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 rhinitis, headache, and rash when using CCP; however, management reported that the current CCP was a different brand than that used by the former worker. The authors were unable to evaluate the effects of the previously used CCP and concluded that no symptoms were related to the current use of CCP.

Sim and Echt 1993. In response to a request from the Health Commissioner for Kentucky, Sim and Echt [1993] investigated an outbreak of skin disorders among 10 laboratory workers at the Health Services Building in Frankfort, Kentucky. Workers were concerned about their symptoms, which they felt resulted from contact with CCP forms that accompanied the biological specimens analyzed in the laboratories. Itchy skin and rashes on exposed skin and areas where clothes rub were reported in early May of 1993, soon after the start of fibrous glass insulation installation in the mechanical rooms that housed the air-handling units for the laboratories. Symptoms were reported more often in the early part of the week, were less severe in the latter part of the week, and usually resolved on the weekends. The symptoms tended to recur upon returning to work the following week. Several nonskin symptoms were reported during medical interviews with some workers, including breathing difficulties, headaches, sinus infections, irritated eyes, and a tingling sensation of the nose and lips. Three of the workers reporting skin symptoms did not handle CCP forms. The number of workers with symptoms who handled CCP was not reported. Although a new printing of CCP forms occurred at the beginning of 1993, the manufacturer indicated that no change to the forms had recently occurred. The nature of some of the symptoms was consistent with the irritant dermatitis caused by exposure to insulation, and the onset of symptoms also coordinated well with the timing of this operation. The authors concluded that the most likely cause of the symptoms was irritant dermatitis due to contact with glass fibers.

Zimmer and Hadwen 1993. See Section 3.2.1 for a description of this study.

'Ziem and McTamney 1997.' In the United States, Ziem and McTamney [1997] published a case series of patients assigned the diagnosis of multiple chemical sensitivity (MCS). MCS is a controversial diagnosis used by some practitioners to refer to illness in persons who typically describe multiple symptoms attributed to numerous and varied environmental chemical exposures in the absence of objective, diagnostic physical findings or laboratory test abnormalities that define an illness. A new name for the condition—idiopathic environmental intolerances—was recommended in 1996 by a workshop organized by the International Programme on Chemical Safety of the World Health Organization [American Academy of Allergy, Asthma, and Immunology 1999; Miller 1997]. Cullen [1987] proposed the most commonly referenced definition of MCS: an acquired disorder characterized by recurrent symptoms that (1) are referable to multiple organ systems, (2) occur in response to demonstrable exposure to many chemically unrelated compounds at doses far below those known to cause harmful effects in the general population, and (3) do not correlate with any single widely accepted test of physiological function. The Interagency Workgroup on Multiple Chemical Sensitivity [1998], in reviewing three categories of proposed theories of causation (immunological, neurological, and psychological), found many variations and theories that were interrelated.

Two of 91 patients attributed their conditions to CCP. For one of these patients, few immunologic changes were demonstrated, and most of the values were within normal limits. The authors believed that immune measures preand post-challenge testing were unlikely to show major changes and were therefore not diagnostic of specific MCS etiologies. They reported that after being away from exposure for