WITH increasing frequency, patients are appearing in physicians' offices with complaints stemming from exposure to environmental irritants.
We physicians sometimes refer to the irritants as "sensitizers," "stressors" or "excitants." Regardless of the name, they are responsible for many of the allergy-like and other symptoms doctors see in their daily practice.
Unfortunately, many physicians do not recognize the source of these symptoms. When this occurs and treatment, therefore, isn't successful, the patients may be shunted from one doctor to another in an effort to find a cure. All too often, when a cure continues to be elusive, we conclude that the illness isn't real, that it's all "in the patient's head."
But the fact is that almost any treatment is doomed to failure when the cause of the illness has not been recognized.
It's no surprise that environmental illness has assumed such an important role in recent years. Only in the past few decades have we seen the huge increase in pesticide use and the extent to which our food, air and water have been exposed to synthetic and toxic chemicals.
Terms such as the "sick building syndrome," which only recently have entered our vocabulary, underline the increasing recognition of the influence of environmental conditions on the nation's health. Add to these factors the toxic waste dumps, use of food preservatives and manufacture of synthetic products, and the increasing threat of environmentally related illness becomes all too apparent.
There's even a specialty in medicine for treating these illnesses. It's called clinical ecology or environmental medicine. Those who practice it maintain that many patients, who are referred from one medical specialist to another because no specific cause of their illness can be established, are actually being affected by environmental factors. These may include biological substances such as dusts, pollens, foods and infectious organisms; organic and inorganic chemicals; nutritional and psychological factors and many others.
Still, some physicians question whether environmental medicine is a legitimate specialty. In an article published recently in a major medical journal, a researcher compared the psychiatric status of 23 patients who had a diagnosis of environmental illness with that of 46 "psychiatrically normal" control subjects. He reported that 15 (65 percent) of the environmentally ill patients met the criteria for some form of emotional disturbance, compared with only 13 (28 percent) of the control subjects.
This, he concluded, showed that patients who believe they have an environmental illness really are troubled by an emotional disorder.
Although the article appeared in a reputable publication, its argument was really a house of cards. The assertion that ill patients -- regardless of the cause of their illness -- are often emotionally depressed hardly qualifies as news. It is the unusual patient who does not become anxious and distraught in the face of a chronic illness. A finding that sick people are more depressed than healthy people is really not earth-shattering.
Allergies can no longer be thought of only in terms of pollen, dust and animal dander, which cause wheezing, nasal congestion, sneezing and hives. The subject is much broader. Sensitizers are present in our air, water, food and medications, and symptoms may include headache, weakness, diarrhea, depression and fatigue.
What causes these symptoms, however, is not "just in the patient's head." It's very real and, potentially, very dangerous. By looking for underlying physical causes and not ignoring the role that stress can play in intensifying medical symptoms, the physician can help many patients with environmental illness.
Neil Solomon, whose syndicated medical advice column appears The Evening Sun, is a former Maryland health secretary. He writes from Towson.