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Validation of a Brief Screening Instrument for Chemical Intolerance in a Large U.S. National Sample

1
Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
2
Hayward Score, Carmel, CA 93921, USA
*
Author to whom correspondence should be addressed.
Academic Editors: Paul B. Tchounwou and Dudley E. Shallcross
Int. J. Environ. Res. Public Health 2021, 18(16), 8714; https://doi.org/10.3390/ijerph18168714
Received: 23 June 2021 / Revised: 10 August 2021 / Accepted: 12 August 2021 / Published: 18 August 2021
(This article belongs to the Section Public Health Statistics and Risk Assessment)
Background: Chemical intolerance (CI) is characterized by multisystem symptoms triggered by low levels of exposure to xenobiotics including chemicals, foods/food additives, and drugs/medications. Prior prevalence estimates vary from 8–33% worldwide. Clinicians and researchers need a brief, practical screening tool for identifying possible chemical intolerance. This large, population-based study describes the validation of a three-item screening questionnaire, the Brief Environmental Exposure and Sensitivity Inventory (BREESI), against the international reference standard used for assessing chemical intolerance, the Quick Environmental Exposure and Sensitivity Inventory (QEESI). Methods: More than 10,000 people in the U.S. responded to the BREESI and the QEESI in a population-based survey. We calculated the overall prevalence of CI in this sample, as well as by gender, age, and income. Common statistical metrics were used to evaluate the BREESI as a screener for CI against the QEESI. Results: The prevalence estimate for QEESI-defined chemical intolerance in the U.S. was 20.39% (95% CI 19.63–21.15%). The BREESI had 91.26% sensitivity (95% CI: 89.20–93.04%) and 92.89% specificity (95% CI: 91.77–93.90%). The positive likelihood ratio was 12.83 (95% CI: 11.07–14.88), and the negative likelihood ratio was 0.09 (95% CI: 0.08–0.12). Logistic regression demonstrates that the predicted probability of CI increased sharply with each increase in the number of BREESI items endorsed (Odds Ratio: 5.3, 95% CI: 4.90–5.75). Conclusions: Chemical intolerance may affect one in five people in the U.S. The BREESI is a new, practical instrument for researchers, clinicians, and epidemiologists. As a screening tool, the BREESI offers a high degree of confidence in case ascertainment. We recommend: screen with the BREESI, confirm with the QEESI. View Full-Text
Keywords: chemical intolerance; drug intolerance; food intolerance; QEESI; BREESI; multiple chemical sensitivity; toxicant-induced loss of tolerance; prevalence chemical intolerance; drug intolerance; food intolerance; QEESI; BREESI; multiple chemical sensitivity; toxicant-induced loss of tolerance; prevalence
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MDPI and ACS Style

Palmer, R.F.; Walker, T.; Kattari, D.; Rincon, R.; Perales, R.B.; Jaén, C.R.; Grimes, C.; Sundblad, D.R.; Miller, C.S. Validation of a Brief Screening Instrument for Chemical Intolerance in a Large U.S. National Sample. Int. J. Environ. Res. Public Health 2021, 18, 8714. https://doi.org/10.3390/ijerph18168714

AMA Style

Palmer RF, Walker T, Kattari D, Rincon R, Perales RB, Jaén CR, Grimes C, Sundblad DR, Miller CS. Validation of a Brief Screening Instrument for Chemical Intolerance in a Large U.S. National Sample. International Journal of Environmental Research and Public Health. 2021; 18(16):8714. https://doi.org/10.3390/ijerph18168714

Chicago/Turabian Style

Palmer, Raymond F., Tatjana Walker, David Kattari, Rudy Rincon, Roger B. Perales, Carlos R. Jaén, Carl Grimes, Dana R. Sundblad, and Claudia S. Miller 2021. "Validation of a Brief Screening Instrument for Chemical Intolerance in a Large U.S. National Sample" International Journal of Environmental Research and Public Health 18, no. 16: 8714. https://doi.org/10.3390/ijerph18168714

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