L'Association pour la santé environnementale du Québec / Environmental Health Association of Québec

How to Manage – Health

Diagnosis of Environmental Sensitivities

The Quick Environmental Exposure and Sensitivity Inventory (QEESI) is a validated questionnaire for chemical intolerance and the most widely used screening instrument available for personal use. Researchers and clinicians around the world use the QEESI to document symptoms and intolerances. People who use the QEESI find it helpful for self-assessment. It’s also a useful tool for you to take to your doctor to explain your exposures and symptoms.

Click here to view QEESI

Taking An Exposure History: A mnemonic (CH2OPD2) helps to organize the history, and the forms below can be given to patients to be completed at home and reviewed at a subsequent educational counseling visit.

Click here to view: Taking an Exposure History (CH2OPD2)

Multiple Chemical Sensitivities (MCS)

Initiation and subsequent sensitization observed in cases of environmental sensitivities:

  1. Symptoms are reproducible following repeated chemical exposure;
  2. The condition is chronic;
  3. Lower exposure levels than those previously tolerated, or tolerated by the general population, lead to the manifestation of symptoms;
  4. Symptoms improve or disappear when the incitants are removed;
  5. Responses occur to multiple chemically unrelated substances;
  6. Symptoms involve multiple organ systems;

Still not refuted in the literature published almost two decades later

Definition used both in clinical practice and in research

Recently (2018) confirmed by the Ministry of Health and Long Term Care (MOHLTC) Ontario by a group of experts using the Delphi process

These diagnostic criteria were then validated by University of Toronto researchers, who also determined additional symptoms common in people with MCS.

  • Having a stronger sense of smell than others.
  • Difficulty concentrating.
  • Feeling dull or groggy.
  • Feeling spacey.

Bartha, L., et al., Multiple chemical sensitivity: a 1999 consensus. Archives of Environmental Health: An International Journal, 1999. 54(3): p. 147-149.
McKeown-Eyssen, G.E., et al., Multiple chemical sensitivity: discriminant validity of case definitions. Archives of Environmental Health: An International Journal, 2001. 56(5): p. 406-412.
Nethercott, J.R., et al., Multiple chemical sensitivities syndrome: toward a working case definition. Archives of Environmental Health: An International Journal, 1993. 48(1): p. 19-26.
Ontario Ministry of Health and Long-Term Care, Guiding Principles for the Diagnosis of Environmental Sensitivities/Multiple Chemical Sensitivity. Centre for Effective Practice, 2018:

Also noted commonly in the international medical literature:

  • Onset of MCS most commonly reported after acute exposure to pesticides, solvents
  • Pain and fatigue may be severely disabling
  • If exposures are constant, sensitivities may be “masked” and not recognized until…

The Tipping Point

Cumulative contamination leads to tipping points. For example:

  • we are surpassing the environmental tipping point with climate change
  • human body burden and cellular/organ injuries build up over time

Multiple exposures can cause multiple effects, but until overloaded, a person may not feel ill. Sensitivities to various substances are individual, but may “spread” to more types of exposures.

Hospital protocol

A Practical Guide for Hospital Staff

Part 1: Pollution Prevention
Part 2: Environment-Sensitive Care

This guide is based on current knowledge and parts of it may be changed as new research findings emerge with regard to the effects of the environment on health and effective prevention and remediation strategies. Suggestions are offered which may assist refinement of hospital policies that promote and protect health, as well as optimize the care for individuals with environment-linked illnesses. It is acknowledged that the available evidence upon which these suggestions are based varies in quantity, type, and quality. Some suggestions in this guide may not be suitable for some hospitals. This publication was developed as a collaborative process over several years, and thus in total may not necessarily represent the views of individual contributors. The Canadian Society for Environmental Medicine assumes no liability for any damage, injury or expense that may be incurred as a result of this publication.

Medic Alert

(This is NOT an advertisement for Medic Alert)

Accidents happen, that is why they are called accidents. Are you prepared for this? Would you not want the person treating you in an emergency to know about your allergies, sensitivities and whatever else may be affecting you, especially if you can’t talk?

To be a part of the Medic Alert system, you have to subscribe and purchase either a bracelet or necklace.

Your bracelet or necklace is engraved with the most vital information and/ or a telephone number of your health professional – in case he/she can follow up with more information that is important. Also, a 24/7 hotline provides additional information on your medical record. Mention that you have an emergency bag and give its location.

To find out more contact: 1.800.668.1507

Always Keep A Bag Ready

A medical emergency can happen at any time. Being prepared is preferable to panicking at the last minute. In view of your sensitivities, it is a good idea to take certain precautions and pack an emergency bag beforehand.

1. Print out the Hospital Guides for people with Environmental Sensitivities :

Part 1: Pollution Prevention
Part 2: A Practical Guide for Hospital Staff

2. Contact your local hospital, give them a copy of the guides and ask them how they will accommodate you if you have an emergency.

List of items suggested for your emergency bag:

  1. Mattress protector, sheet to cover mattress, another mattress protector in a larger size to go on top
  2. Sheets
  3. Blankets
  4. Pillows
  5. Pillow cases
  6. Bath towel, hand towels, wash cloths
  7. Soap, shampoo, toothbrush, toothpaste
  8. Safe oxygen tubing (discuss with your doctor, tygon tubing is available)
  9. Ceramic mask for oxygen
  10. Appropriate clothes
  11. Cleaning products for the room and bathroom
  12. Extra towels to roll and place at the bottom of the door to keep out hospital smells
  13. Plates, fork, spoon, glass, water bottles
  14. Table lamp (to avoid neon lights)
  15. Find out what arrangements can be made to provide food for you

Inform the family member with whom you live about this bag and why you have prepared it. Let them know that you will need the bag at the hospital in any emergency situation.

Healing Treatments: What To Look For

You have been diagnosed with or suspect that you suffer from environmental sensitivities. Your doctor or health care provider should be knowledgeable about this condition, and be able to understand and address your concerns. Look for a clinic or office with a minimum of possible triggers such as scents, toxic chemicals, mould and cell phones.

Your health care provider should be able to assist you with a personalised plan which may include:

  • Advice about triggers that provoke symptoms, and how to clean up your home and workplace
  • Advice on the value of organic food, clean air and clean water – and, if possible, where to get them
  • Identifying the triggers that affect you
  • Lowering the total load of toxicants and ongoing triggers that affect the body
  • Addressing safe removal of mercury fillings and identifying safer alternatives
  • Introducing you to a rotation diet
  • Addressing nutritional deficiencies and building up nutrients required for detoxifying
  • Healing detoxification pathways. Detoxification pathways can be damaged by pesticides, chemicals present in everyday products, toxic metals such as mercury, arsenic, lead, etc.
  • Detoxification with sweating using sauna or heat therapy, agents to remove toxins from the body and oxygen therapy
  • If required, testing for gluten intolerance, sources of hidden infections (such as Lyme, etc., or parasites), hormone imbalances, heavy metals and chemicals.

It is important to follow all instructions given to you by your environmental doctor or health care provider, and to take responsibility for following your health plan.

Living with Environmental Sensitivities obliges patients to become very aware of their environment, and to be vigilant about its effects on their health. Keeping a diary to record symptoms and the places in which they occur such as shopping malls, banks and grocery stores, will give you a good idea of what you can safely do and what you should avoid. This will serve as a tool to help you follow your progress. It will not always be smooth sailing, but you will probably notice that your downturns become increasingly shorter and /or less intense as you begin to recover, especially if you practise avoidance. This will encourage you. With patience, avoidance, clean air and water, healthy food, and time, things will get better.

Success in managing your condition depends to a large extent on finding a healthy place to live and work. Find social support for things like shopping, banking, etc., so that you are not exposed when you are not doing well. With time this will improve and you may be able to go out on your own.

In your quest for healing you may want to try acupuncture, homeopathy, naturopathy, lymphatic drainage or other holistic therapies. Look for a practitioner whose office is scent-free and who is knowledgeable about environmental sensitivities.


Science has shown that, because of genetic differences, some people are less able than others to metabolize all the substances we are exposed to in our environment. They are more susceptible to adverse effects from harmful exposures they encounter in air, food, water, consumer products and the built environment.

The sooner a patient is diagnosed by a physician certified in environmental medicine, the better the health outcome. If a patient has to wait a long time to be treated, it will be more difficult to recover. Nonetheless, there are some things that patients can do on their own to help with their recovery. These are the SEEDS of health.

S – Sleep: This is when our body does most of its regenerative work. It’s important to give it good working conditions. Refer to the guide on how to create and maintain a healthy bedroom. Adopt healthy sleeping habits that promote restful and adequate sleep. Keep electronic gadgets such as the television, electric clock, cordless phone, etc., out of your bedroom.

E – Environment: Keep your environment free from triggering agents and toxins. Remove all personal and cleaning products that do not have the ecocert logo or other certification logos. Make sure any products in your environment are scent-free. Ventilate well if you live in an area where the outdoor air quality is good; if not, use a reputable air purifier with a HEPA filter and activated carbon.

E – Exercise: Start to exercise to your ability, gradually increasing as you are able to tolerate more. Get a friend to walk with you in nature parks or on paths beside a river or lake. Look for less polluted areas where you feel most comfortable.

D – Diet: Improve your diet; eat organic food, and only those foods that you tolerate well. Rotate your foods for best results, always avoiding foods to which you are allergic.

S – Support: Build a support network consisting of family, friends and/or co-workers. Include medical, social and spiritual resources. Explain your medical condition and your need for healthy, scent-free spaces so that you can function. Use peanut allergies as an example when you request accommodation. Contact ASEQ-EHAQ for help and intervention.

Based on the document SEEDS of health © Dr Lynn Marshall (2003)

ActionHealth EffectNotes
Immediately – lower total load of
substances that you notice trigger
symptoms, such as chemicals,
moulds and electromagnetic
fields. This is the basis of
Over time, reduces sensitivities and lessens symptomsReplace your triggering exposures with clean air and safer consumer products.
Stop the spreading phenomena as
quickly as possible by eliminating
the most common substances
known to trigger symptoms in
others with environmental
Over time, reduction of sensitivities and symptomsUse only certified organic, scent-free products.
Elimination dietIdentifies food sensitivitiesIntroduction of a new food should be done cautiously. Obviously, you should never introduce foods to which you already know you are allergic.
Four-day rotation diet with
tolerated foods
Lowers total load and with time may increase tolerance to certain foods.

Minimizing exposure to toxins often entails lifestyle changes, including:

  1. Eat organic food.
  2. Follow a healthy diet with foods you can tolerate.
  3. Drink filtered water.
  4. Use least-toxic housecleaning products.
  5. Use least-toxic personal hygiene products.
  6. Reduce stress levels; cultivate stress management techniques.