Position statement on IEI
Position statement on IEI
The American Academy of Allergy, Asthma and Immunology in Milwaukee issued a recently updated position statement on idiopathic environmental intolerance (IEI) that makes the following recommendations for diagnosis and treatment of this enigmatic condition:
Diagnostic methods
The diagnosis of IEI is made primarily on the basis of the patient’s history, without any defining criteria. There are no diagnostic symptoms, and there are no diagnostic objective physical signs. Many different tests and procedures have been proposed, but no single test or combination of tests has been validated as diagnostic. The tests most frequently used by practitioners who diagnose IEI are provocation-neutralization and a panel of immunologic tests. The latter encompasses measurements of serum immunoglobulins, complement levels, blood lymphocyte subset counts, auto-antibodies, and serum antibodies to chemicals. Some practitioners obtain blood, urine, or fat levels of environmental chemicals, as well as brain-imaging studies, neuropsychologic testing, and psychological/psychiatric interviews. Studies to date have failed to confirm that any immunologic tests are diagnostic for chemically induced symptomatology. The diagnostic validity of the other procedures has yet to be tested.
Treatment recommendations for patients with the diagnosis of IEI
Those physicians who view the symptoms of IEI as arising from the toxic effect of environmental chemicals and foods stress an avoidance program that is sometimes extreme. This is usually supplemented with vitamins and minerals, occasionally with intravenous gamma globulin, and often with "neutralizing" administration of chemical and food extracts by injection or sublingual drops. To date, no controlled clinical trial has been carried out to evaluate this approach. There is evidence that such a program may make the patient worse. Others advocate an undocumented form of "detoxification" through induced sweating and the administration of oral minerals and oils.
[The full text of the position statement is available from AAAAI, 611 E. Wells St., Milwaukee, WI 53202. Telephone: (414) 272-6071. Fax: (414) 272-6070. For clinical information, call the physician and referral information line at (800) 822-2762. Web site: www.aaaai.org.]
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