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Good Scents Sense

Perfumes, fragrances can affect respiratory patients.

It all began one spring day in Allentown, PA, circa 1994. Susan Herbert, CRTT, GRT, was working as a therapist at Lehigh Valley Hospital and living in an apartment nearby. "They put new carpeting in my apartment and it caused my eyes to burn and tear (from the chemicals)," she recalled. "It was instantaneous and lasted."

She had always suffered from mild asthma, but soon her condition intensified. "I started to suck Halls drops and take neb treatments just to get through the work day," she said. "At the end of June, I crashed." Herbert was hospitalized for three weeks with an acute exacerbation of asthma.

Next spring, Herbert found she could no longer get to the hospital due to the tree pollen outside. "It was like inhaling fire," she said. "I couldn't work, because I couldn't come out of the house."

Since then, she has experienced offshoots of neurological and endocrinary aliments that have left her unable to leave the house without donning a surgical mask. Additionally, she cannot tolerate even minute traces of fragrances. They make her cataplectic, she told ADVANCE.

MCS Troubles
Herbert has since found a name for the condition that confines her to the indoors most of the year: Multiple Chemical Sensitivity Syndrome (MCS).

It is a lightning rod condition that eludes strict medical diagnosis. For example, the American Medical Association (AMA) futilely attempted to develop a position statement for MCS in 1999. "There is extreme polarization around the issue," explained Richard J. Jackson, MD, director of the National Center for Environmental Health at the CDC and co-chair of the interagency work group that drafted the report. "MCS advocates believe we have not adequately incorporated the literature that supports their position, and the critics have argued that we have been too willing to listen to the advocates."

It may be impossible for a position statement on this issue to be developed by the federal government, said Dr. Jackson, who called the condition a label in search of scientific basis. Without that basis, MCS does not technically exist as a diagnosis, although the Social Security administration currently recognizes it as a legitimate cause for disability.

Twenty-three doctors on the work group did sign a tentative MCS diagnosis criteria, which was published in the Archives of Environmental Health. Their findings:

  • Symptoms are reproducible with repeated chemical exposure;

  • It is a chronic condition;

  • Trace exposure results in syndrome manifestation;

  • Symptoms improve when the incitants are removed;

  • Responses occur to multiple chemically unrelated substances;

  • Symptoms involve multiple organ systems.

    Smell Triggers
    Regardless of whether MCS is physiological, neurological or psychological, for Herbert it is all too real.

    Before spring 1994, she never noticed how many of her fellow therapists wore perfumes to work. In fact, she was one of them. Now she wonders how anyone who treats respiratory patients could sport potential triggers like scented products. "Fragrance is very underrated as a serious irritant to people who have serious airway inflammatory problems," she said.

    She recommends therapists should start ridding themselves of scented soaps, perfumes and hair sprays and buy unscented versions. They need to read the ingredients on products. If the label lists anything as a fragrance, then it is a potential irritant. "Most products have unscented versions right on the same shelf," she said. "It is a matter of choice."

    Another problem relates to using chemically dense cleansers in the house. She advises people to seek out so-called "Green Products," which limit or eliminate harsh chemicals. In any case, it is still preferable to clean when children are not present, and while leaving the windows open to ensure proper ventilation.

    "Chec" Mate
    Additional tactics to achieve a healthy indoor environment are available through the Children's Health Environmental Coalition (CHEC), a non-profit organization dedicated to educating the public.

    Also offered through CHEC are a video called "Not Under My Roof!" starring Olivia Newton-John and Kelly Preston and a clearing house of indoor environmental tidbits. One example: "Synthetic carpeting along with their backings and glues contain so many chemicals that some people call them a 'toxic soup.'"

    Finally, Herbert asked caregivers to be vigilant in the future: "As respiratory therapists, we owe it to our patients to know better, to act on that knowledge especially in the workplace and to teach our patients, especially the parents of asthmatic children, that lowering the level of respiratory irritants in their homes can significantly reduce symptoms."

    For more information about CHEC, visit the organization's Web site at

    Shawn M. Proctor is an assitant editor of ADVANCE.

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