Thursday, July 12, 2012

Chemical Intolerance in Primary Care Settings: Prevalence, Comorbidity, and Outcomes

Chemical Intolerance in Primary Care Settings: Prevalence, Comorbidity, and Outcomes

David A. Katerndahl, MD, MA1⇓,
Iris R. Bell, MD, PhD2,
Raymond F. Palmer, PhD1 and
Claudia S. Miller, MD, MS1
+ Author Affiliations
1University of Texas Health Science Center at San Antonio, San Antonio, Texas
2University of Arizona College of Medicine, Tucson, Arizona

CORRESPONDING AUTHOR: David Katerndahl, MD, Family & Community Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr San Antonio, TX 78229-3900,


PURPOSE This study extends previous community-based studies on the prevalence and clinical characteristics of chemical intolerance in a sample of primary care clinic patients. We evaluated comorbid medical and psychiatric disorders, functional status, and rates of health care use.

METHODS A total of 400 patients were recruited from 2 family medicine clinic waiting rooms in San Antonio, Texas. Patients completed the validated Quick Environmental Exposure and Sensitivity Inventory (QEESI) to assess chemical intolerance; the Primary Care Evaluation of Mental Disorders (PRIME-MD) screen for possible psychiatric disorders; the Dartmouth–Northern New England Primary Care Cooperative Information Project (Dartmouth COOP) charts for functional status; and the Healthcare Utilization Questionnaire.

RESULTS Overall, 20.3% of the sample met criteria for chemical intolerance. The chemically intolerant group reported significantly higher rates of comorbid allergies and more often met screening criteria for possible major depressive disorder, panic disorder, generalized anxiety disorder, and alcohol abuse disorder, as well as somatization disorder. The total number of possible mental disorders was correlated with chemical intolerance scores (P <.001). Controlling for demographics, patients with chemical intolerance were significantly more likely to have poorer functional status, with trends toward increased medical service use when compared with non–chemically intolerant patients. After controlling for comorbid psychiatric conditions, the groups differed significantly only regarding limitations of social activities.

CONCLUSIONS Chemical intolerance occurs in 1 of 5 primary care patients yet is rarely diagnosed by busy practitioners. Psychiatric comorbidities contribute to functional limitations and increased health care use. Chemical intolerance offers an etiologic explanation. Symptoms may resolve or improve with the avoidance of salient chemical, dietary (including caffeine and alcohol), and drug triggers. Given greater medication intolerances in chemical intolerance, primary care clinicians could use the QEESI to identify patients for appropriate triage to comprehensive nonpharmacologic care.

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