1716f Environmental intolerance – a clinical perspective

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Environmental intolerance is relatively prevalent in the general population, recognised by the patients as highly variable symptoms attributed to different perceived harmful exposures such as indoor environment, chemicals, odours, electromagnetic fields and noise. It is not uncommon with progression from a few triggers and symptoms to a multifaceted complex of symptoms triggered by multiple factors. Typically, the symptoms occur at very low exposure levels, below thresholds of acute toxicologic effects and at levels tolerated by a large majority of the population. To understand the background of environmental intolerance, a multi-professional approach is needed with knowledge of allergy, public health, toxicology, physics, chemistry, psychiatry and psychology. In Uppsala we have developed a model where the patients have individual consultations with a medical doctor, an industrial hygienist and a psychologist, respectively. The overall aim is a thorough evaluation of symptoms, exposure and temporal relationship to rule out a medical disease aiming at curative treatment. A well-defined disease is only established in a minority of the cases. Instead, a holistic approach is needed including analysing a range of aspects that may contribute to the condition. The attitude towards the patient, in the professional team, is characterised by active listening, seriousness, confidence building and sufficient time for the patient to describe symptoms and triggers. The final assessment of the patient is made by the physician after discussing the results of the examinations made by other members of the team. By a respectful response aiming for a trustful relationship a discussion can then continue with the patient giving objective information, based on scientific state of the art, related to environmental intolerance. An individual treatment plan includes, if necessary, medical treatment and cognitive behavioural therapy to encourage the patient to refrain from an avoidance behaviour for the triggers, thus improving quality of life and social functioning.

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