The section of reference papers on allergies / hypersensitivities / multiple chemical sensitivity (MCS) in ME / CFS is very important.
Throughout the ME / CFS literature there is extensive reference to allergies.
Most of those references to allergies / MCS in ME / CFS are not in this section, but are scattered throughout other sections (e.g. general papers on ME / CFS, neuroendocrinology etc).
For ease of reference, the following extracts from those papers are illustrative.
"Could it be that enteroviral infection, in predisposed or previously sensitised subjects, sets in train some process, say of an allergic nature, which accounts for the similarity of symptoms and the chronic relapsing course?
"We do not know if the 'allergic process' is entirely self‑perpetuating".
Encephalomyelitis resembling benign myalgic encephalomyelitis. SGB Innes. Lancet 1970:969-971
Special Article: Benign Myalgic Encephalomyefitis ir Epidemic Neuromyasthenia. AM Ramsay. Update, September 1978:539-542
"Many myalgic encephalomyelitis patients also experience food and chemical intolerances, and are often therefore unusually sensitive to the side effects of drugs".
Myalgic encephalomyelitis. Cory Matthew.
"in the long term sufferer, patients are often anxious to identify food and chemical allergies"
Myalgic encephalomyelitis and the general practitioner
"Our clinical impression, however, is that there is a high incidence of atopic illness in patients with this syndrome"
The postviral fatigue syndrome ‑ an analysis of the
findings in 50 cases.
"These screening tests do not preclude an abnormality in immune function in these patients ... previous alternative diagnoses in these patients have included antibody negative lupus erythernatosus and allergic diathesis"
Evidence for Active Epstein‑Barr Virus Infection in Patients with Persistent Unexplained Illness: Elevated Anti‑Early Antigen Antibodies. James F Jones et al. Ann Int Med 1985:102:1:1-7
"By all regards ... many of these patients appeared to be neurotic. However, our detailed studies have uncovered a series of subtle yet objective organic abnormalities in these patients. Importantly, nearly all of the patients studied had increased T cell mediated suppression ... which showed increased numbers of OKT4 positive (helper‑inducer) cells..."
Persisting Illness and Fatigue in Adults with Evidence of Epstein‑Barr Infections. Stephen E Straus, G Tosato et aL Ann Int Med 1985:102:7-16
"Eighty percent of patients with CA‑EBV (is ME / CFS demonstrate clinically significant IgE mediated allergic disease, including ... food and drug reactions. The data indicate that patients with CA‑EBV have ... a high association with hypersensitivity states ... percent positive responsiveness to allergens is consistent with the high degree of allergy observed in these patients"
Correlation between allergy and persistent Epstein‑Barr virus infections in Chronic Active EBV infected patients. George B Olsen, James F Jones et al J All Clin Immunol 1986:78:308-314
"Patients in this study have significantly increased (1) responsiveness towards specific allergens, (2) responses towards greater numbers of allergens (3) increased numbers of IgE-positive T cells and B cells .... and (6) elevated serum IgE levels than do patients with mild or moderate allergic disease alone. Patients ... demonstrate an increased incidence of allergies and symptoms, indicating various neurologic disorders"
Specific allergen‑induced Epstein‑Barr T nuclear antigen‑positive B cells from patients with CA EBV infections. George B Olson, James F Jones et al J Allergy Clin Immunol 1986:78:315-320
" ....the clinical observation that most of these individuals report or demonstrate ... allergic disease (at) an uncommonly high prevalence rate"
Chronic Epstein ‑ Barr Virus Infection. James F Jones, Stephen E Straus. Ann Rev Med 1987. 38:195-209
"Patients ... tend to tolerate medications very poorly and many have a history of allergies including drug allergies"
The Epstein‑Barr Virus and Chronic Fatigue. Irving E Salit. Clinical Ecology 1987 / 88:V:3:103-107
"A history of allergies was reported by 64% of patients".
The 'Chronic, Active Epstein‑Barr Virus Infection' Syndrome and Primary Fibrornyalgia. D Buchwald, DL Goldenberg, JL Sullivan, AL Komaroff. Arthritis & Rheumatism 1987:30:10:1132-1136
"...the possibility that temporary viral infection might produce a permanent change leading to disease. When the disease presents, the virus might not be present so that Koch's postulations for the disease would not be fulfilled.
"We are then considering a group of disorders in which there may be an inherited genetic predisposition ... to disease occurrence if infection is present, associated with some other environmental factor (which) may be chemical. There is much talk of a symbiosis between a virus infection and food intolerance in patients with the postviral fatigue syndrome. There is a natural tendency to reject such a 'fringe medicine' approach ... There are, however, simple examples of similar concatenation of infection and environment, where the cause is known"
Viruses and neuropsychiatric disorders. JF Mowbray. JRSM 1988 81:311-312
"Many patients with this syndrome ... have had chemical toxicity diagnosed many patients with long‑term symptoms develop food sensitivities.
The Myalgic Encephalomyelitis Syndrome. JC Murdoch. Family
Practice 1988:5:4:302-306. Pub.
"This article summarises recent studies of the syndrome and emphasises our assessment of one of its more common manifestations, allergy. Many patients report inhalant, food or drug allergies. Allergies are a common feature of patients with the chronic fatigue syndrome. Among the features of this syndrome is a high prevalence of allergy, an allergy that appears to be substantial, both by history and by skin testing"
Allergy and the Chronic Fatigue Syndrome. Stephen E Straus, Janet Dale et al J Allergy Clin Immunol 1988:81:791-795
"A variety of immunological abnormalities were detected, including abnormal T4 T8 lymphocyte subset ratios, dysfunction of natural killer cells, abnormal proliferation of B cells and decreased IgG concentrations"
Postviral Fatigue Syndrome.
"It is also clear that acquisition of T cell deficiency, particularly of the CD8 subset, can itself impair immune regulation and predispose to atopy not previously experienced by the patient. Three of the criteria are sufficiently frequent to suggest they should become part of the routine screening of such patients, and these are a subnormal level of CD8 lymphocytes ...... What seems to be especially related to the ME symptoms in our clinically selected patients is a failure to show the expected rise and normalisation of CD8 numbers. In the present study, the patients show a 40% incidence of both clinical and laboratory evidence of atopy. It has been shown that T cell deficiency, particularly of the suppressor subset, can predispose to atopy, which can indeed be acquired by patients without a genetic family history"
CD8 Deficiency in Patients with Muscle Fatigue Following Suspected Enteroviral Infections (Myalgia Encephafitica). JR Hobbs, JF Mowbray et all In: Protides of the Biological Fluids. Jan 1990:36
"Several authors have detected histories of atopy and high frequencies of skin test reactivity to selected allergens, suggesting an allergic mechanism may play a role in the aetiology of the disease. Multiple other immunological abnormalities have been noted ....the importance of such abnormalities ... may serve as markers for a subset of patients ....who have measurable immunological abnormalities"
Treatment of Patients with Chronic Fatigue Syndrome. Nelson Gantz & Gary Holmes. Leading Article. Drugs 1989:36:6:855-862
"There do seem to be considerable overlaps between the presentations of ME, post viral fatigue syndrome and multiple allergies .... multiple allergies to foods and less often to inhalants are quite common"
Thoughts on the management of myalgic encephalomyelitis. Michael Jenkins. British Homeopathic Journal 1989:78:6-14
"The 89 full responders were divided into five groups ... group 2 patients had a specific diagnosis (of) food allergy"
Postviral syndrome - how can a diagnosis be made? SJ Bowman, J Brostoff, S Newman, JF Mowbray. JRSM 1989:32:712-716
"Myalgic encephalomyelitis ... is similar in most respects to the other chronic fatigue syndromes ... on medical history, the only clearly striking finding is a high frequency of atopic or allergic illness (in about 50 ‑ 70%) .... On immunologic testing, we and others have found evidence of subtle and diffuse dysfunction"
The Chronic Fatigue Syndrome: Definition, Current Studies and Lessons for Fibromyalgia Research. AL Komaroff & D Goldenberg. J Rheumatol 1989:16:19:2327
"Dr Rob Loblay discussed the relationship between CFS and intolerance to food substances .... he stressed that these substances ... appear to be an important precipitant of symptoms in patients with CFS Carefully designed, double blinded challenges ... showed that a significant minority (34%) of patients benefited from dietary modification"
Muscle versus brain: chronic fatigue syndrome. AR Lloyd.
Conference Report from international conferences on CFS in
"A high incidence of concomitant atopic disorders may prove to be a useful diagnostic point"
The chronic fatigue syndrome: a return to common sense. AM Denman. Postgrad Med Journal 1990:66:499-501
"Preferably, patients with CFS who have such abnormalities might be considered a subset of the larger group: i.e.. persons with CFS who have immune dysfunction"
Defining the Chronic Fatigue Syndrome. Gary P Holmes. Rev Inf Dis 1991: 13:1:S53-S55
"There is little doubt that classic allergy and atopy are inexplicably prevalent in CFS. In a recent study, a high proportion (50%) of patients with CFS were found to be reactive to a variety of inhalant or food allergens when inoculated epicutaneously in the classic manner. In the healthy population, reactivity rarely exceeds 15‑20%"
History of the Chronic Fatigue Syndrome. Stephen E Straus, Rev Inf Dis. 1991:13:1:S2-S7
"The patients' medical histories reveal one clearly striking finding: a high prevalence of atopic or allergic illness (for 40 -70%)"
Symptoms and Signs of Chronic Fatigue Syndrome. AL Komaroff & D Buchwald Rev Inf Dis 1991:13: 1:S8-S I I
"in fact, allergies are a common feature of patients with US" (refs 11,13,51,52).
Review of Laboratory findings for Patients with Chronic Fatigue Syndrome. D Buchwaid & A Komaroff. Rev Inf Dis 1991:13:1:S12-S18
"Our investigations have..produced evidence of ... a decrease in CD8 suppressor cells with resulting elevation of the ratio of CD4 to CD8 cells"
Chronic Fatigue Syndrome in
"Allergies ... may predispose a person to the development of US following an if immunologic assault"
Fatigue: Definition and Management Ivan Barofsy & Marcia West Legro. Rev Inf Dis 1991:13:1:S94-S97S
"The numerous attempts to elucidate the pathogenesis of chronic fatigue syndrome are evoked by the names .... chronic Epstein‑Barr virus infection and total allergy syndrome (twentieth century disease)". It is known that such patients are remarkably likely to have a history of atopy pre‑dating the onset of chronic fatigue syndrome (50‑83%). Patients may have an immune system that responds over‑emphatically to environmental or internal stimuli ... aspects of the immune reaction may not be stoppable even after an insult is over"
Chronic Fatigue Syndrome. WK Cho & GH Stollerman. Hospital Practice 1992:221-245
"Patients with chronic fatigue syndrome are reported to have a higher incidence of allergic conditions. Indeed, it has been speculated that heightened allergic responsiveness may be a risk factor for the development of the syndrome. In Particular, the diverse clinical and immunological features have been argued to reflect an ongoing state of immune activation"
Plasma and Cerebrospinal Fluid Monoamine Metabolism in Patients with Chronic Fatigue Syndrome: Preliminary Findings. MA Demitrack, Stephen E Straus et al. Biol Psychiatry 1992:32:1065-1077
"On past medical history, the only clearly striking finding in our studies is a high frequency of atopic or allergic illness (in approximately 50 ‑ 80%, in contrast to a background prevalence of about 10% in the population at large Immunological studies suggest that in US, the immune system is in a state of chronic activation"
Clinical presentation of chronic fatigue syndrome. AL Komaroff.
Ciba Foundation Symposium 173: Chronic Fatigue Syndrome. Wiley,
"It has been noted for a number of years that a history of allergies appears to be an important risk factor for US, and the spectrum of illnesses associated with a dysregulated immune system now must include US"
Summary and Perspective: Epidemiology of Chronic Fatigue Syndrome. Paul H Levine. Clin Inf Dis 1994:18:1:S57-S60
Books which specifically refer to allergies being part of ME / CFS
As well as published medical reference papers, there are a large number of published books which also refer to allergies as being part of ME / CFS.
In addition, there are official documents such as The UK National Task Force Report on ME / CFS (1994); the US Information for Physicians (1996) and the Australasian Medical Association Guidelines for Physicians (1997).
The many worldwide patients' support groups also make a point of referring to the high prevalence of allergies in ME / CFS in their Newsletters, journals and literature, including information packs which are sent out to doctors.
US Government agencies formally recognise that in such conditions, allergies are a serious problem and a legitimate disability; many States and Government Departments (including the US Department of Justice, the US Department of Housing and Urban Development and the US Department of Education), thereby affording sufferers protection under specific laws enacted to safeguard the civil rights of the disabled.
From a medico‑legal perspective, there are numerous cases in the literature.
An illustrative (but non‑comprehensive) selection of books includes the following:
Better Recovery from Viral Illness. Darrel Ho-Yen.
Myalgic Encephalomyelitis. Celia Wookey. Croom Helm, 1986. ISBN 07099-3672-9
The Body at War. John Dwyer. Unwin Hyman, 1988 ISBN-O-04-320225-X
(John Dwyer, Professor of Medicine at the
Living with ME Charles Shepherd. Cedar 1989 (William Heinemann Ltd) ISBN 0434-11156-2
M.E. Postviral Fatigue Syndrome Anne Macintyre Unwin Hyman 1989 ISBN 004-440318-6
Why M.E? Belinda Dawes & Damien Downing. Grafton 1989 ISBNO-586-20666-3
M.E. What is it? Mike Franklin & Jane Sullivan. Century 1989 ISBN 0-7126-2966-1
Understanding ME David Smith. Robinson Publishing,
The Complete Guide to Food Allergy and Intolerance Jonathan Brostoff & Linda Gamlin Bloomsbury 1989 ISBN 0-7475-0242‑0
Chronic Fatigue Syndrome Jay A Goldstein Published by The CFS Institute,
The Disease of a Thousand Names David S Bell Pollard Publications,
Postviral Fatigue Syndrome ed Rachel Jenkins & James Mowbray John Wiley & sons,
The Clinical and Scientific Basis of Myalgic Encephalomyelitis
Chronic Fatigue Syndrome ed: BM Hyde The Nightingale Research Foundation,
Environmental Medicine in Clinical Practice
This list is far from comprehensive, but is merely illustrative.
ALLERGIES AND MCS IN ME / CFS
Enhancement of IgE‑Mediated Histamine Release from Human Basophils by Viruses: Role of Interferon. S Ida, J Hooks et al. The Journal of Experimental Medicine 1977:145:892 - 906
Allergy to food and chemicals‑ the scope of the problem. S Todd. Nursing Times March 1978:438 - 441
Food Allergy: Fact or Fiction? R Finn, HN Cohen. The Lancet Feb 1978:426 - 428
Diagnosing Food and Chemical Susceptibility. WJ Rea. Continuing Education Sept 1978:47 - 59
The Environmental Aspects of Ear, Nose, and Throat Disease: Part 1. WJ Rea. JCEORL & Allergy July 1979:41 - 57
The Environmental Aspects of Ear, Nose, and Throat Disease: Part 2. WJ Rea. ORL &Allergy Digest Sept 1979:41 - 55
Food Allergy and Intolerance in 100 Patients - Local and Systemic Effects. MH Lessof, DG Wraith et al. Quarterly Journal of Medicine, New Series XLIX 1980:195:259 - 271
Viruses as Nonspecific Modulators of Immunological Reactivity. BF Semenov.
Acta Virol 1981:25:122 - 128
Intestinal Permeability in Patients with Eczema and Food Allergy. PG Jackson, MH Lessof et al. The Lancet June 13:1981:1285 - 1286
Late‑onset atopic eczema and multiple food allergies after infectious mononucleosis. R StC Barnetson et al. British Medical Journal 1981:283:1086
The Immunology of Allergy. In: Disease and the Environment. ‑Ed. AR Rees, HJ Purcell. Proceedings of the Inaugural Conference of the Society for Environmental Therapy 1981:65 - 78
Hypersensitivity to Mains Tap Water in Adults: its Clinical
Features and Treatment. CWM
Food Intolerance: A Major Factor in the Pathogenesis of Irritable
Bowel Syndrome. VA Jones, P McLaughlan et al. The Lancet
Food and Chemical Sensitivity. JJ McGovern, JA Lazaroni et al. Arch Otolaryngol 1983:109:292 - 297
Total allergy syndrome: what evidence can be established?
N Mike, P Asquith. Proceedings of 2nd Fisons Food Allergy Workshop, pub.
The Medicine Publishing Foundation,
Adverse reactions to foods. DH Allen et al. The Medical
Gut and Joint Disease. C Carini, J Brostoff. Annals of Allergy 1985:55:624 - 625
What is the current state of knowledge of ecological illness or total allergy syndrome? Is there an immune basis to this condition? J Brostoff. British Medical Journal 1985:290:1884
ME: Post‑viral Fatigue Syndrome and How to Cope With It Croom Helm 1986
Food Intolerance. RH
Immunological and Clinical Aspects of Food Allergy. J Brostoff, GK Scadding. Adv. Med. 1986:21:286 - 302
Specific allergen‑induced Epstein‑Barr nuclear
antigen-positive B cells from patients with chronic‑active Epstein‑Barr
virus infections. GB
Correlation between allergy and persistent Epstein‑Barr
virus infections in chronicactive Epstein‑Barr virus‑infected patients.
Environmental Illness: A Disorder of Immune Regulation. AS Levin, VS Byers. Occupational Medicine Oct - Dec 1987:669 - 681
The Worker With Multiple Chemical Sensitivities: An Overview. MR Cullen. Occupational Medicine State of the Art Reviews 1987:2:4:655 - 661
IgE complexes in food allergy. C Carini et al. Annals of Allergy 1987:59:110 - 117
Presentation by Mark Loveless, specialist in infectious diseases,
Myalgic encephalomyelitis‑ how to care for a sufferer.
Laboratory Diagnosis of Food Intolerance. DLJ Freed. In: Brostoff and Challacombe, Bailliere Tindall 1987
Chronic Fatigue Syndrome and Chemical Overload. RA Buist. International Nutrition Review 1988:8:4:173 - 175
Poor sulphoxidation ability in patients with food sensitivity. GK Scadding, R Ayesh et al. British Medical Journal 1988.‑297:105 - 107
The Body at War. J Dwyer. Pub. Unwin Hyman 1988
Environmental Illness. WJ Rea. 1988:207 - 214
Allergy and the chronic fatigue syndrome. SE Straus et al. J.Allergy Clin. Immunol May 1988:791 - 795
The relationship between viral infections and onset of allergic diseases and asthma. VB Busse. Clinical and Experimental Allergy 1989:19:1 - 9
Chronic Fatigue Syndrome. GH Ross, JA Monro. CMAJ 1989:140:361
Chronic Fatigue Syndrome. GH Ross, WJ
Chemical Sensitivity in Physicians. WJ Rea, GH Ross et al. Clinical Ecology 1989:6:4:135 - 141
Why ME? (Food Allergies) Dr B Dawes, Dr D Downing. Grafton 1989:43
Understanding ME. Dr DG Smith. Robinson Publishing 1989:180 - 186
Diseases of Food Hypersensitivity. DD Metcalfe. The
A New Manifestation of Seminal Fluid Hypersensitivity. N Mike, G Bird, P Asquith. Quarterly Journal of Medicine New Series 75 1990:276:371 - 376
Multiple Chemical Sensitivity. JB Sibbison. The Lancet
Food allergy and pelvic pain. BA Gbolate, R
Notes on ME / CFS (myalgic encephalomyelitis, chronic fatigue syndrome). ANZMES leaflet 1991
Postviral Fatigue Syndrome ‑‑Laboratory Abnormalities.
Buchwald. ed. Rachel Jenkins & James Mowbray John Wiley & Sones,
Multiple Chemical Sensitivity. Special Report. B Hileman.
Review by John M Balbus Kornfeld: Chemical Exposures: Low
Levels and High Stakes. NA Ashford, CS Miller. Van
Book: Chemical Exposures: Low Levels and High Stakes. NA Ashford,
CS Miller pub. Van
What causes ME? David Freed. Interaction: The Journal of ME Action 1992: No. 11
Reactions to food additives. MH Lessof. Journal of the Royal Society of Medicine 1992:85:513 - 515
Hypersensitivity to environmental factors. Journal of the
Advancing the understanding of multiple chemical sensitivity
(MCS): Overview and recommendations from an AOEC workshop. KM Rest.
Immunologic, Psychological and Neuropsychological Factors in Multiple Chemical Sensitivity. GE Simon, IN Daniell et al. Annals of Internal Medicine 1993:19:2:97 - 103
Chronic Fatigue Syndrome: Influence of Histamine, Hormones and Electrolytes. L Dechene. Medical Hypotheses 1993:40:55 - 60
Hypersusceptibility to chemicals: risk factors for neurological disease? Editorial: A Williams. Journal of Neurology, Neurosurgery, and Psychiatry 1993:56:943 - 946
Comparison of Patients With Chronic Fatigue Syndrome, Fibromyalgia, and Multiple Chemical Sensitivities. D Buchwald, D Garrity. Arch Intern Med 1994:154:2049 - 2053
Effective Allergy Practice (1994). Report of the British Society for Allergy and Environmental Medicine with The British Society for Nutritional Medicine. A Document on Standards of Care and Management for the Allergy Patient. Ed:HM Anthony, S Birtwistle, J Brostoff, D Freed, N Williamson et al (BSAENM)
Clinical management of chronic fatigue syndrome ‑ Physiology. DJ Clauw. Journal of CFS 1995:1:314:185 - 190
Unexplained Illness: the mind versus the environment. MJ Radcliffe, P Ashurst, J Brostoff. Journal of the Royal Society of Medicine 1995:88:678 - 679
Chronic Fatigue Syndrome as a Delayed Reaction to Chronic
Low‑dose Organophosphate Exposure.
Recognition of Multiple Chemical Sensitivity by Federal Authorities. A Donnay. Pub. MCS Referral & Resources, 1996
Potential animal model of multiple chemical sensitivity with cholinergic sensitivities. Overstreet DH, Miller CS et al. Toxicology 1996:111:1 - 3
An Expert's Explanations on MCS. I Bell. The CFIDS Chronicle Winter 1997:91 - 92
Government Agencies Acknowledge MCS The CFIDS Chronicle Spring 1997:49
Chemical Sensitivity: Allergic to the 201h Century. D Jones. WDDTY. Nov 1997:8:8:1 - 4
Multiple Chemical Sensitivity (MCS). Chemical Injury Information Network Leaflet 1998.
Allergology: Blimps versus nuts. H Anthony et al. The Lancet 1998:351:221 - 222
The relationship between chronic fatigue syndrome, fibromyalgia and chemical sensitivity. A Vojdani, P Choppa. Fourth International AACFS Research & Clinical Conference on CFIDS Oct 1998: Abstract page 100
Prevalence and Overlap of Chronic Fatigue Syndrome and Fibromyalgia Syndrome Among 100 Patients With Multiple Chemical Sensitivity. Fourth International AACFS Research & Clinical Conference on CFIDS Oct 1998 Abstract page 53
A Report on MCS - Background and Historical Review. Article. US Government Web Site 1998.
A Review of multiple chemical sensitivity. RA Graveling, A Pilkington et al. Occup Environ Med 1999:56:73 - 85
Multiple Chemical Sensitivity: A 1999 Consensus. Archives of Environmental Health May/June 1999:54:3:147 - 149
Multiple Chemical Sensitivity ‑ Recognition and Management. Third Scientific Report of the British Society for Allergy, Environmental and Nutritional Medicine. Ed: KK Eaton and HM Anthony. Pub BSAENM, Knighton 2000.
PAPERS FROM THE AMERICAN TRIAL LAWYERS ASSOCIATION ON MCS
(sent by Earon S Davis of ATLA)
1. Winning Workplace Litigation: What You Must Know to Represent Your Client's Interests Effectively.
Earon S Davis. Pub The
i) MCS ‑ an Overview
ii) a New Disease
iv) The Trial Lawyer's Dilemma
2. The New Chemical Victims. Earon S Davis. Ecological Illness Law Report 1985:3:415:16 - 20
3. Multiple Chemical Sensitivity. Indoor Pollution News, 19 1h April 1990, pub . Buraff Publications.
4. Ecological Illness Law Report. ed: Earon S Davis. June 1988:5.1‑2
5. Ecological Illness: The Effects on The Neighbourhood Can Be Deadly. Earon S Davis. TRIAL, October 1986 (ATLA)
6. Some Recent Professional Activities Involving MCS / Earon S Davis
7. Selected Publications and Presentations, 1978 ‑ 1990 / Earon S Davis
8. Worker with MCS: Legal Aspects. Earon S Davis.
vi) What is MCS?
vii) The Medico - Legal Standard
viii) Gaps in the Public Health System
ix) Growing Recognition of MCS
x) MCS and The Law
xi) The Workers Rights