EpistemisIdiopathic environmental hypersensitivity
Specialty: General.
Why it occurs
- Dysfunction of the hepatic detoxification mechanisms phase I and phase II (which alters the rate of clearance of common volatile organic compounds)
- Phenomena of central sensitization of the nervous system (where low-intensity chemical sensory stimuli trigger disproportionate autonomic and immunological responses)
- Single previous exposure to high concentrations of neurotoxins or pesticides (which leaves a state of permanent hyperreactivity in neuronal receptors)
- Systemic mast cell dysregulation (mast cell activation syndrome that releases proinflammatory mediators when faced with non-immunological stimuli)
- Somatoform or anxiety disorders with extreme sensory hypervigilance towards odors or substances in the environment.
Initial workup
Pulmonary function tests (basal and challenge spirometry), determination of serum tryptase during a crisis, total IgE and specific IgE antibodies for common allergens, profile of organic metabolites in urine, and detailed neuropsychological evaluation.
red flags
Systemic reactions that include acute bronchospasm with wheezing, angioedema of the lips or larynx that compromises the airway, severe hypotension or immediate syncope after exposure to fragrances or solvent odors.
Standard management
- Desloratadine — 5 mg orally once daily to stabilize the peripheral histaminergic response
- Montelukast — 10 mg orally at night to modulate the inflammatory response mediated by leukotrienes
- Calcium carbonate or sodium bicarbonate (according to individual symptomatic indication to try to balance the general metabolic response).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- General
- Listed causes
- 5
- Treatment options
- 3