromyalgia, chronic fatigue syndrome, or myofascial pain syndrome were reported over the past year. The effectiveness of cognitive behavioral therapy and behavior therapy for chronic pain in adults was emphasized. A favorable outcome of fibromyalgia and chronic fatigue syndrome in children and adolescents was reported.

 

Source: Buskila D. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. 2000 Mar;12(2):113-23. http://www.ncbi.nlm.nih.gov/pubmed/10751014

 

Neurally mediated hypotension in fatigued Gulf War veterans: a preliminary report

Abstract:

BACKGROUND: Many patients with chronic fatigue syndrome (CFS) have neurally mediated hypotension when subjected to head-up tilt, suggesting autonomic nervous system dysfunction. Some Gulf War veterans have symptoms similar to CFS. Whether they also tend to have neurally mediated hypotension is unknown.

METHODS: We performed 3-stage tilt-table testing on 14 Gulf War veterans with chronic fatigue, 13 unfatigued control Gulf War veterans, and 14 unfatigued control subjects who did not serve in the Gulf War. Isoproterenol was used in stages 2 and 3 of the tilt protocol.

RESULTS: More fatigued Gulf War veterans than unfatigued control subjects had hypotensive responses to tilt (P < 0.036). A positive response to the drug-free stage 1 of the tilt was observed in 4 of 14 fatigued Gulf War veterans versus 1 of 27 unfatigued control subjects (P < 0.012). Heart rate and heart rate variation during stage 1 was significantly greater in the fatigued group (P < 0.05).

CONCLUSION: We conclude that more fatigued Gulf War veterans have neurally mediated hypotension than unfatigued control subjects, similar to observations in CFS. Autonomic nervous system dysfunction may be present in some fatigued Gulf War veterans.

 

Source: Davis SD, Kator SF, Wonnett JA, Pappas BL, Sall JL. Neurally mediated hypotension in fatigued Gulf War veterans: a preliminary report. Am J Med Sci. 2000 Feb;319(2):89-95. http://www.ncbi.nlm.nih.gov/pubmed/10698092

 

Prevalence of chronic fatigue and chemical sensitivities in Gulf Registry Veterans

Abstract:

More than 68000 of the 700000 veterans of the Gulf War have become members of the Veteran Affairs’ Gulf War Registry. In 1995, we undertook a questionnaire study of the symptoms and medical histories reported by a randomly selected subsample of 1935 of these veterans to characterize their complaints. All results reported were based on questionnaire responses without face-to-face evaluation or physical examinations.

Inasmuch as initial registry symptoms overlapped those of Chronic Fatigue Syndrome and Multiple Chemical Sensitivities, we also included standard questions for these syndromes in the questionnaire. A total of 1161 (60%) individuals responded, and there were no major demographic biases; therefore, 15.7% of registry veterans qualified for Chronic Fatigue Syndrome in accordance with the 1994 Centers for Disease Control definition.

In addition, 13.1% qualified for multiple chemical sensitivities in accordance with a widely used definition, and 3.3% of the respondents had both conditions. There were no effects of gender, race, branch, duty status (active or reserve), or rank, although Multiple Chemical Sensitivities was somewhat more prevalent in women and African Americans.

The data gleaned in this study suggested that the unexplained symptom syndromes of Chronic Fatigue and Multiple Chemical Sensitivities may characterize an appreciable portion of the complaints of those who volunteered for the Veterans Affairs’ Gulf War Registry, and further investigation is warranted.

Comment in: Gulf War Syndrome, Chronic Fatigue Syndrome, and the Multiple Chemical Sensitivity Syndrome: stirring the cauldron of confusion. [Arch Environ Health. 1999]

 

Source: Kipen HM, Hallman W, Kang H, Fiedler N, Natelson BH. Prevalence of chronic fatigue and chemical sensitivities in Gulf Registry Veterans. Arch Environ Health. 1999 Sep-Oct;54(5):313-8. http://www.ncbi.nlm.nih.gov/pubmed/10501146

 

Paraoxonase/MCS

Work in multiple laboratories on paraoxonase polymorphism has shown that this mammal enzyme protects against chlorpyrifos and other organophosphates differentially, depending on which inherited forms of the enzyme predominate. This variable ability to process pesticides exists in humans and is trackable ethnically (1), and very recent articles have suggested the polymorphism may be responsible for host susceptibility to Gulf War syndrome (2,3). Because my own interest is in multiple chemical sensitivity (MCS) mechanisms, I immediately searched Medline (National Library of Medicine, Bethesda, MD) for publications that included paraoxonase and MCS, fibromyalgia, or chronic fatigue syndrome (CFS), which have been suggested as being overlapping or identical with each other and with Gulf War syndrome (4,5). I found no other references at all.

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1566473/pdf/envhper00513-0015b.pdf

 

Source: Rowat SC. Paraoxonase/MCS. Environ Health Perspect. 1999 Aug;107(8):A395. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1566473/pdf/envhper00513-0015b.pdf

 

Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome

Abstract:

Fibromyalgia was almost completely absent from an urban affluent population compared with poor urban and rural communities. Seventeen percent of Gulf War veterans with soft tissue syndromes had fibromyalgia, a much higher rate than was seen in previous studies of rheumatic disease in the military population. A state of central hyperexcitability in the nociceptive system was reported in fibromyalgia. Altered functioning of the stress-response system has been further documented in fibromyalgia and chronic fatigue syndrome.

Administration of growth hormone to patients with fibromyalgia who have low levels of insulin-like growth factor 1 resulted in improvement in their symptoms and tenderness. An association between chronic fatigue syndrome and initial infections was demonstrated. A correlation between particular immunologic abnormalities and measures of disease severity was documented in chronic fatigue syndrome. Concomitant fibromyalgia in other rheumatic diseases was a major contributor to poor quality of life. A favorable outcome of fibromyalgia in children was reported; the majority of patients improved over 2 to 3 years of follow-up. Treatment of patients with fibromyalgia continues to be of limited success.

 

Source: Buskila D. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. 1999 Mar;11(2):119-26. http://www.ncbi.nlm.nih.gov/pubmed/10319215

 

Human herpesviruses in chronic fatigue syndrome

Abstract:

We have conducted a double-blind study to assess the possible involvement of the human herpesviruses (HHVs) HHV6, HHV7, Epstein-Barr virus (EBV), and cytomegalovirus in chronic fatigue syndrome (CFS) patients compared to age-, race-, and gender-matched controls.

The CFS patient population was composed of rigorously screened civilian and Persian Gulf War veterans meeting the Centers for Disease Control and Prevention’s CFS case definition criteria. Healthy control civilian and veteran populations had no evidence of CFS or any other exclusionary medical or psychiatric condition. Patient peripheral blood mononuclear cells were analyzed by PCR for the presence of these HHVs.

Using two-tailed Fisher’s exact test analyses, we were unable to ascertain any statistically significant differences between the CFS patient and control populations in terms of the detection of one or more of these viruses. This observation was upheld when the CFS populations were further stratified with regard to the presence or absence of major axis I psychopathology and patient self-reported gradual versus acute onset of disease. In tandem, we performed serological analyses of serum anti-EBV and anti-HHV6 antibody titers and found no significant differences between the CFS and control patients.

 

Source: Wallace HL 2nd, Natelson B, Gause W, Hay J. Human herpesviruses in chronic fatigue syndrome. Clin Diagn Lab Immunol. 1999 Mar;6(2):216-23. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC95690/ (Full article)

 

Developing case definitions for symptom-based conditions: the problem of specificity

Symptom-based conditions are postulated organic diseases that are characterized primarily by chronic physical (somatic) symptoms (1, 2). Contemporary conditions associated with multisystem complaints are generally referred to as chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivities, silicone associated atypical rheumatic disease, sick building syndrome, and most recently, Gulf War syndrome (table 1). Possibly related disorders that will not be considered in the following analysis include epidemic neuromyasthenia, hyperventilation syndrome, reactive hypoglycemia, post-lyme disease syndrome, and irritable bowel syndrome (3).

Although the need to consistently define symptombased conditions has been repeatedly emphasized, there has been limited progress in establishing widely accepted diagnostic criteria (1,4). Based on reports in English-language publications, symptom-based conditions were analyzed to determine why it has been difficult to develop case definitions of unique diseases.

You can read the rest of this article here: http://epirev.oxfordjournals.org/content/20/2/148.long

 

Source: Hyams KC. Developing case definitions for symptom-based conditions: the problem of specificity. Epidemiol Rev. 1998;20(2):148-56. http://epirev.oxfordjournals.org/content/20/2/148.long (Full article)