How Chemically Sensitive Are You?

There's a quiz to find out if toxic exposures are linked to your health issues

Toxicant-Induced Loss of Tolerance is difficult to detect as it often causes multiple symptoms in different parts of the body.(DimaBerlin/Shutterstock)

A new theory of a disease process caused by pesticides and other toxic chemicals may explain multisystem symptoms for which a disease cause hasn’t been found.

Many in the medical community have identified widespread pesticide and other chemical exposure as a real health threat, causing serious debilitating health effects.

A questionnaire is now used as a diagnostic tool—along with an introductory brief version of the questionnaire—to help reveal whether you might unknowingly have an underlying disease process called toxicant-induced loss of tolerance, or TILT.

We’re all exposed to toxic chemicals on an ongoing basis, but for some of us, these exposures become intolerable. Perhaps the exposures have accumulated to a problematic level or their bodies are suffering a condition that inhibits their ability to tolerate these chemicals. Whatever the cause, TILT is the result.

This information was presented by Dr. Claudia Miller at the Beyond Pesticides Forum: Seminar 1 on Health, which took place on Sept. 15.

Miller is a professor emeritus and member of the research faculty in the Department of Family and Community Medicine at The University of Texas Health Science Center at San Antonio. She has both treated and studied the effects of toxic chemical and pesticide exposure.

Miller is coauthor of “Chemical Exposures: Low Levels and High Stakes,” which you can read for free online, courtesy of the Hoffman Toxicant-Induced Loss of Tolerance Program at the University of Texas Health San Antonio. The book explores the issue of chemical intolerance among a rising number of people.

Brief Questionnaires Can Help Identify Chemical Exposure

As humans, we’re exposed to so many more new synthetic chemicals than our ancestors were 50, 100, or even 300 years ago. To get an idea if chemical exposure may be behind some symptoms and health issues you’ve experienced, answer these three questions from the Brief Environmental Exposure and Sensitivity Inventory (BREESI) questionnaire:

1. 1. Do you feel sick when you’re exposed to tobacco smoke, certain fragrances, nail polish/remover, engine exhaust, gasoline, air fresheners, pesticides, paint/thinner, fresh tar or asphalt, cleaning supplies, or new carpet or furnishings? By sick, we mean headache, difficulty thinking, difficulty breathing, weakness, dizziness, upset stomach, and so forth.
   2. Are you unable to tolerate, or do you have adverse or allergic reactions to, any drugs or medications (such as antibiotics, anesthetics, pain relievers, X-ray contrast dye, vaccines, or birth control pills) or to an implant, prosthesis, contraceptive chemical or device or other medical, surgical, or dental material or procedure?
   3. Are you unable to tolerate, or do you have adverse reactions to, any foods such as dairy products, wheat, corn, eggs, caffeine, alcoholic beverages, or food additives (such as MSG and food dye)?

If you answer “yes” to any of these three questions, consider taking the free online Quick Environmental Exposure and Sensitivity Inventory (QEESI) at tiltresearch.org/qeesi-online and sharing the results with your doctor.

QEESI is the internationally validated reference standard for assessing chemical intolerance and the TILT disease process. It has been translated and used by researchers in more than 16 countries and in more than 80 studies published in peer-reviewed journals.

In surveys of 10,000 U.S. adults who took the brief version, BREESI, 20 percent reported intolerances to chemicals, foods, and drugs, while more than half reported food intolerances.

In chemically intolerant U.S. adults, nearly half of those who have taken the longer QEESI questionnaire reported one or more initiating events. Those initiating events included exposure to mold, remodeling or construction, combustion products, medical procedures and implants, and pesticides. Treatment involves avoidance of the chemicals that trigger symptoms, as well as resolving or healing from the initiating chemical exposure event. One example is properly removing mold in the home if exposure to mold and the toxins that go with it, called mycotoxins, is the initiator.

The Basics of Toxicant-Induced Loss of Tolerance (TILT)

A toxicant is a toxic substance that’s produced by or is a byproduct of man-made activities. Amid this modern spread of toxicants, Miller has proposed a new theory of disease, Toxicant-Induced Loss of Tolerance (TILT), which has the following two stages of development:

• Initiation: caused by a one-time acute event; a series of exposures; or long-term, low-level exposures to toxic chemicals.

• Triggering: caused by previously tolerated chemicals, food, or drugs that can cause multi-system symptoms.

TILT can be confusing to detect because it can cause symptoms in many body systems: cardiovascular; respiratory; ear, nose, and throat; skin; connective tissue and musculoskeletal; gastrointestinal; neuropsychological; and miscellaneous syndromes, such as chronic fatigue syndrome or Gulf War syndrome. Being in a toxic environment day after day can “mask” the symptoms and hide the relationship between exposures and symptoms.

Potential initiators and triggers for TILT include:

• Pesticides.
• Cleaning agents, including ammonia, bleach, and disinfectants.
• Solvents, including paints and glues.
• Drugs and medical devices, including anesthetics, antibiotics, vaccines, implants, and chemotherapy.
• Oil and petroleum products.
• Combustion-related products, including tobacco smoke, tar and asphalt, natural gas, soldering and welding, and engine exhaust.
• Indoor Air Volatile Organic Compounds (VOCs), including new carpet, plasticizers, formaldehyde, fragrances, and mold VOCs.

Most people spend the majority of their day indoors, where volatile organic compound exposures are five to 10 times greater than outdoors. These very low-level indoor exposures can trigger symptoms in “TILTed” individuals, Miller said.

Chemical Intolerance, TILT Are Different Than Allergies

Chemical intolerance and TILT aren’t the same as classic allergies that involve immunoglobulin E (IgE) antibodies, which most allergists are looking for. The TILT disease process involves toxicant sensitization of mast cells, our immune system’s first responders to foreign chemical substances, including synthetic organic chemicals, foods and food additives, medications, and recreational drugs.

In a study published in Environmental Sciences Europe in 2021, Miller and her researcher colleagues gave the following rundown and background on mast cells (MCs):

“These sentinel cells guard the perimeters of our skin and other organs, warding off invaders and protecting our internal milieu. They serve as first responders to most bodily invasions and insults.

“Largely lying in wait, these warriors spring into action if they perceive a major threat, releasing a vast array of mediators all at once.

“Once triggered, MCs can deploy more than 1,000 distinct cell-surface mediator receptors resulting in inflammation, allergic-like phenomena, or altered tissue growth and development.”

Dramatic Increases in Exposure to Chemicals

Miller said three major events have occurred in the past few centuries that have dramatically increased our exposure to toxic chemicals that have overactivated our mast cells.

1760–1820: The industrial revolution gave birth to the chemical industry, resulting in a new chemical presence in human society and the environment.

1940s-present: Research, much of it spurred by World War II, led to new synthetic organic chemicals and their rapid adoptions, including synthetic chemical pesticides, herbicides, insecticides, solvents, dyes, and fragrances. These chemicals creep ever deeper into our personal environments.

Early 1970s: The oil embargo and energy conservation efforts in the 1970s triggered a shift in building design that came with a host of problems. Homes and buildings were sealed more tightly without adequate ventilation to ensure sufficient air exchange. The result was moisture buildup and the development of “sick buildings” that became breeding grounds for toxic molds and the accumulation of contaminants given off from everything from paint to cleaning products. Indoor air pollutants have risen to levels higher than ever before as outgassing from volatile and semi-volatile organic chemicals became trapped indoors.

Only now are researchers learning that our contemporary chemical exposures may be provoking mast cells to release their inflammatory mediators, resulting in “mast cell activation syndrome” with chronic and/or recurrent multi-system symptoms.

Taking the QEESI questionnaire and sharing the results with doctors may help more people identify the previously unrecognized TILT disease process, mast cell activation syndrome or chemical intolerance, and chemical exposures that may have initiated illness, Miller said.

Stories of Toxic Chemicals Causing Terrible Effects 

An important part of the questionnaire asks if other people or pets in the household have experienced health problems. Sometimes the answer to this question can provide previously missed information.

Dr. Claudia Miller

In Miller’s case, in 1977, she and her husband moved to an old house, and she made what she later realized was a mistake by hiring an exterminator to spray. Within a few months, her kitten died. She now knows that kittens are especially sensitive to the organophosphate insecticides that are sprayed by exterminators—something we all should be aware of because these types of insecticides are still heavily used today.

Jane Little

Jane Little—a BBC journalist who had to drop out of her career for a couple of long spells because of chemical-related health challenges—introduced Miller at the forum. She said she got “hit hard by herbicides” and was plagued by severe neurological symptoms after walking her dog in an area that had been sprayed with two different pesticide concoctions.

She eventually realized that she suffered her first extreme reaction to chemicals when a cocktail of disinfectants was used on her father’s family farm in England in 2001. She believes that may be the instigating event in both her and her father’s chemical intolerance.

As long as she avoids the chemicals that trigger uncomfortable symptoms, she’s mostly well now. But her experience led her to research and report on chemical-induced disease, including in the deeply personal “Allergic to the 21st Century” radio documentary she did for the BBC.

Melissa Diane Smith is a holistic nutrition counselor and journalist who has been writing about health topics for more than 25 years. She’s the author of several nutrition books, including “Syndrome X,” “Going Against the Grain,” “Gluten Free Throughout the Year,” and “Going Against GMOs.”