{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T17:10:37Z","timestamp":1767373837655,"version":"3.40.5"},"reference-count":56,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T00:00:00Z","timestamp":1729555200000},"content-version":"unspecified","delay-in-days":295,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prim Health Care Res Dev"],"published-print":{"date-parts":[[2024]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S146342362400046X_as1\">\n\t    <jats:title>Aim:<\/jats:title>\n\t    <jats:p>The goals of this investigation were to 1) identify and measure exposures inside homes of individuals with chemical intolerance (CI), 2) provide guidance for reducing these exposures, and 3) determine whether our environmental house calls (EHCs) intervention could reduce both symptoms and measured levels of indoor air contaminants.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S146342362400046X_as2\">\n\t    <jats:title>Background:<\/jats:title>\n\t    <jats:p>CI is an international public health and clinical concern, but few resources are available to address patients\u2019 often disabling symptoms. Numerous studies show that levels of indoor air pollutants can be two to five (or more) times higher than outdoor levels. Fragranced consumer products, including cleaning supplies, air fresheners, and personal care products, are symptom triggers commonly reported by susceptible individuals.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S146342362400046X_as3\">\n\t    <jats:title>Methods:<\/jats:title>\n\t    <jats:p>A team of professionals trained and led by a physician\/industrial hygienist and a certified indoor air quality specialist conducted a series of 5 structured EHCs in 37 homes of patients reporting CI.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S146342362400046X_as4\">\n\t    <jats:title>Results:<\/jats:title>\n\t    <jats:p>We report three case studies demonstrating that an appropriately structured home intervention can teach occupants how to reduce indoor air exposures and associated symptoms. Symptom improvement, documented using the Quick Environmental Exposure and Sensitivity Inventory Symptom Star, corresponded with the reduction of indoor air volatile organic compounds, most notably fragrances. These results provide a deeper dive into 3 of the 37 cases described previously in Perales et al. (2022).<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S146342362400046X_as5\">\n\t    <jats:title>Discussion:<\/jats:title>\n\t    <jats:p>We address the long-standing dilemma that worldwide reports of fragrance sensitivity have not previously been confirmed by human or animal challenge studies. Our ancient immune systems\u2019 \u2018first responders\u2019, mast cells, which evolved 500 million years ago, can be sensitized by synthetic organic chemicals whose production and use have\u00a0grown exponentially since World War II. We propose that these chemicals, which include now-ubiquitous fragrances, trigger mast cell degranulation and inflammatory mediator release in the olfactory-limbic tract, thus altering cerebral blood flow and impairing mood, memory, and concentration (often referred to as \u2018brain fog\u2019). The time has come to translate these research findings into clinical and public health practice.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/s146342362400046x","type":"journal-article","created":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T07:11:58Z","timestamp":1729581118000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":3,"title":["Environmental house calls can reduce symptoms of chemical intolerance: a demonstration of personalized exposure medicine"],"prefix":"10.1017","volume":"25","author":[{"given":"Rodolfo","family":"Rinc\u00f3n","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger","family":"Perales","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6621-9038","authenticated-orcid":false,"given":"Raymond F.","family":"Palmer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jackie F.","family":"Forster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1398-1389","authenticated-orcid":false,"given":"Jessica F.","family":"Hernandez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6543-7639","authenticated-orcid":false,"given":"Bryan","family":"Bayles","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8165-9613","authenticated-orcid":false,"given":"Carl","family":"Grimes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5904-4719","authenticated-orcid":false,"given":"Carlos R.","family":"Ja\u00e9n","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia S.","family":"Miller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2024,10,22]]},"reference":[{"key":"S146342362400046X_ref25","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2001.tb05810.x"},{"key":"S146342362400046X_ref44","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.anthro.33.070203.143754"},{"key":"S146342362400046X_ref31","first-page":"445","article-title":"Toxicant-induced loss of tolerance--an emerging theory of disease?","volume":"105","author":"Miller","year":"1997","journal-title":"Environmental Health Perspectives"},{"key":"S146342362400046X_ref48","doi-asserted-by":"publisher","DOI":"10.1097\/JOM.0000000000001272"},{"key":"S146342362400046X_ref8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0668.2006.00437.x"},{"key":"S146342362400046X_ref5","first-page":"300","article-title":"A national population study of the prevalence of multiple chemical sensitivity","volume":"59","author":"Caress","year":"2004","journal-title":"Archives of Environmental and Occupational Health"},{"key":"S146342362400046X_ref47","doi-asserted-by":"publisher","DOI":"10.1007\/s11869-016-0442-z"},{"volume-title":"Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula","year":"2004","key":"S146342362400046X_ref14"},{"key":"S146342362400046X_ref49","doi-asserted-by":"publisher","DOI":"10.1007\/s11869-018-0625-x"},{"key":"S146342362400046X_ref12","doi-asserted-by":"publisher","DOI":"10.1080\/00039896.1992.9935941"},{"key":"S146342362400046X_ref20","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.8988"},{"key":"S146342362400046X_ref19","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jea.7500244"},{"key":"S146342362400046X_ref22","doi-asserted-by":"publisher","DOI":"10.1186\/s12302-021-00504-z"},{"key":"S146342362400046X_ref57","article-title":"Mechanisms of action of addictive stimuli, toxicant-induced loss of tolerance","volume":"96","author":"Miller","year":"2000","journal-title":"Addiction"},{"key":"S146342362400046X_ref29","doi-asserted-by":"publisher","DOI":"10.1191\/074823399678846862"},{"key":"S146342362400046X_ref7","first-page":"209","article-title":"The treatment of patients with medically unexplained symptoms in primary care: a review of the literature","volume":"7","author":"Edwards","year":"2010","journal-title":"Mental Health in Family Medicine"},{"key":"S146342362400046X_ref55","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17238972"},{"key":"S146342362400046X_ref51","doi-asserted-by":"publisher","DOI":"10.1007\/s11869-019-00672-1"},{"key":"S146342362400046X_ref15","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1346"},{"key":"S146342362400046X_ref52","unstructured":"U.S. Department of Health and Human Services (2018) Six Domains of Health Care Quality. 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