Three questions for identifying chemically intolerant individuals in clinical and epidemiological populations: The Brief Environmental Exposure and Sensitivity Inventory (BREESI)

PLoS One. 2020 Sep 16;15(9):e0238296. doi: 10.1371/journal.pone.0238296. eCollection 2020.

Abstract

The Quick Environmental Exposure and Sensitivity Inventory (QEESI) is a validated questionnaire used worldwide to assess intolerances to chemicals, foods, and drugs, and has emerged as the gold standard for assessing chemical intolerance (CI). Despite a reported prevalence of 8-33%, epidemiological studies and routine primary care clinics rarely assess CI. To help address this gap, we developed the Brief Environmental Exposure and Sensitivity Inventory (BREESI)-a 3-item CI screening tool. We tested the BREESI's potential to predict whether an individual is likely to be classified as chemically intolerant if administered the 50-item QEESI. We recruited 293 participants from a university-based primary care clinic and through online participation. The statistical sensitivity, specificity, and positive and negative predictive values of the BREESI were calculated against the validated QEESI. Ninety percent (90%) of participants answering "yes" to all three items on the BREESI fit the QEESI criteria for being very suggestive of CI based upon their chemical intolerance and symptom scores (positive predictive value = 90%). For participants endorsing two items, 93% were classified as either very suggestive (39%) or suggestive (54%) of CI (positive predictive value = 87%). Of those endorsing only one item, 13% were classified as very suggestive of CI, and 70% as suggestive. Of those answering "No" to all of the BREESI items, 95% were classified as not suggestive of CI (i.e., negative predictive value = 95%). The BREESI is a versatile screening tool for assessing potential CI useful for clinical and epidemiological applications, based upon individuals' past adverse responses in a variety of settings. Just as health care professionals routinely inquire about latex allergy to prevent adverse reactions, the BREESI provides an essential screen for CI. Together, the BREESI and QEESI provide new diagnostic tools that may help predict and prevent future adverse reactions to chemicals, foods, and drugs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Diagnostic Tests, Routine*
  • Environmental Exposure / adverse effects*
  • Female
  • Health Surveys
  • Humans
  • Male
  • Mass Screening*
  • Multiple Chemical Sensitivity / diagnosis*
  • Multiple Chemical Sensitivity / epidemiology
  • Multiple Chemical Sensitivity / etiology
  • Prevalence
  • ROC Curve
  • Surveys and Questionnaires / statistics & numerical data*
  • Texas / epidemiology

Grants and funding

Marilyn Brachman Hoffman Foundation, Fort Worth, Texas. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.