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Chris, Thanks for your input. I was hoping that you would have some pointers. I knew that this one was going to be difficult. I doubt that the employer will be willing to fork out for the relevant testing (as I mentioned a V small company). I am concerned that this individual is still at work - but they have been for 17 months although it was undiagnosed until recently. Financial reasons are keeping this person at work at present and I feel unable to make any recommendations with so little knowledge and prior to receiving the specialist report. My instinct is to send them home but I don't want to over react so I have recommended a common sense approach until I know more ie. no contact with chemicals inc cleaning products and increased cleaning to keep dust levels down. Looks like I have some bedtime reading to do! Kind Regards Lesley Bamford BSc(hons) SCPHN-OH Occupational Health Advisor ________________________________ From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Chris Packham Sent: 30 September 2011 07:45 To: [log in to unmask] Subject: Re: [OCC-HEALTH] Multiple chemical sensitivity (MCS) In the fourth edition of the Textbook of Dermatology (Rook, Wilkinson, et. al) there is a section dedicated to multiple sensitivities. Chapter 14 by Wilkinson and Rycroft write of concomitant sensitivities, and divide these into four groups: Multiple non-specific reactivity sensitivity Multiple primary specific sensitivities Multiple secondary specific sensitivities, i.e. cross-sensitization Multiple reactions to several compounds containing an identical allergen, i.e. false cross reaction. This condition is described also in other dermatological books and journals and is not that uncommon. However, caution is needed in assuming that this is what you are dealing with. It may be that this person is atopic and simply suffering from an irritant reaction at a lower level of exposure that would normally be required. Alternatively it could be a combination of irritant and allergic reactions, possibly combined with other factors, e.g. stress, sub-clinical constitutional conditions, etc. From the information so far available it does not appear that any detailed clinical testing has been done, i.e. patch/prick test or RAST. This is a prerequisite for being able to manage the condition. So referral for proper investigation is essential. In addition to investigating the respiratory symptoms I would wish to see appropriate testing done by a suitably experienced dermatologist. Once the clinical diagnosis is known, then a plan can be formulated to (hopefully) allow that person to continue at their current work. Regards Chris Chris Packham EnviroDerm Services Unit 10, The Mews, Mitcheldean, GL17 0SN Tel: 01386 832 311 ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ##################################################################################### Attention: The information contained in this message and or attachments is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any system and destroy any copies. All messages sent to and from South Staffordshire Water PLC may be monitored to ensure compliance with internal policies and to protect our business. E-mails are not secure and cannot be guaranteed to be error free as they can be intercepted, amended, lost or destroyed or contain viruses. Anyone communicating with us by e-mail is taken to accept these risks. South Staffordshire Water PLC Green Lane, Walsall, WS2 7PD Registered in England No. 2662742 ##################################################################################### ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH