Jule Klotter

Electrohypersensitivity Diagnosis and Treatment

In March 2020, Dominique Belpomme and Philippe Irigaray, who are affiliated with the European Cancer and Environment Research Institute, published a review article about electrohypersensitivity. The article is based on a registered database that they have maintained since 2009, which contains clinical information on over 2000 patients with electrohypersensitivity (EHS) and multiple chemical sensitivity (MCS). The World Health Organization’s 2005 fact sheet 296, “Electromagnetic fields and public health,” says that “EHS is characterized by a variety of non-specific symptoms….[and] resembles MCS, another disorder associated with low-level environmental exposure to chemicals….” WHO does not recognize EHS as an illness that can be diagnosed and treated medically. Belpomme and Irigaray want WHO to add EHS to the international classification of diseases (ICD).

The review authors conducted a prospective study, using questionnaire-based interviews and clinical physical examinations of the first 727 consecutive cases included in the database: 521 (71.7%) self-reported EHS only; 52 (7.1%) reported MCS only; and 154 (21.2%) reported EHS and MCS. Two-thirds of the EHS-only and MCS-only groups were women, and women accounted for three-fourths of the combine EHS/MCS group.

Like MCS, those with EHS report diverse symptoms—many of which are neurological—including the following: headache (88%), dysesthesia (pain, itchy, or burning sensations; 82%), ear heat/otalgia (70%), dizziness (70%), tinnitus (60%), concentration/attention deficiency (76%), immediate memory loss (70%), fatigue (88%), insomnia (74%), and tendency for depression (60%). The EHS patients report that the symptoms arise or increase with exposure to electromagnetic field sources. While the incidence of some clinical symptoms (eg, headache, balance disorder, concentration/attention deficiency) was statistically similar in those with EHS only and MCS only, other symptoms appeared more often in those with EHS, including dysesthesia, ear heat/otalgia, tinnitus, hyperacusis (sound sensitivity), dizziness, immediate memory loss, insomnia, and fatigue. Patients with both EHS and MCS tended to be more ill. The EHS/MCS group also was more likely to be inflicted with skin lesions (45%), found mostly on the hands—“particularly on the hand which held the mobile phone.”

Belpomme and Irigaray sought biomarkers that characterize EHS and/or MCS.  They found increased histamine in both EHS and MCS patients (30-40%), “suggesting a low-grade inflammatory process is involved….”  Also, about twenty percent of the 727 patients had autoantibodies against O-myelin.  About 80% of EHS patients had increased levels of one or more of the measured oxidative/nitrosative stress-related biomarkers: thiobarbituric acid reactive substances (TBARS), oxidized glutathione, and nitrotyrosine. Patients with EHS also had abnormal neurotransmitter profiles.

In addition to blood and urine biomarkers, the doctors used radiological tests to find clues about these conditions. They report that brain imagery, including CT scans, MRIs, and angioscans, “are usually normal” in both EHS and MCS patients. Transcranial Doppler ultrasound, however, shows decreases in mean pulsatility index in cerebral arteries, particularly in those with both EHS and MCS, resulting in decreased blood flow velocity. Ultrasonic cerebral tomosphygmography (UCTS)  shows that people with EHS and/or MCS tend to have decreased capillary blood flow to the limbic system and the thalamus in the brain: “Although these abnormalities are not specific, since they may be similar to those found in Alzheimer’s disease and other neurodegenerative disorders, we recently confirmed that UCTS could presently be one of the most accurate imaging techniques to be used to diagnose EHS and/or MCS and to follow objectively treated patients.”

Because EHS and MCS symptoms are diverse and non-specific, Belpomme and Irigaray suggest ruling out known pathologies that could account for the symptoms first. A repeatable association between EMF exposure and changes in clinical symptoms, as well as the presence of chemical sensitivities (which is associated with EMF), indicate the possibility of electrohypersensitivity.  Increased histamine (in absence of allergy) and/or increased oxidative/nitrosative stress-related biomarkers are found in about 70% of patients with EHS. By adding ultrasonic imaging, Belpomme and Irigaray were reportedly able “to objectively diagnose EHS in about 90% of EHS self-reported patients.”

The authors report that many EHS patients have “a profound deficit in vitamins and trace minerals, especially in vitamin D and zinc, which should be corrected.” They have also used fermented papaya preparation and Ginkgo biloba to restore brain pulsatility. Treatment also includes glutathione, antioxidants, anti-histaminics (if histamine levels are high), and anti-nitrosative medications. Avoidance of electromagnetic radiation and chemical stressors and use of protective measures are also important. In the authors’ experience, symptoms may decrease and even disappear with treatment and protection, but “hypersensitivity to EMF and/or MCS-related chemical sensitivity never disappears…EHS and MCS appear to be associated with some irreversible neurological pathological state, requiring strong and persistent prevention.”

Electrohypersensitivity affects 3% to 5% of the population in many countries, according to current estimates.  As environmental exposure to man-made electromagnetic radiation continues to increase, the incidence is likely to grow. Belpomme and Irigaray organized an international scientific consensus meeting on EHS and MCS in 2015 (Brussels) during which “scientists unanimously asked WHO to urgently assume its responsibilities, by classifying EHS and MCS as separate codes in the ICD, so as to increase scientific awareness of these two pathological entities in the medical community and the general public, and to foster research….” WHO has not yet responded.

Belpomme D, Irigaray P. Electrohypersensitivity as a Newly Identified and Characterized Neurologic Pathological Disorder How to Diagnose, Treat, and Prevent It.  Int J Mol Sci. 2020;21:1915.

Altered Microbiome and Fibromyalgia

Can the composition of the GI microbiome become an objective diagnostic measure for fibromyalgia? A group of Canadian researchers conducted a controlled study that compared the microbiomes of 77 women with fibromyalgia (FM) to 79 control volunteers.      The control group consisted of first-degree female relatives of the patients (genetic control; n=11), male and female household members of the patients (environmental controls; n=20), and unrelated healthy women (n=48). Dietary analysis found no significant differences between the FM group and controls.

Using 16S rRNA and metagenome methods, the researchers validated the presence of 196 species in 156 stool samples from the participants. (Another 80 species were not in the database used to make identification.) Species diversity between the FM group and control groups differed nonsignificantly, but there was a significant difference in abundance: “…species found in higher abundance in FM patients clustered together, whereas those found in higher abundance in controls clustered separately.” Most notably, the women with FM had less butyrate metabolism-related bacteria, such as F. prausnitzii and B. uniformis, but an increase in others (ie, F. plautii, I butyriciproducens). The researchers also found an association between the abundance of several organism groups and FM-related symptoms (ie, pain intensity and distribution, fatigue, sleep disturbances, and cognitive issues).

After identifying composition differences, the Canadians used machine-learning algorithms to define the types of organisms most associated with FM and used this analysis to determine which patients were controls and which were diagnosed with FM. Using microbiome composition alone, they were able to differentiate patients from controls (receiver operating characteristic area under the curve 87.8%).  The authors say, “…these results suggest that the composition of the microbiome could be indicative of the diagnosis of FM.”

More research, of course, is needed. This study population was small and consisted primarily of Caucasians; GI microbiome composition varies with geographic location, diet, lifestyle, and ethnicity. But the study does open the possibility of an objective way to diagnosis fibromyalgia. The authors note that this study was not designed to show a cause-effect relationship between altered microbiome and fibromyalgia.

Minerbi A, et al. Altered microbiome composition in individuals with fibromyalgia. Pain. November 2019;160(11):2589-2602.

Fragrances and Chemical Sensitivity

Australian Anne Steinemann, an internationally recognized authority on indoor air quality and fragranced consumer product emissions, recently looked at the incidence of chemical sensitivity in four countries. Chemical sensitivity usually arises from exposure to commonly used petrochemical products and pollutants (eg, pesticides, building materials, solvents, new carpet and paint, and consumer products). Steinemann used population samples that mirrored the age, gender, and region of the general population: United States (US; n=1137), Australia (AU; n=1098), Sweden (SE; n=1100), and the United Kingdom (UK; n=1100). Her epidemiological study also looked at chemical sensitivity’s co-prevalence with fragrance sensitivity (health problems from fragranced products), medically diagnosed multiple chemical sensitivities (MCS), asthma/asthma-like conditions, and autism/autism spectrum disorders.

Chemical sensitivity affects 19.9% of the general population across the four countries (US 25.9%, AU 18.9%, SE 16.3%, UK 18.5%). More people in the general population reported sensitivity to fragrances: (US 34.7%, AU 33.0%, SE 27.8%, UK 33.1%). Not unexpectedly, the incidence of fragrance sensitivity is even higher among people with chemical sensitivity: (US 81.0%, AU 82.6%, SE 77.7%, UK 86.8%). In addition, the incidences of asthma/asthma-like conditions and of autism spectrum disorders were higher among those with chemical sensitivity.

Steinemann says that fragranced consumer products—such as air fresheners/deodorizers, laundry products, cleaning products, personal care products (eg, soap, hair products), and perfumes—“can be a primary trigger of health problems.” Fragrances are particularly problematic for people with chemical sensitivity and can trigger several symptoms, including respiratory problems (50.2%), mucosal symptoms (39.4%), migraine headaches (36.9%), skin problems (29.9%), asthma attacks (25.2%), and neurological problems (17.7%). Nine percent of the general population reported losing workdays or a job in the previous year because of sickness from fragranced product exposure in the workplace.

The most highly rated treatment for chemical sensitivity, according to a 2003 survey of 917 people with self-reported multiple chemical sensitivity, is avoidance;  56.5% of the 875 people who tried it found chemical avoidance very helpful and 38.0% found it somewhat helpful. Yet, avoiding fragrances and troublesome chemicals is challenging. As Steinemann explains in an article on fragrance-free policies, no country monitors the health effects of the 4000 documented fragrance ingredients. Most product labels do not report fragrance ingredients. Even “fragrance-free” products may not be devoid of fragrance chemicals; “products called ‘unscented’ may in fact be a fragranced product with the addition of a masking fragrance to cover the scent.” Steinemann also reports that products reportedly “green,” “natural,” “organic,” or made with essential oils also emit many of the same potentially hazardous chemicals as regular fragranced products. One option for finding fragrance-free products is to use the US Environmental Protection Agency’s search engine (https://www.epa.gov/saferchoice/products).

Gibson PR, Elms A N-M, Ruding LA. Perceived Treatment Efficacy for Conventional and Alternative Therapies Reported by Persons with Multiple Chemical Sensitivity. Environmental Health Perspectives. September 2003; 111(12);1498-1504.

Steinemann a. Ten questions concerning fragrance-free policies and indoor environments. Building and Environment. 2019;159

Steinemann A. International prevalences of chemical sensitivity, co-prevalences with asthma and autism, and effects from fragranced consumer products. Air Quality, Atmosphere & Health. 2019;12:519-527.     

Medicinal Cannabis and Opioid Use

Can the use of medicinal cannabis (MC) by patients with chronic pain decrease their use of opioids? Several studies based on patient surveys and/or interviews indicate that people are using MC, when available, as an alternative or as a complement to pain medication that allows them to use fewer addictive opioids—or taper off the drugs altogether. Patients report that medical cannabis acts more quickly, has fewer side effects than opioid medications, and increases their quality of life.

As Bia Carlini, PhD, explained in a 2018 article, pre-clinical research studies have verified that exogenous cannabinoids (like those in the marijuana plant) provide pain relief by binding to the body’s endocannabinoid receptors. Randomized clinical trials have shown that cannabinoid agents “are effective analgesics for chronic pain,” but most of the studies involved pharmaceutical products like Nabiximols (a botanical extract not available in the US) or Nabilone, a synthetic THC. These studies cannot verify that medical marijuana use, in which the plant is usually smoked or consumed, has the same effects.

Although the US government restricts the use of marijuana, which is listed as a Schedule 1 drug (no medicinal value and high potential for abuse), some states now permit its medicinal use. As a result, real-world evidence is showing that MC use appears to be useful in treating pain with less adverse effects. For example, Medicare prescriptions for pain have decreased in states with legal MC, and a 2014 JAMA Internal Medicine study showed that states with legal MC had significantly lower death rates from opioid overdose (1999-2010) than those that did not. Still, at this point, no randomized controlled trials have compared the effectiveness of opioids to MC in relieving pain.

The federal government has not supported MC research until recently. The National Institutes of Health has awarded a grant to researchers at Albert Einstein College of Medicine and Montefiore Health System for a prospective cohort study that will follow 250 patients with recent MC certification, severe chronic pain, and opioid use for 18 months (NCT03268551).  Its estimated date of completion is June 30, 2022. States that permit MC also are conducting research. Using tax money from marijuana sales, the Colorado Public Health Department has funded a double-blind crossover study with 100 participants that assesses how cannabis compares to oxycodone and to a placebo in reducing neck and back pain (NCT 02892591). This study is scheduled to conclude in January 2021. Studies like these may provide more evidence that medical cannabis can be as effective and less harmful than opioid drugs in treating chronic pain.

Carlini B. Role of Medicinal Cannabis as Substitute for Opioids in Control of Chronic Pain: Separating Popular Myth from Science and Medicine. University of Washington Alcohol and Drug Abuse Institute. February 2018.

This column was originally published in Townsend Letter (November 2020).

Published June 15, 2024

About the Author

Jule Klotter has a master’s in professional writing from the University of Southern California. She joined Townsend Letter’s staff in 1990. Over the years, she has written abstract articles for “Shorts” and many book reviews that provide information for busy practitioners. She became Townsend Letter’s editor near the end of 2016.