Polyallergy (multiple chemical sensitivity) is associated with excessive healthcare utilization, greater psychotropic use, and greater mental health/f

Dolphin · Aug 7, 2018

https://www.sciencedirect.com/science/article/pii/S0033318218304183

Original Research Article
Polyallergy (multiple chemical sensitivity) is associated with excessive healthcare utilization, greater psychotropic use, and greater mental health/functional somatic syndrome disorder diagnoses: a large cohort retrospective study
Xavier F.JimenezMD, MA1
NicoleShirvaniMD2
OliviaHogueMPH1
MattKarafaPhD1
George E.TesarMD1
1Cleveland Clinic; Cleveland, OH2Asante Behavioral Health; Medford, OR
Received 7 May 2018, Revised 26 July 2018, Accepted 27 July 2018, Available online 2 August 2018.

https://doi.org/10.1016/j.psym.2018.07.016Get rights and content

Abstract
Objective
Associations between the crude capture of polyallergy – also known as multiple chemical sensitivity (MCS) or multiple drug intolerance syndrome (MDIS) – and mental health/functional somatic syndrome disorders, healthcare utilization, or other clinical phenomenon have not been examined extensively.

Methods
An IRB-approved retrospective chart review of all patients between age 18 and 70 who had a clinical encounter at a large medical center between 2009 and 2014. Patients were stratified into 4 categories based on the absolute number of chart-documented allergies: 1) no allergies; 2) normal allergy (1-4 allergies); 3) polyallergy (5-9 allergies); and 4) “ultrapolyallergy,” (≥ 10 allergies), which were corroborated through a sensitivity analysis. Demographics, comorbidities, and medications were clustered per allergy grouping. ANOVA, Chi square, and multivariable logistic regression analyses were employed to test for associations.

Results
2,007,434 patients were examined (“no allergy” group, n = 1,423,631, 70.9%; “normal allergy” group: n = 549,927, 27.4%; “polyallergy” group n= 29,453, 1.5%; “ultrapolyallergy” group, n= 4,423, 0.22%). Proportion of females increased from 51% in the “no allergy” group to 89.6% in the “ultrapolyallergy” group (p <0.001). Rates of mental health and functional somatic syndrome disorder diagnoses increased significantly across allergy groups (p <0.001). All psychotropic medication classes were increased significantly across allergy groups (p <0.001). Healthcare utilization was also significantly elevated across allergy cohorts (p<0.001).

Conclusions
This study demonstrates that polyallergy/MCS may serve as a crude yet meaningful indicator of comorbid psychopathology. Drug intolerance mechanisms are reviewed, and both clinical and investigational implications are examined.

Keywords
Multiple drug intolerance syndrome
multiple chemical sensitivity
anxiety
polyallergy
central sensitization
Psychosomatics
Available online 2 August 2018

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Wonko · Aug 7, 2018

So...people who are sicker use healthcare more and take more drugs than those who are less sick? And somehow they are sicker because they use healthcare more and take more drugs rather than, as most people would think, the other way round?

Trish · Aug 7, 2018

Rates of mental health and functional somatic syndrome disorder diagnoses increased significantly across allergy groups (p <0.001). All psychotropic medication classes were increased significantly across allergy groups (p <0.001). Healthcare utilization was also significantly elevated across allergy cohorts (p<0.001).
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I've only read the abstract but I can't see that the conclusion follows from the results unless you have a preconceived idea of cause and effect.

My conclusion from that information is that it looks likely that the patients with multiple allergies are being misdiagnosed as having functional disorders, probably on the basis of having multiple intractable symptoms and being female; mis-prescribed psychotropic drugs because the doctors have misdiagnosed them; and keep having to go back to the doctor because they are not recovering. The opposite of what the authors conclude.

Hoopoe · Aug 7, 2018

High healtcare utilization is due to lack of effective treatment.

rvallee · Aug 7, 2018

So many papers mixing up cause and effect entirely in ways that defy disbelief. Like the psychosocial ideologues puzzling over why sick people think they are sick, as if it were some deep mystery.

I'm getting a sense that Occam's razor is not a prominent of medical school curriculum.

Little Bluestem · Aug 7, 2018

I wonder who decides that patients with MCS need more psychotropic drugs. I'm guessing it is the doctors, not the patients.

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