Managing environmental sensitivity: an overview illustrated with a case report.

While the adverse impact of certain environmental agents is well established and affect individuals in a predictable dose-dependent manner, the validity of some exposure syndromes, such as environmental sensitivity, attributed to the influence of environmental chemicals in low, usually harmless doses, is less certain. Diagnosis of environmental sensitivity is subjective, and both standard medical and complementary and alternative treatment often fails to provide clinically meaningful functional gains. Existing evidence suggests that in many individuals with these syndromes, psychosocial factors play a prominent role. In this article we present an approach to managing patients presenting with sensitivities to environmental agents that includes identifying and managing organic disease, obtaining a thorough biopsychosocial history, confirming a diagnosis, and developing a rehabilitative process that focuses on support and improvements in function. A case of multiple chemical sensitivity illustrates this approach.