Pyrethrins are the insecticidally active components of pyrethrum extract, derived from flowers of Chrysanthemum cinerariifolium and used in commercial and consumer insecticide products. Most dermal testing performed with pyrethrum extracts was done before current refined pyrethrum concentrate became available (before 1967).

A group of  Scientists analyzed presently commercially available pyrethrum allergen extracts to determine the concentration of pyrethrins and the putative sensitizer pyrethrosin.

Six commercial pyrethrum allergen extracts were purchased from four major allergen suppliers and analyzed for pyrethrin I and pyrethrosin by using a capillary gas chromatograph equipped with a flame ionization detector.

The commercial pyrethrum allergen extracts contained no detectable pyrethrins or pyrethrosin. In comparison, the pyrethrum standard provided by the McLaughlin Gormely King Company, a major refiner of pyrethrum, contained 20% pyrethrins and 0.49% pyrethrosin. No compounds observed in the chromatogram of the refined pyrethrum concentrate were present in the allergen extracts.

Caution should be used when interpreting the results of tests performed with current pyrethrum allergen extracts because pyrethrins and pyrethrosin may not be present. Moreover, unknown components such as high-molecular-weight proteins or other impurities that may cause dermal reactions could be present in significant amounts.

Literature:

Osimitz TG, Franzosa JA, Maibach HI., Pyrethrins and pyrethrosin content in commercial allergen extracts, Dermatitis. 2009 Dec;20(6):338-40.

The occurrence of gluten intolerance in the Finnish population has doubled in the past twenty years. In the early 1980s, about one per cent of adults in Finland had gluten intolerance, but the figure has since gone up to two per cent by the 2000s.

“We’ve already seen a similar trend emerge earlier on where allergies and certain autoimmune disorders are concerned. Screening has shown that gluten intolerance occurs in 1.5 per cent of Finnish children and 2.7 per cent of the elderly. The higher figure for older people is explained by the fact that the condition becomes more frequent with age,” says Professor Markku Mäki. Mäki has set up an internationally acclaimed research team on gluten intolerance, developing screening tests for gluten intolerance. Mäki is head of a research project in the Academy of Finland’s Research Programme on Nutrition, Food and Health (ELVIRA).

According to Mäki, gluten intolerance may often be symptom-free, and people may be unaware that they have the condition if their symptoms are mild or atypical. Three out of four people with gluten intolerance have not been diagnosed, which also means that they are as yet going without treatment.

Better diagnosis methods needed

Mäki’s research team has concluded that the criteria for diagnosing gluten intolerance must be rewritten, since early stages of the condition do not meet the criteria, yet is important to treat. The current criteria for diagnosis focus on damage to the intestinal villi and the small intestine, established in a tissue sample from the small intestine. However, early stages of gluten intolerance are not identifiable from tissue samples.

People may suffer from gluten intolerance, yet have no intestinal symptoms. They may, however, have symptoms unrelated to the intestinal tract. Serious problems with nutrient absorption have become rare; instead, sufferers generally have anaemia due to iron deficiency or folic acid deficiency as their main symptom. If researchers manage to develop sensitive, accurate antibody tests, it will become possible to identify people with early stages of gluten intolerance, who are in need of further treatment. At present, there is no single test to reliably identify early stages of gluten intolerance.

Sufferers are hoping for a diagnosis method that does not involve endoscopy. Researchers are hard at work, looking for new and better markers for gluten intolerance to allow for easier diagnosis of the condition.

Patients are also hoping for an ‘anti-gluten pill’. Mäki says that some form of pill with enzymes that break down gluten may prove feasible in the future.

Literature: Academy of Finland, Gluten intolerance in Finland has doubled, March 5, 2010

In an international newsgroup for activists and scientists which looks into the topic of environmental related diseases, toxic caused illnesses and chemical sensitivity, a posting about the ICD-10 concerning MCS was issued by a German activist (see appendix). She presented a written answer from the DIMDI, which she received in response to a question she wrote. She misinterpreted the answer of the DIMDI, in parts she mistakenly translated from German to English, and furthermore left out important points.

E.g. the term “quality assurance” mentioned in the letter of the DIMDI was left out. But the importance of it is essential, as only quality assurance by the means of proper clinical diagnostics after international recognized criteria can lead to an adequate therapy. In the context of “QM” (quality management) the German Medicine focuses on this. So the readers who could not read the original German letter were totally confused and misinformed about the importance of the ICD-10 for MCS in Germany.

Dr. Tino Merz, legal expert for Environmental issues gives his view:

PART I - Artificial Confusion about the ICD-10

It is fascinating to watch all the possibilities of misinterpretation again and again. In order to avoid all incorrect interpretations, we published the “Information’s for Physicians”. The ICD-10 Classification of the WHO and the diagnosis criteria for MCS, CFS, FM and TE can be found in it, without much comment. But as shown, even that can be confuscated.

ICD 10 – List of Diagnosis

Thus and because it is not the first time that wrong conclusions were drawn from wrong ideas, in absolute clear words: the international classification of diseases, 10th edition (since 1992) is a list of about 70.000 diagnosis, which are divided into 22 chapters. The diagnosis to be included are recognized and, due to that, legal diagnosis. That’s important for jurisprudence. The medical Definitions (e.g. diagnostic criteria) are not listed there.

Talking the ICD-10 to Death: Off Topic

Because of this, we included both in the information’s for physicians. The diagnostic criteria are for matters of diagnose, the ICD-10 term is for the legal classification. “T78.4… allergy, unspecified” lists MCS under external injuries, namely as acquired immune deficiency in the characteristic of an unspecified allergy or hypersensitivity. Already earlier an activist lady supposed this to be insufficient. She provided scientific arguments to justify it. Well, that’s off topic. The ICD-10 is a formal [schematic] classification. The phrase “T78.4 does not recognize “MCS” as a medical diagnosis.” is entirely wrong. The ICD-10 list does exactly this: It recognizes MCS as a defined diagnose.

Self-made artificially produced Confusion causes Damage

Since it is this way, in coincidence with the classification as physical and external injury, the attempts don’t stop, which want to relativize what has been scientifically decided for a about a decade. The reinterpretation as “IEI” was rejected by the WHO in 1996. The psychogenic thesis was not phrased until the international discourse was resolved just with the ICD-10 entry. The trick applied is genial. As chemicals harm the mental functions, exactly this is turned against the harmed. The psychogenic thesis swaps cause and effect. This allows to misinterpret any study as wrong as desired. This has nothing to do with science (see blog entry: Erlanger Fake (German only). Nevertheless this allows to create confusion. It is combined with loudness and intimidation. The apodosis from the DIMDI shows that the official tried to avoid trouble. The activist made the classic mistake: “Never ask something, if you don’t know the answer in detail”. Now the asking activist also wrongly judges: she suggests a new finding (“eye-opening”) to be that the ICD-10 does not list recognized diagnosis. What else then? This is the genuine purpose of the ICD. Even those who propagate the psychogenic thesis don’t dare something like this. Therefore, such nonsense is extremely helpful, but only for confusion and to cause damage to the afflicted.

No Question: Environmental related Diseases are recognized long ago

Nobody can deny seriously that environmental related diseases have been recognized long ago. But it is possible to achieve nearly everything with half-truths and prevarications if the afflicted don’t inform themselves. So the others get them where they want them to be.

As legal expert I often have to experience lawsuits that fail, because clients decide wrong, following their view, as they do not know the legal background and the legal interpretation of the scientific knowledge and ignore the advice.

Author: Dr. Tino Merz for CSN – Chemical Sensitivity Network, January 29, 2009

Additional information’s (German only):

• www.dr-merz.com
• Strategy Paper for MCS (pdf)
• Information for physicians about MCS, CFS, EMS, TE (pdf)

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APPENDIX:

The activist’s newsgroups posting from early January:

The German ICD-10 Coding Guidelines have taken on an important role in Germany since 2002. Because of the cross mapping from the German payment system (known as the Fallpauschale [FP] and Sonderentgelt [SE]) for the hospital inpatient billing requirements to the implementation of the German DRG (G-DRG) payment system, an increasing awareness for the necessity of correct coding could be seen. As of August 15, 2003, Germany named the ICD-10 version ICD-10-GM (German Modification). Usage of the ICD-10-GM: In Germany, the practicing physician is legally responsible for documenting and coding patient charts that are seen in his/her office, and the hospital physician is legally responsible for documentation and coding of the hospital inpatient/outpatient admissions.

Multiple Chemical Sensitivity (MCS) has been formally registered as a physical illness by the German Institute of Medicine, Documentation and Information, and is classified within the German version of the World Health Organization (WHO) International Classification of Diseases ICD-10-GM, Code T 78.4… allergy, unspecified.

For clarification whether MCS has been recognized as a physical illness or not, I wrote to Dr. Ursula Kueppers at the DIMDI. On December 22, 2009 she sent the below reply. An eye-opener to me are the last sentences of her e-mail:

“The ICD-10 can only partly be helpful in deciding the obviously unsolved controversy whether a disease like MCS is to be listed under physical illnesses or mental (psychogenetic, psychiatric) disorders. The facts of this issue have to be discussed by medical experts and can only be answered by them.”

The essence of her statement is that ICD-10-GM, code T78.4 does not recognize “MCS” as a medical diagnosis. The German government simply put “MCS” into the index of the German ICD-10-GM for different purposes (statistics, payment, etc.) in the National Health Care System.

Best to everyone,

xxx

Cited written reply from the DIMDI*

Dear Ms. XXXX

I apologize for not answering your question earlier.

The ICD-10-GM serves in the Germany Federal Republic for different purposes in the public health (amongst others for the billing system, quality assurance, statistics). The ICD-10-GM is based on the ICD-10 edition of the World Health Organization (WHO).

Normally, the ICD-10 (-GM) does not define diseases, but classifies illnesses in Chapters and Groups etc. considering specified criteria. This structure of the ICD-10 (-GM) has its roots in history. You can read more about that in Volume 2 (Instruction Manual) of the WHO’s ICD-10 edition. [English WHO version ]

As to MCS the status quo is that MCS is actually coded in the ICD-10-GM under “T78.4… allergy, unspecified” and thus it is not assigned to Chapter V – Mental and behavioral disorders. From my point of view the explanation text there provides a good reason for the coding under T78.4. “This category is to be used as the primary code to identify the effects, not elsewhere classifiable, of unknown, undetermined or ill-defined causes. For multiple coding purposes this category may be used as an additional code to identify the effects of conditions classified elsewhere.”

For the final judgment of the obviously not cleared matter of dispute, whether such a disease like MCS has to be seen as a physical or mental illness, the ICD-10 help is limited. This question has to be discussed on its merit by medical experts and only they can answer it.

Yours sincerely,

p.p.

Dr. Ursula Kueppers

DIMDI – German Institute for Medicinal Documentation and Information

Medical Classifications

The DIMDI is an Institute of the German Federal Ministry of Health’s (BMG) Portfolio.

* (Translated by BrunO)

PART II - Update: Emotionality and Misinformation do damage to MCS sufferers

In his previous blog post Dr. Merz wrote how activists and support groups generate artificial confusion about the code for MCS in the ICD-10. For about three years some patient “advocates” apply to put this diagnostic-key forcefully into question or even deny its existence, which describes MCS as an organic disease. Though CSN has spread a non-ambiguous letter from the DIMDI, these attacks don’t stop. And actually, there is no comprehension. The circulation of misinformation organized by an activist even on national and international levels continues. For weeks she is posting falsifying information’s about the ICD-10 concerning MCS in various newsgroups. She tries to morally legitimate her behavior which is harmful to all MCS suffers in one of the recent posts by mentioning her own failed lawsuit.

The Opinion about the MCS ICD-10, spread by an Activist Lady:

According to Dr. Kueppers at the DIMDI (German Institute of Medicine, Documentation and Information – medical classifications), the purpose of the ICD-10-GM classification system is only medical billing, statistics. She wrote that the ICD-10 (-GM) does not as a rule define illnesses.

Despite the ICD-10-GM classification system, code 78.4… allergy, unspecified, MDs, psychiatrists, psychologists, medical experts still can assign the dx “mental”, “psychogenetic”, “psychosomatic” disorder for our illness, if they want to do so.

To offer evidence for this sad truth, I would like to inform you on my own experience with the German legal system. In April 2002 I went to court. In a lawsuit at the regional court Bonn, the expert witness, a respected professor and director of the university hospital in Cologne stated the below in evidence, though he had to be familiar with the ICD-10 classification system:

>> As to conventional (orthodox, traditional) medicine, a clinical syndrome such as “MCS” is not known and recognized. “Multiple Chemical Sensitivities” as the plaintiff translates the term for the illness do not have any influence on the therapeutic procedure within the limitations of conventional medical treatment. “MCS” is a matter of non-medical practitioners (homeopaths, and others).>>

This lawsuit caused a kind of “PTSD” in me. So if I stumble across articles “GERMANY IS THE FIRST COUNTRY TO RECOGNIZE MULTIPLE CHEMICAL SENSITIVITY ( MCS) AS A PHYSICAL DISEASE”, for instance, the one by Christiane Tourtet it still hurts, and I swallow my anger about the experienced injustice.

Best from Germany,

XX

*Note: DIMDI’s name in not translated correctly. DIMDI means “German Institute for Medicinal Documentation and Information”. It is not an Institute for Medicine; it is not called “German Institute of Medicine, Documentation and Information”.

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Dr. Tino Merz about the restated Misinterpretations of the Activist:

You have to start reading the text of the activist from the end. The writer is hurt and annoyed about an expert opinion, which says MCS does not at all exist in traditional medicine. Instead of figuring out how to counteract such nonsense effectively – if the professor does not know the ICD, he may be incompetent or prejudiced – she swallows her anger.

Well, she is unable and unwilling to believe what Dr. Kueppers wrote in her precise letter to Silvia Mueller. Probably she asked if it really was true. That’s the old truth: “If you ask long enough …”. Meanwhile pressure was put on Ms. Dr. Kueppers. So she backpaddles and our writer presents her the opportunity to buckle.

At last, our writer teaches the world and proclaims the sad truth, that there are no diagnoses in the ICD and the physicians do not have to pay any regard to it.

This activity shows how those, which – knowing the truth – deny the state of science, succeed to turn an immense whole scientific literature into garbage, as seen by presenting their pseudo science as new scientific finding (Erlanger Fake Method: swap cause and effect), apostrophizing it as traditional medicine correctness and demanding above all, to accept it as “serious”. Obviously they succeed in making many support groups to accept it. I point to a quote in my strategy paper about “the belief in science”. An activist lady states in it non-acceptance of MCS is due to journalists and politicians belief in science. Thus the activist accepts MCS is scientifically unexplained. In consequence, the sad truth is that such support groups assist to dig their own grave.

Author: Dr. Tino Merz for CSN – Chemical Sensitivity Network, February 5, 2009

Translation: BrunO with help of John. Thank you to both of them!

A new study by researchers at UCLA and Brigham and Women’s Hospital in Boston suggests that improvements in air quality over the past decade have resulted in fewer cases of ear infections in children.

Ear infections are one of the most common illnesses among children, with annual direct and indirect costs of $3 billion to $5 billion in the United States.

“We believe these findings, which demonstrate a direct correlation between air quality and ear infections, have both medical and political significance,” said study co-author Dr. Nina Shapiro, director of pediatric otolaryngology at Mattel Children’s Hospital UCLA and an associate professor of surgery at the David Geffen School of Medicine at UCLA. “The results validate the benefits of the revised Clean Air Act of 1990, which gave the Environmental Protection Agency more authority to implement and enforce regulations reducing air-pollutant emissions. It also shows that the improvements may have direct benefit on health-quality measures.”

The research appears in the February issue of Otolaryngology–Head and Neck Surgery, the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation.

The researchers reviewed National Health Interview Survey data for 120,060 children between the years of 1997 and 2006 and measured the number of instances of three disease conditions for each year — frequent ear infections (three or more within a year), respiratory allergy and seizure activity, which is not influenced by air quality but was included as a control condition.

These numbers were then cross-referenced with the EPA’s air-quality data on pollutants, including carbon monoxide, nitrous dioxide, sulfur dioxide and particulate matter, for the same time period. The study authors discovered that as air quality steadily improved, the number of cases of frequent ear infections significantly decreased.

The results also showed that there was not an association between improved air quality and improved rates of pediatric respiratory allergy, possibly due to the fact that allergens are not pollutants.

Reference: UCLA, Amy Albin,  Improved air quality linked to fewer pediatric ear infections, January 27, 2010

If your baby were suffering from colic, would you treat him with artificially dyed and sweetened simethicone (the chemical in drugs such as Mylanta and Mylicon) or first try an emulsion of fennel seed oil?  If your young daughter developed a persistent rash, would you prefer the doctor to prescribe antihistamines or a diet rich in omega fatty acids?

More and more, it’s likely you’d give the second choice a try. The big news is that mind-body pediatrics has come of age over the past generation. It’s a trend that seems very appropriate for a generation of parents looking for foods without pesticides and cosmetics without solvents.

A major symptom of its acceptance is the publication of the first textbook book on Integrative Pediatrics, edited by the avuncular and reassuring Dr. Andrew Weil, the U.S.’s best known non-conventional medicine practitioner and spokesperson.   The august National Institutes of Health has set up a center devoted to its study while the American Academy of Pediatrics has formed a practitioners’ Section.  And you can now find pediatricians across the nation who will use integrative practices to care for your children (click on hyperlink to members, select Section on Complementary and Alternative, for a listing by zip code; also www.aaemonline.org).

This kind of medical care works to keep children well by instilling a long-life pattern of healthy living and by treating simple problems such as ear aches without resorting to the overuse of drugs.  It particularly lends itself to caring for children with chronic illnesses, such as cancer, juvenile arthritis, obesity, asthma and developmental disorders such as autism and ADHD, where conventional medicine hasn’t a great track record of cures.  In fact, there’s been a major increase in the number of prescription medications used to treat symptoms of childhood chronic illnesses, despite the absence of data that they are effective in curing the underlying problems.

If the incidence of chronic childhood illnesses continues the upward climb it has taken over the past two decades, and as more families understand the link between prevention and treatment, integrative pediatrics may very well become the standard practice of the future.

Probably only grandmothers like me remember when revered New York Times journalist James Reston, returning from a 1972 reporting trip to China with President Nixon, wrote about his surprising experience in undergoing an emergency appendectomy with acupuncture as the only sedative.  That launched our nation’s first timid and by now vast interest in alternative medicine, from acupuncture to meditation, massage and body manipulation, biofeedback, exercise, nutrition and the use of botanically-based supplements.

Now that these techniques are no longer “alternative” to conventional western medicine but have become pretty much an accepted part of it, they are called “integrative” (meaning they’re integrated into standard practice) or “holistic” or “complementary” or “environmental” (a term especially acknowledging the effect of toxic exposures).

In my interviews with integrative pediatricians, they explain, first and foremost, that the power in holistic practice is their relationship with the child and her family, that healing is inexorably bound to the connection between practitioner and patient.

To create that connection, they spend lots of time meeting and talking and educating.  They build a team with the parents; the pediatrician acts like a quarterback helping the parents navigate the health care system.  In the first months of a child’s life, they focus on frequent well-baby care where they also design individualized schedules for vaccinations and treat problems that may arise, such as colic. These conversations with parents and patient continue as the child grows, so different from the usual harried, cookie-cutter 15-minute consultation.

If you visit Dr. Lawrence Rosen, a 43-year-old MIT grad and Mt Sinai-trained integrative pediatrician, you’ll find his pleasant office in New Jersey a paragon of green construction – the flooring, cabinetry and paint were chosen as the safest, least toxic (his website offers resources on green pediatrics construction based on his research and experiences). Even the staff’s dishware is either glass or nontoxic plastic made from recycled materials. Dr. Rosen explains that “the build-up of low-level toxic exposures is responsible for more illnesses than one-time higher exposure.”  He’s given him practice a name: The Whole Child Center, and he blogs when he can about natural parenting practices.

One of his patients is a ten-year-old girl (let’s call her Jenny) with asthma so severe she was using several different inhalers and several different allergy medications every day. Some of the steroid-based drugs were affecting her appetite and causing weight gain, while their continued use could have threatened her long-term development. Yet she still found it hard to participate in school sports. Jenny also had eczema and food allergies. “Rather than prescribing more medicines to suppress her symptoms, I looked for ways to balance her immune system response,” Dr. Rosen explained. He didn’t remove her from her medications immediately, to avoid an attack, but slowly over time worked with Jenny to integrate complementary therapies.

He started her on a daily probioitic, –which are supplements or foods like yogurt, rich in beneficial live microorganisms such as lactic acid bacteria.  He told her mom to ensure her diet included lots of fruits and vegetables with their healing antioxidants as well as foods with high levels of omega-3 fatty acids. Jenny was encouraged to build up her physical strength by swimming and walks outdoors in nature.  Dr. Rosen also worked with her on relaxation techniques including guided imagery and breathing (“Everyday Blessings: The Inner Work of Mindful Parenting,” by Jon Kabat-Zinn.and his wife, Myla). After careful monitoring, she’s now mostly weaned from her prescription meds, uses an inhaler infrequently, and has achieved her dream of participating in sports. Whereas last year she had missed 40 days of school, this year it was down to five.

A young patient with cancer in remission might be treated with similar practices, to support his immune system and his body’s overall strength and resilience.

“Conventional Western medicine is about fixing disease, mainly acute illnesses. It’s oriented around disease labeling and treatment,” Dr. Rosen says. Integrative pediatricians focus on wellness and innate balance of health.

Author: Alice Shabecoff for CSN – Chemical Sensitivity Network, January 9, 2010

Alice Shabecoff is the co-author with her husband Philip of Poisoned Profits: The Toxic Assault on our Children, published by Random House last year.  See their website, www.poisonedprofits.com

Related article from Alice Shabecoff:

• Our planet, our children – How are your children doing?
• My mother made me fat

Information Sources:

• A membership association of environmental physicians: American Academy of Environmental Medicine
• For families and practitioners; has a member directory: Holistic Pediatrics Association
• A practitioner group: Integrative Practitioner

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To my readers: I’m working on a related article that will focus on the way that nutrition can heal developmental disorders such as ADHD and autism.  And another article on how today’s health care system impedes the use of integrative pediatrics.