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Validation of a Brief Screening Instrument for Chemical Intolerance in a Large U.S. National Sample

Author

Listed:
  • Raymond F. Palmer

    (Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA)

  • Tatjana Walker

    (Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA)

  • David Kattari

    (Hayward Score, Carmel, CA 93921, USA)

  • Rudy Rincon

    (Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA)

  • Roger B. Perales

    (Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA)

  • Carlos R. Jaén

    (Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA)

  • Carl Grimes

    (Hayward Score, Carmel, CA 93921, USA)

  • Dana R. Sundblad

    (Hayward Score, Carmel, CA 93921, USA)

  • Claudia S. Miller

    (Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA)

Abstract

Background: Chemical intolerance (CI) is characterized by multisystem symptoms triggered by low levels of exposure to xenobiotics including chemicals, foods/food additives, and drugs/medications. Prior prevalence estimates vary from 8–33% worldwide. Clinicians and researchers need a brief, practical screening tool for identifying possible chemical intolerance. This large, population-based study describes the validation of a three-item screening questionnaire, the Brief Environmental Exposure and Sensitivity Inventory (BREESI), against the international reference standard used for assessing chemical intolerance, the Quick Environmental Exposure and Sensitivity Inventory (QEESI). Methods: More than 10,000 people in the U.S. responded to the BREESI and the QEESI in a population-based survey. We calculated the overall prevalence of CI in this sample, as well as by gender, age, and income. Common statistical metrics were used to evaluate the BREESI as a screener for CI against the QEESI. Results: The prevalence estimate for QEESI-defined chemical intolerance in the U.S. was 20.39% (95% CI 19.63–21.15%). The BREESI had 91.26% sensitivity (95% CI: 89.20–93.04%) and 92.89% specificity (95% CI: 91.77–93.90%). The positive likelihood ratio was 12.83 (95% CI: 11.07–14.88), and the negative likelihood ratio was 0.09 (95% CI: 0.08–0.12). Logistic regression demonstrates that the predicted probability of CI increased sharply with each increase in the number of BREESI items endorsed (Odds Ratio: 5.3, 95% CI: 4.90–5.75). Conclusions: Chemical intolerance may affect one in five people in the U.S. The BREESI is a new, practical instrument for researchers, clinicians, and epidemiologists. As a screening tool, the BREESI offers a high degree of confidence in case ascertainment. We recommend: screen with the BREESI, confirm with the QEESI.

Suggested Citation

  • Raymond F. Palmer & Tatjana Walker & David Kattari & Rudy Rincon & Roger B. Perales & Carlos R. Jaén & Carl Grimes & Dana R. Sundblad & Claudia S. Miller, 2021. "Validation of a Brief Screening Instrument for Chemical Intolerance in a Large U.S. National Sample," IJERPH, MDPI, vol. 18(16), pages 1-12, August.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:16:p:8714-:d:616828
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    References listed on IDEAS

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    1. Caress, S.M. & Steinemann, A.C., 2004. "Prevalence of Multiple Chemical Sensitivities: A Population-Based Study in the Southeastern United States," American Journal of Public Health, American Public Health Association, vol. 94(5), pages 746-747.
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    Cited by:

    1. Sandra Fares-Medina & Isabel Díaz-Caro & Rebeca García-Montes & Inmaculada Corral-Liria & Soledad García-Gómez-Heras, 2022. "Multiple Chemical Sensitivity Syndrome: First Symptoms and Evolution of the Clinical Picture: Case-Control Study/Epidemiological Case-Control Study," IJERPH, MDPI, vol. 19(23), pages 1-19, November.
    2. Tamami Suzuki & Yoshiko Bai & Yuko Ohno, 2024. "Prevalence and Factors Related to High Risk of Multiple Chemical Sensitivity among Japanese High School Students," IJERPH, MDPI, vol. 21(7), pages 1-17, July.

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