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The reactive airways dysfunction syndrome (RADS), the reactive upper airways dysfunctionsyndrome (RUDS), the sick building syndrome (SBS), and the multiple chemical sensitivitysyndrome (MCS) are overlapping disorders in which there is an intolerance to environmentalchemicals. The onset of these illnesses is often associated with an initial acute chemicalexposure. To understand the pathophysiology of these conditions, a study of the nasal pathologyof individuals experiencing these syndromes was undertaken. Preliminary data indicate that thenasal pathology of these disorders is characterized by defects in tight junctions between cells,desquamation of the respiratory epithelium, glandular hyperplasia, lymphocytic infiltrates, andperipheral nerve fiber proliferation. These findings suggest a model for a relationship between thechronic inflammation seen in these conditions and an individual's sensitivity to chemicals. Apositive feedback loop is set up: the inflammatory response to low levels of chemical irritants isenhanced due to the observed changes in the epithelium, and the epithelial changes arepropagated by the inflammatory response to the chemicals. This model, combined with theconcept of neurogenic switching, has the potential to explain many aspects of RADS, RUDS,SBS, and MCS in a unified way. Originally published Environ Health Perspect 105(Suppl 2):473-478 (1997

Hypothesis for Induction and Propagation of Chemical Sensitivity Based on Biopsy Studies