Frequently Asked Questions

1. Do you recommend any doctors who specialize in treating chemical intolerance?

2. Is there any help for people with chemical intolerances?

3. I noticed you used the term chemical intolerance. Is that the same as chemical sensitivity?

4. Is there a treatment facility for people who are chemically intolerant?

5. How is chemical intolerance diagnosed?

6. Is there a special diet you recommend for TILT?

7. What is the Personal Precautionary Principle?

8. What is the TILT test and where can I find it?

9. Why doesn’t my doctor recognize TILT or chemical intolerances as a diagnosis?

10. Do you consult on worker’s comp and disability claims?

11. Do you see patients?

12. Are there treatments that you recommend other than avoidance?

1. Do you recommend any doctors who specialize in treating chemical intolerance?
I do not recommend particular doctors. Choosing a doctor is a very personal matter. In part it depends on your specific health problems. Any doctor can be helpful if he or she listens to you and takes your symptoms and intolerances seriously.
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2. Is there any help for people with chemical intolerances?
Absolutely! People who are chemically intolerant often feel better once they learn how to avoid substances that make them sick. Family support is essential. I have seen patients take the time to research and reduce exposures to volatile organic chemicals (cleaning agents, fragrances, gasoline). This may involve the help of one’s family and workplace. Initially, individuals may go through withdrawal and feel worse for a period of several days. Subsequently, most are better able to identify exposures that trigger symptoms. The best recoveries that I've seen occur when patients take the time to identify their food intolerances, but this should be done with medical guidance.
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3. I noticed you used the term chemical intolerance. Is that the same as chemical sensitivity?
I no longer use the term “chemical sensitivity” — chemical intolerance more accurately describes the responses to chemicals, foods, and drugs that we see with TILT, or Toxicant-induced Loss of Tolerance. When patients experience adverse reactions that are immunologically (Ig-E) mediated, these reactions are considered “allergic” in nature, and we say patients are “sensitive” to the substance that causes the allergic reaction. Responses that are non-Ig-E-mediated are termed “intolerances.” Allergists use skin tests and blood tests (RAST) to identify classical allergies (e.g., to dust mites, pet dander, and some foods). While helpful, these methods only identify a subset of the exposures that may be making patients ill. TILT specifically addresses intolerances, rather than allergies/sensitivities, although many patients have both. Additionally, the term “intolerance” is readily understood and accepted and translates meaningfully to other languages.
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4. Is there a treatment facility for people who are chemically intolerant?
Unfortunately, no academic medical center has built an Environmental Medical Unit (EMU). An EMU is a controlled in-patient hospital unit designed to isolate patients from exposures that trigger their symptoms. It is widely accepted that such a unit is an essential tool for diagnosis, research and treatment of conditions suspected of having environmental origins. This goes far beyond the study of chemical intolerances, with potential benefits for understanding conditions as diverse as asthma, AD/HD, autism, autoimmune diseases.
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5. How is chemical intolerance diagnosed?
Chemical intolerance is not a diagnosis per se. Intolerances can be associated with a wide variety of medical diagnoses (e.g., migraine, asthma, depression). These diagnoses are labels based upon recognized constellations of signs and symptoms, but they do not indicate what made the patient sick (etiology). Doctors need to (1) explore environmental exposures that may have initiated TILT, and (2) try to identify exposures that are triggering current symptoms (e.g., headache, difficulty breathing, mood changes). The QEESI is the only validated screening tool for assessing intolerances, triggers, and life impact.
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6. Is there a special diet you recommend for TILT?
About 90 percent of the chemically intolerant patients who we’ve studied also report food intolerances. A rotary elimination diet can reveal which foods are provoking symptoms. These diets are very challenging, but without eliminating problem foods patients continue to have symptoms. Inhalants (airborne chemicals) and ingestants (foods, medications, alcohol, caffeine) need to be explored simultaneously.
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7. What is the Personal Precautionary Principle?
The Personal Precautionary Principle recognizes that not every exposure will be regulated at the levels needed to protect the most vulnerable individuals—children, pregnant women, or the chemically susceptible. However, many exposures cannot be avoided at the personal level (vehicle emissions, community-wide exposures), so strong protections for our air and water are vital. Unfortunately, the price of a safer environment may be out-of-reach for those who need it most. Nevertheless, informed consumer choices (e.g., cleaning and personal care products, pest control, foods) can improve individual health and influence the marketplace.
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8. What is the TILT test and where can I find it?
The TILT test is a validated assessment tool, the Quick Environmental Exposure and Sensitivity Inventory, known as the QEESI. The QEESI screens for symptoms, common chemical and food intolerances, life impact of intolerances, and masking . You can take it online at http://www.qeesi.org. Doctors can use the QEESI in their practice to get a one-time “snapshot” or to measure changes over time, either pre- and post-exposure, or pre- and post-treatment.
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9. Why doesn’t my doctor recognize TILT or chemical intolerances as a diagnosis?
There is no insurance billing code for chemical intolerance. Doctors can only diagnose and bill for conditions resulting from TILT such as migraine, asthma, depression.
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10. Do you consult on worker’s comp and disability claims?
Although I don’t do any legal work, my publications may be helpful and they are available free of charge on my website.
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11. Do you see patients?
I no longer see patients. I am dedicated to advancing research related to Toxicant-induced Loss of Tolerance (TILT). TILT represents a new class of diseases, involving a two-step disease process not previously recognized. In effect, we are at the “germ theory” stage in terms of our understanding of TILT. I feel I can best help individual patients by focusing my efforts on research and writing. Although I no longer consult on individual cases, patients frequently find it helpful to take their QEESI results and my publications to their personal doctors.
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12. Are there treatments that you recommend other than avoidance?
At the present time, there are no validated treatments for chemical intolerance. In my professional experience, most patients improve by avoiding chemical and food triggers, although this can be an arduous task. Clearly, we need more research, and specifically, we need an Environmental Medical Unit (EMU) in every major academic medical center.
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Contact Information

Dr. Claudia Miller
Department of Family & Community Medicine
University of Texas Health Science Center at San Antonio
7703 Floyd Curl Drive (222 MCS)
San Antonio, TX 78229-3900

emailButton mail@drclaudiamiller.com

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