Prevalence rates and Impact of Multiple Chemical Sensitivity in Australia
By Dr Sharyn Martin,2015
Prevalence rates of between 1.0 and 2.9% have been estimated for Multiple Chemical Sensitivity in the states of South Australia and New South Wales, Australia, Table 1.
Prevalence of Multiple Chemical Sensitivity
The largest survey at over 15,000 individuals was in NSW where 2.9% of the population had been diagnosed with MCS. This was similar to a rate of 2.6% established in a smaller survey in NSW to determine health effects from a smoke stack. A survey of over 5,000 parents in NSW determined that 2.5% of 2 to 15 year olds had been diagnosed with MCS and is similar to the percentage seen for adults. In the South Australian study (Fitzgerald D., 2008) 1.0% of those surveyed had been diagnosed with MCS lower than the rates seen in the three NSW surveys. Fitzgerald noted that as there are no diagnostic guidelines for MCS in Australia, it is possible that 1% prevalence is due to under reporting of some of the chemical hypersensitivity individuals. Some chemical hypersensitivity individuals had symptomology more aligned with the MCS cases and could represent undiagnosed MCS.
Table 1.Studies to determine rates of chemical hypersensitivity and diagnosed MCS in Australians.
|Study||Survey population||Number in survey||Hypersensitivity to chemicals %||Diagnosed MCS %|
|2002 NSW Health Survey of Australian Population of adults||Adults||15,442||24.6||2.9|
|2004 NSW Investigation of Health effects of the M5 East Motorway||Adults||1,431||2.6|
|SA study of self-reported MCS in adults, Fitzgerald D. 2008.||Adults||4,000||16||1.0|
|2007-2008 NSW Health Survey on the health of Children||Children(2-15 years)||5,171||7.5||2.5|
Prevalence of Chemical Hypersensitivity
Prevalence rates of chemical hypersensitivity were, 7.5% for children 2-15 year old, 16% for the South Australian survey and 24.6% in the 2002 NSW survey.
In the South Australian study (Fitzgerald D., 2008) 6% of those reporting hypersensitivity stated that it seriously affected their quality of life, with 8.4% males and 15.7% females reporting moderate to severe problems. Within the hypersensitivity group, 15.3% males and 31.9% female participants stated that they had received medical treatment for their chemical sensitivity.
Chemicals causing illness
Chemicals that were attributed to triggering hypersensitivity in adults were perfumes or aftershaves (82.5%), tobacco smoke 42.2%,New building or renovation 40.4%, Pesticides or herbicides 37.2%, Petrochemicals 32.0% Vehicle smoke 27.1% and other chemicals 19.0% (Fitzgerald, 2008).
Odours or smells that caused illness in 2-15 year old were Cleaning agents, Petrol or exhaust fumes; Perfumes or aftershaves, Scented soap or shampoo or other toiletries, Scent of flowers such as jasmine, gardenia, wattle, etc, Fresh paint, Pesticides, and Cigarette smoke (2007-2008 NSW Health Survey).
Symptoms experience from exposure to chemicals
The main symptoms for children from exposure to chemical odours or smells were cough or wheeze (35.6%), nose or sinus irritation (28.8%), headache (24.3%), nausea (20.8%), aches or pains (10.9%), feeling generally unwell (8.1%), feeling anxious, worried or depressed (1.8%) and fatigue (1.8%) (2007-2008 NSW Health Survey).
The symptoms experienced by hypersensitive adults included headaches (40%), asthma or other breathing problems (37%), burning eyes, nose or throat (31%), nausea or stomach problems (18%), eczema (17%), fatigue (9%) and dizziness or fever (9%) (Fitzgerald, 2008).
While these studies have determined the rate of hypersensitivity and diagnosed MCS in a survey population, an ASEHA 2011 survey looked at the impact and burden associated with chemical sensitivity and how that can seriously affect a person’s life to the point where they become isolated and disabled.
Impact and Burden of MCS
In 2011, ASEHA undertook a survey of 50 Australians (26 Qld, 6 NSW, 2 ACT, 5 SA, 3 Vic, 2 WA and 3 unspecified) with MCS. The survey was designed to determine the impact and burden that MCS places on their lives, and to determine what their needs are in order to improve their quality of life. The survey demonstrates an area of unmet need amongst those with sensitivity to chemicals that are ubiquitous in our environment.
In the ASEHA survey 74% of participants had been medically diagnosed with MCS, the mean duration of years with MCS was 22 years (min 2 yrs to max 71yrs).
The factors that impact the quality of life for MCS sufferers:
- Barriers to medical and allied health services,
- Lack of medical assistance,
- Low community/social support,
- Lack of safe affordable housing,
- Inability to work and financial hardship and the living adjustments required to live with MCS.
These create and perpetuate the personal distress that affects the degree of isolation and disability.
Barriers to medical and social services encountered by individuals with MCS.
Table 2. Ability to Access medical and social services.
|Can you safely access these services||Health Services %||Allied Health Services %||Disability and Social Services %||Aged care facilities %|
A high number of individuals were unable to access health services including Aged care facilities. This is becoming an issue as the MCS population ages (Table 2).
The main barriers given for the inability to access these services were Poor Indoor air quality (22); ubiquitous nature of perfumes (17); use of indoor chemical pest control (3); unable to meet strict criteria to access auxiliary services and/or financial hardship (3). Indoor Air Quality issues include contaminants such as perfume and pesticides. Fragrance is the most troubling chemical and least necessary barrier to health services.
Poor indoor air quality is a major detriment to MCS/ES disability access to most public buildings including hospitals and other health care facilities. Many are unable to access the necessary services and care.
Level of Support from friends, family and GP
In the ASEHA survey the level of support from family was 68% and Friends 44.9%. This can often be due to scepticism by family members or friends and can affect the individual’s ability to socialise becoming another burden that adds to the personal distress.
In this survey, 42.6% reported that their General Practitioner was helpful, 29.8% as sympathetic with 27.7% neither helpful nor sympathetic. The lack of support or understanding from a medical practitioner delays effective treatment and management and does not dispel the disbelief by others. For some the lack of medical support has meant that they have not been able to access social or disability support. They are unable to qualify for services or having their cases rejected due to lack of medical support.
Work and Finances
The majority of individuals (84%) were unable to work, of those unable to work 68% received a disability or aged pension. A lack of financial security adds to the personal distress and can place extra strain on relationships and families.
Disability and Isolation
The resultant isolation felt by MCS people in our survey was found to be high for 38% of participants, medium for 50% and low for 12% of the participants.
Isolation occurs when MCS becomes so severe the patient loses the ability to leave home to go shopping, go to church, go to the beach, park, take part in some form of entertainment, visit the doctor or the dentist. Individuals stop going out to avoid the disabling symptoms experienced when exposed to commonly used chemicals. These are ubiquitous in the indoor air of many public built environments. The need for an early diagnosis of chemical sensitivity, identification of chemical(s) involved and avoidance strategies put into place is paramount to preventing the problem from evolving into MCS and the severe form of the disease. MCS patients should always be encouraged to move around in society as much as possible to avoid isolation.
Individuals with MCS suffer general disability from their health problems. This is combined with the disability that results from exposure to chemicals that are ubiquitous in the environment and extremely difficult to avoid.
The degree of disability amongst this survey population was found to be 52% reporting total disability, 44% partial disability and 4% not at all.
The disability (94% partial to total) and isolation (88% medium to high) indicates a need in the community which is not being met.
Isolation also happens when family and friends withdraw support because they either do not believe the MCS patient or they can no longer deal with the MCS lifestyle that is based on avoidance and special need. In many cases families and friends are not prepared to take the necessary steps such as to be fragrance free during visits.
Without prompting 16 of the 50 participants noted that assistance with low allergy housing was needed.
Services Needed by those with MCS
The last part of the survey identifies what those with MCS feel they require to assist them in improving their quality of life. A high priority in this survey was air filters, Table 3. These help in reducing the amount of pollution in the immediate area depending on the size and capacity of the filter. In some cases more than one filter is required and this can become very expensive with no rebates or assistance with their purchase. A car air filter can facilitate a safe haven for those needing to travel to shopping areas or health facilities. Other aides include water filters, personal masks that can be worn to avoid chemical exposures in indoor air, and oxygen for use during high exposures or recovery from an exposure. Other areas were for assistance with daily chores such as shopping, house work, and home maintenance. These can be either too physically demanding or involve exposure to contaminated environments. Living conditions was also an area of concern with needs for safe housing, respite accommodation and an advocate/carer. Unfortunately people disabled by chemicals are not recognised as disabled.
Table 3. Required Services/Products
|Services/Products needed||No selecting each category|
|Low Allergy Housing||16|
|Safe cleaning products||1|
I would like to add to this access to computers and the internet. These can reduce the feeling of isolation and allow people to investigate products and aides to assist with creating a safe environment as well as staying in contact with other people. Support groups can provide pertinent information and advice as well as companionship and sense of community.
Conclusion from the ASEHA survey
MCS is a chronic disease with an average of 22 years duration and carries with it a high degree of disability and isolation. We found a high degree of unmet needs in the MCS community most prominent of which is the barriers to accessing services
Individuals with MCS disability have no opportunity to improve their lives, their health or take part in society AND are often unable to work to support themselves. They may lose the support from family and friends and can become isolated.
Income support from welfare services is insufficient to provide for their special needs in housing, disability aids, medical aids. Food and nutrient support is often required as food allergy/intolerance is often a coexisting factor along with inability to take many medications.
Some need extensive home modifications made to reduce levels of mould and Volatile Organic Compunds (VOCs) in the home environment. Disability accommodations need to be made safe for the chemically sensitive. This applies to hospitals and other health care facilities, in-home services, emergency services, aged care facilities and the workplace to allow disability access without discrimination. This may be as simple as making a fragrance free environment by engaging in education of staff that fragrances are solvent based products, can be dangerous and can significantly contaminate indoor air.
MCS is a hidden disease. Sufferers are often isolated from friends, family and community by their illness. I hope that by gathering and disseminating information that highlights these problems it will raise awareness of these issues and the unmet needs of those with MCS.
Unmet needs the way forward
Targeted educational programs are required to promote awareness of MCS amongst service providers including Complementary Medicine practitioners about the need for safe non-perfumed environments. There is also a requirement for education regarding the dangers of exposure to commonly used chemicals and the relevance of these to a MCS person’s life. In the Fitzgerald 2008 survey, the Final question of the phase II survey asked participants: – Do you agree or disagree with the statement? Chemical sensitivity is a valid health condition with valid symptoms. 86% agreed or strongly agreed with this statement.
There needs to be an acknowledgement of the necessity for Clinical Diagnostic guidelines for MCS and other Environmental Sensitivity diseases, and to act on the recommendations of the 2010 Australian MCS scientific literature Review. While many General Practitioners may recognise some of the symptoms of MCS, the lack of Clinical Guidelines is inhibiting the early recognition of a disease that can be prevented or at the least managed to prevent it developing into a chronic disease that leads to financial hardships, loss of a social network to the point of complete isolation in order to survive.
Fitzgerald D, 2008. Studies on self-reported multiple chemical sensitivity in South Australia. Environmental Health 8, no3. 33-39.
NSW Population Health Survey 2007-2008 Report on Child Health www.health.nsw.gov.au
NSW Department of Health 2004. Investigation into the possible health impacts of the M5 East Motorway Stack on the Turrella community. Phase 2 – a cross-sectional survey of symptom prevalence. www.health.nsw.gov.au
NSW Department of Health. 2002 NSW Public Health Bulletin Supplement Volume 14, Number S-4 December, 2003 The NSW Adult Health Survey. www.health.nsw.gov.au
Martin S., 2015. MCS A snapshot for Action. Environmental Sensitivities Symposium, March 2015.