Dr. Stephen Barrett "M.D." is an outspoken individual who retired
from psychiatry in 1993 and then proclaimed himself "the media"
in 2001. He was never board-certified in psychiatry, and he was
never board-certified in anything else. He has zero experience as
a practitioner in every form of internal, dermatological, and dental
medicine. In addition, he was not a researcher in any capacity,
either. He was neither a biochemist, nor a vaccinologist, nor a
medical technologist, nor anything similar.
An Allegation of Stephen Barrett that Calls for a Response:
Stephen Barrett alleged, throughout his anti-MCS literature,
that a primary test for chemical sensitivities consists in ...
(I) a very subjective and non-quantitative form of testing ...
(II) by which a diluted chemical solution is placed under ...
the tongue of a patient (or injected through his skin), ...
(III) followed by nothing more than the patient reporting if
whether or not he experiences any symptom from the
administered chemical solution.
This allegation, in combination with numerous omissions
of fact, can easily deceive a beginner into assuming that
there has never been a test to prove the existence of
chemical sensitivities. This allegation, therefore, calls for
a response.
The Response:
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
To start, the testing for IgE-mediated chemical allergies has
been conducted via mainstream medical RAST testing. The
specific chemicals tested are found in the OCCUPATIONAL
PANEL of a RAST TEST order form. This means that main-
stream medical science recognizes the undisputed existence of
chemical allergies. Case closed. The never-board-certified
Stephen Barrett loses again. It would do the intrusive slander-
er well to stay out of things that do not concern him.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
In addition:
(1) The testing for chemical sensitivities has included, but
has not been limited to, ...
(I) ... the traditional skin prick test, otherwise known as the
SPT.
(II) In skin prick testing, a test-subject is regarded as having
tested positive when a visible and measurable wheal,
equal to or larger than a designated size, appears as a
result of the skin test.
(III) The size of the wheal is then recorded in numerical form,
and numerical measurement constitutes objectivity.
IgE-mediated Chemicals, via the Process of Haptenation
(2) The purpose for the SPT is to test for immediate onset
Type I hyper-reactivity. Such a reaction occurs within
one hour of exposure.
(I) IgE stands for Immunoglobulin E, and an immunoglobu-
lin is a protein produced by plasma cells & lymphocytes,
serving the function of an antibody.
(II) A number of chemicals have been found to trigger im-
mediate onset reactions, and a subset of those have
been discovered to be IgE-mediated, via a process
known as "haptenation."
(III) Haptein is a greek word which means "to fasten," and
a hapten is a low weighted molecular agent that reacts
with an antibody, but cannot induce the formation of
an antibody until it is fastened to either a carrier protein
or to a large antigenic molecule. Chemicals happen to
be agents of low molecular weight.
Type IV Hypersensitivity Reactions
(3) In addition, there are a significant number of chemicals
which have been found to induce Type IV, cell-mediated
hyperreactivity. This is known as "delayed allergic reac-
tivity," and this type hypersensitivity results in dermatitis.
(I) Concerning Type I and Type IV hyper-reactivity, the
Practice Parameter for Allergy Diagnostic Testing, as
is issued by the Joint Council of Allergy Asthma and
Immunology, states:
"Many chemicals (e.g., sulfonechloramides,
azo dyes, parabens, fragrances) used as
additives in foods, drugs, and cosmetics
may induce either IgE-mediated reactions
or contact dermatitis, or both." [Ann Al-
lergy 1995; 75:543-625]
Non-immunological Chemical Sensitivity Reactions,
Including Anaphylaxis
(4) In addition, a number of chemicals have been identified
as irritants, being that they trigger very real "nonimmuno-
logical" responses. There is even a nonimmunolgical form
of anaphylaxis, called an "anaphylactoid reaction." Such
a reaction produces the same final result as doe an immuno-
logic anaphylactic reaction, and the only difference between
the two types of reactions is in the triggering mechanism of
them. That is to say:
"An anaphylactoid reaction is another type of
immediate reaction that mimics anaphylaxis.
While symptoms and treatments are the same
the reason for the reaction is not. An ana-
phylactoid reaction does not involve the IgE
antibodies' immune system and is not consid-
ered a true allergic reaction. Even so, the
reaction can be just as serious." [American
College of Allergy, Asthma & Immunology]
See:
http://www.acaai.org/public/advice/anaph.htm
(I) Thus, there is Allergic Asthma, and then there is Irritant-
induced Asthma. One type of asthma is immunologic,
while the other type is not. You are not inclined to run
a 26 mile marathon in either case, whenever you are
exposed to your asthma triggers.
Allergic Sensitization, Direct Irritation,
and Pharmacological Reactions
(5) Hypersensitivity reactions can be triggered via:
(a) Allergic Sensitization. This is induced by repeated
exposure to a sensitizing agent such as formaldehyde,
glutaraldehyde, or phenyl isocyanate. And then, upon
becoming sensitized, further exposure to the agent re-
sults in an antibody release and/or an inflammatory
chemical release.
(b) Direct Irritation. This is induced in those who are
"atopic;" (in those who possess chronic vulnerabilites
or pre-existent conditions). Such persons develop
"symptoms immediately after exposure to substances
such as chlorine, ammonia, sulfur dioxide, and envi-
ronmental smoke."
(c) Pharmacological Reaction. This comes as a result
of the fact that some chemicals and nonchemical agents
elevate the production of chemicals that naturally exist in
the body. An example of a naturally existent chemical
in the body, able to have its level elevated by nontoxic
chemical exposure, is acetylcholine. A case in point is
the organophosphate/carbamate class of pesticide. Even
at nontoxic levels, it can elevate the level of acetylcholine
in the lungs, because that class of pesticide inhibits the
enzyme acetylcholinesterase.
For further understanding on this, see the Mayo Clinic's
teaching on Occupational Asthma. It is found at:
http://www.mayoclinic.com/health/occupational-asthma /DS00591/DSECTION=3&
A Sample of IgE-mediated Chemicals
(6) For confirmation purposes, examples of IgE-mediated
chemicals which can be involved in skin testing, include
the following:
(a) The disinfectant Ortho-phthalaldehyde.
It has even resulted in anaphylaxis, concerning the
product "Cidex OPA." See:
<> Nine episodes of anaphylaxis following cystoscopy
caused by Cidex OPA (ortho-phthalaldehyde) high-
level disinfectant in 4 patients after cystoscopy.
{J Allergy Clin Immunol. 2004 Aug;114(2):392-7}
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd= Retrieve&db=PubMed&list_uids=15316522&dopt=Citation
(b) Formaldehyde.
It is masked behind a number of aliases, and it outgases
from the shampoo and liquid soap ingredients, DMDM
hydantoin, imidazolidinyl urea, diazolidinyl urea, and
quaternium-15. See:
<> IgE-mediated urticaria from formaldehyde in a
dental root canal compound. (The full text describes
28 cases of Formaldehyde Sensitivity. {J Investig
Allergol Clin Immunol., 2002;12(2):130-3}
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=12371530&dopt=Abstract
<> Exposure to gaseous formaldehyde induces IgE-
mediated sensitization to formaldehyde in school
children. {Clin Exp Allergy, 1996 Mar;26(3): 276-80}
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=8729664&dopt=Abstract
<> IgE allergy due to formaldehyde paste during
endodontic treatment. Apropos of 4 cases:
2 with anaphylactic shock & 2 with generalized
urticaria. {Rev Stomatol Chir Maxillofac. 2000
Oct;101(4):169-74}
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=11103423&dopt=Abstract
(c) Vinyl Sulphone Reactive Dyes.
They are also known as fiber-reactive dyes, as well as
azo dyes. They include Remazol Black B. See:
<> Roll of skin prick test and serological measure-
ment of specific IgE diagnosis of occupational
asthma resulting from exposure to vinyl sulphone
reactive dyes. {Occup Environ Med. 2001 Jun;58
(6):411-6}
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=11351058&dopt=Citation
<> Asthma, rhinitis, and dermatitis in workers exposed
to reactive dyes. {Br J Ind Med. 1993 Jan;50(1):65-
70}
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=8431393&dopt=Abstract
(d) Cyanuric Chloride.
It is used in the production of plastics, herbicides, pharma-
ceuticals, and fiber-reactive dyes. It is also a structural
component of monochlorotriazine and dichlorotriazine dyes.
See:
<> Immunologic cross-reactivity between respiratory
chemical sensitizers: reactive dyes and cyanuric
chloride. {J Allergy Clin Immunol. 1998 Nov;102(5):
835-40}
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=pubmed&dopt=Abstract&list_uids=9819302&query_hl=9
(e) The disinfectant Chlorhexidine.
It has even triggered anaphylaxis. See:
<> FDA Public Health Notice:
Potential Hypersensitivity Reactions to
Chlorhexidine-Impregnated Medical Devices
http://www.fda.gov/cdrh/chlorhex.html
<> Immediate hypersensitivity to chlorhexidine:
literaure review. {Allerg Immunol (Paris) 2004.
Apr;36(4):123-6}
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=pubmed&dopt=Abstract&list_uids=15180352&query_hl=16
(f) Phthalic Anhydride.
Nail polish ingredient, ingredient in specific spray paints, and
an agent used in the making of unsaturated polyester resins,
alkyd resins, polyester polyols, and insect repellents.
<> Detection of specific IgE in isocyanate and phthalic
anhydride exposed workers: comparison of RAST
RIA, Immuno CAP System FEIA, Magic Lite SQ.
{Allergy. 1993 Nov;48(8);627-30}
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=8116862&dopt=Abstract
<> In vitro demonstration of specific IgE in phthalic
anhydride hypersensitivity. {Am Rev Respir Dis.,
1976 May;113(5):701-4}
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve &db=PubMed&list_uids=1267268&dopt=Abstract
(7) The test that Barrett condemns in his anti-MCS literature
is the provocation-neutralization test. And the only type
of practitioner that he mentions in the same literature is
so-called clinical ecologist. Barrett inaccurately explain-
ed the provocation-neutralization test, in his omitting of
pivotal fact, and he additionally gave the illusion that the
only person on earth who tests for chemical sensitivity is
the so-called clinical ecologist.
(I) Firstly, the diagnosing of the various forms of chemical
sensitivity has been occurring in the worlds of the Occu-
pational and Environmental Health Specialist, the Ear
Nose Throat & Allergy Specialist, the Dermatologist,
and even the Chest Physician. In fact, from the world
of the chest physician came the golden rule for diagnos-
ing Irritant-associated Vocal Cord Dysfunction. And,
two pivotal papers on chemical sensitivity were pro-
duced by the head of the department of emergency
medicine of an american university. Yes, emergency
medicine.
(II) And secondly, Barrett failed to mention that the provo-
cation-neutralization test has included the measuring of
objective skin wheals.
Barrett Failed to Mention that it is an Offshoot
of the Serial Endpoint Titration Skin Testing
Procedure, Covered by Aetna Insurance
(8) The provocation-neutralization test is actually an
offshoot of the serial endpoint titration skin testing
procedure, covered by Aetna Insurance. And this
is pertinent to note in light of the observation that
Stephen Barrett has repeatedly stated what Aetna
covers, as if Aetna alone is the ultimate benchmark
in diagnostic testing.
(I) Now, the Skin Endpoint Titration seeks to first identify
a patient's allergens or hymenoptera venom hypersen-
sitivities (such as to that of hornets, bees, wasps, fire
ants, and/or yellow jackets.) That is to say, the Skin
Endpoint Titration first seeks to find the triggering dose
of a hypersensitivity reaction.
(II) The same testing then seeks to find the neutralizing
dose of the same allergen or venom. Now, this is
done for immunotherapy purposes, and the neutraliz-
ing dose is found in a series of skin tests. The dose
at which the patient no longer experiences a hyper-
sensitivity reaction is the "endpoint." It constitutes
the neutralizing dose. It then becomes the "safe
starting dose" for immunotherapy. Thus originates
the name "neutralization" in the provocation-neutrali-
zation test. The goal of the provocation-neutralization
test is to identify the "neutral dose."
(III) In summary, the provocation-neutralization test
looks for objective skin wheals, while simultane-
ously asking the patient how he/she feels when,
of course, such testing involves skin testing. And the
appearance of wheals have been documented in such
testing.
(IV) The diagnostic parameters become exceeded when
the testing is considered positive on an either/or basis;
on the basis of either the appearance of an objective
skin wheal or the subjective reporting of a symptom.
However, this is a test that concerns itself with prog-
nostic parameters, also.
(V) Nonetheless, to consider a test positive exclusively on
the merits of an objective skin wheal is to keep the
diagnostic part of any type of skin test within accept-
able parameters. It's the sublingual drops version of
such testing which raises eyebrows.
Wheal Reactions Showed a Distinct Pattern
(9) Objective skin whealing was consistently documented
during a research undertaking that tested the reliability
of the provocation-neutralization test. The result of
the research goes as follows:
"Reaction by symptoms to foods, chemicals,
and normal saline solution showed a random
pattern, although wheal reactions showed a
distinct pattern."
(I) Let it be repeated. In the skin test version of the
provocation-neutralization test:
"wheal reactions showed a distinct pattern."
(II) The conclusion of that research undertaking goes
as follows:
"Skin response alone may be a more
reliable indicator and require cross-
validation with other tests, such as
oral and inhalation challenges and
comparison with a control popula-
tion." See:
<> Intradermal skin testing for food and chemical
sensitivities: a double-blind controlled study.
{J Allergy Clin Immunol. 1999 May;103(5 Pt 1):
907-11}
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd= Retrieve&db=PubMed&list_uids=10329827&dopt=Abstract
(III) Concerning the prognostic aspect of the provocation-
neutralization test, Aetna states:
"Since provocation-neutralization requires the
provoking and neutralizing of symptoms to a
single item at a time, the patient could be re-
quired to undergo hundreds of individual tests
requiring weeks or months of full-day testing."
(Well, this is what Aetna states.)
(IV) The bottomline is that skin testing has been used to
identify individual chemical sensitivities to chemicals
such as formaldehyde and phenyl isocyanate, and
phthalic anhydride. Tested patients produced the
objective medical finding of visible and measurable
wheals. And this has included forms of testing other
than that of the neutralization-provocation test
(V) Chemically sensitive patients have tested positive in
inhalation challenge testing, as well as in patch testing
(the testing that seeks to detect delayed hypersensitivity
reponses.) And chemically sensitive patients were also
documented as having objective medical findings via
the fiberoptic rhinolaryngoscopy and even the biopsy.
Some patients were found to have inflamed air sacs of
the lungs, while other ones were found to have hepatic
injury in the absence of viral infection. Other ones were
found to have upper-respiratory erythema and swelling.
Chemical Sensitivity exists in a number of forms. It's very
real, and it can be quite brutal. In as much, it has been re-
peatedly documented that chemicals, at ambient (nontoxic)
levels, are not universally harmless.
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