Annals of Occupational and Environmental Medicine

Case Report

Multiple chemical sensitivity triggered by an automobile mechanic's indirect exposure to volatile organic compounds in the Republic of Korea: a case report: Dong-Hoon Cheon, Yoon-Ji Kim, Dongmug Kang, Youngki Kim, Eun-Soo Lee, Ki-Hun Kim, Se-Yeong Kim; Ann Occup Environ Med 2026;38:e7. Published online February 26, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e7

Abstract Abstract in Korean PDF: Background
Multiple chemical sensitivity (MCS) lacks definitive biomarkers, making differential diagnosis reliant on exclusion and symptom reproducibility. In automobile repair shops, volatile organic compounds (VOCs) from cleaning agents pose risks not only to primary users but also to co-workers via indirect exposure. We report a case of MCS suspected to be triggered solely by bystander VOC exposure, highlighting the clinical significance of uncaptured peak exposures in Korea.
Case presentation
A 23-year-old mechanic experienced recurrent headaches, throat irritation, and nausea immediately after co-workers used aerosolized cleaners in a poorly ventilated workspace. Symptoms consistently improved when he was away from work. Routine clinical evaluations were unremarkable. Although the patient underwent surgery for chronic rhinosinusitis, the symptoms persisted specifically upon re-exposure, effectively ruling out structural otorhinolaryngologic causes. Mental health screening indicated only mild depressive symptoms, insufficient to account for the severity of the physical symptoms. The Quick Environmental Exposure and Sensitivity Inventory (QEESI) scores were in the "suggestive" range for MCS. While routine workplace monitoring (8-hour time-weighted average [TWA]) showed non-detectable solvent levels, the nature of aerosol application suggested uncaptured short-term peak exposures. Based on the distinct temporal relationship, the patient was placed under medical observation and assessed as fit for work with restrictions on solvent exposure.
Conclusions
This case highlights the role of indirect VOC exposure as a trigger for MCS symptoms even when routine TWA monitoring indicates minimal concentrations. The discrepancy likely stems from the brief peak exposures triggering central sensitization, underscoring the limitations of standard monitoring. Management strategies must focus on peak-exposure control and fitness-for-work assessments that mandate strict avoidance of organic solvents, regardless of average ambient concentrations.; 국내 자동차 정비사의 휘발성 유기화합물 간접 노출에 의해 유발된 다중화학물질과민증: 증례 보고
배경
다중화학물질과민증(Multiple Chemical Sensitivity, MCS)은 명확한 바이오마커가 부족하여 배제 진단과 증상의 재현성에 의존하여 진단된다. 자동차 정비 현장에서 발생하는 휘발성 유기화합물(VOCs)은 직접 사용자뿐만 아니라 간접 노출되는 주변 작업자에게도 건강상의 위험을 초래한다. 본 저자들은 한국의 일반적인 작업환경측정 체계에서 포착되지 않는 단기 피크 노출(peak exposure)의 임상적 중요성을 강조하며, 간접 노출에 의해 유발된 MCS 사례를 보고하고자 한다.
증례
보고: 23세 남성 정비사가 환기가 불충분한 작업장에서 동료들이 에어로졸 세정제를 사용할 때마다 반복적인 두통, 인후 자극 및 오심을 경험하였다. 증상은 작업장을 벗어났을 때 일관되게 호전되는 양상을 보였다. 일반적인 임상 검사 결과는 정상 범위였으며, 만성 비부비동염 수술 후에도 유기용제 재노출 시 증상이 지속되어 이비인후과적 구조적 원인은 배제되었다. 정신건강 스크리닝 결과는 경미한 우울 증상만을 보였으며, 이는 신체 증상의 심각성을 설명하기에 불충분하였다. 한국판 QEESI(Quick Environmental Exposure and Sensitivity Inventory) 설문 결과 MCS '시사(Suggestive)' 범위에 해당하였다. 작업환경측정 결과(8시간 시간가중평균, TWA)는 유기용제 불검출 수준이었으나, 에어로졸 사용 특성상 측정되지 않은 단기 피크 노출이 의심되었다. 뚜렷한 시간적 인과관계를 바탕으로 환자는 의학적 관찰 대상이 되었으며, 유기용제 노출 제한을 조건으로 '조건부 작업 적합' 판정을 받았다.
결론
본 증례는 통상적인 TWA 측정치가 낮음에도 불구하고 간접적인 VOC 노출이 MCS 증상의 트리거가 될 수 있음을 시사한다. 이러한 불일치는 단기 피크 노출이 중추 감작(central sensitization)을 유발하기 때문으로 보이며, 이는 표준 측정 방식의 한계를 보여준다. MCS의 관리는 평균 노출 농도와 관계없이 피크 노출 제어 및 엄격한 유기용제 노출 회피를 포함하는 업무적합성 평가에 초점을 맞추어야 한다.

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Case Report

Multiple chemical sensitivity caused by exposure to ignition coal fumes: a case report: Myeong-Ja Yun, Dong-Mug Kang, Kyoung-Hye Lee, Young-Ki Kim, Jong-Eun Kim; Ann Occup Environ Med 2013;25:32. Published online November 1, 2013; DOI: https://doi.org/10.1186/2052-4374-25-32

Abstract PDF

Background

Although multiple chemical sensitivity (MCS) is a well-known disorder caused by environmental exposures, MCS caused by occupational exposure has been reported in Korea. Therefore, we report a MCS case caused by environmental exposure to ignition coal after a differential diagnosis to exclude other diseases.

Case report

Since 2011, a 55-year-old woman had experienced edema, myalgia, and other symptoms when she smelled ignition coal near her workplace. She had been diagnosed with fibromyalgia syndrome(FMS) and was treated, with no improvement of symptoms. Since then, she showed the same symptoms after exposure to city gas, the smell of burning, and exhaust gas. To avoid triggering substances, she moved to a new house and used an air purifier. She quit her job in November 2012. After visiting our hospital, she underwent a differential diagnosis for FMS, chronic fatigue syndrome, and somatization disorder. She was diagnosed with MCS by the Korean version of the Quick Environment Exposure Sensitivity Inventory (QEESI). She was educated about the disease and to avoid triggering substances. She received ongoing treatment for her symptoms.

Conclusion

This case showed that symptoms began after smelling ignition coal. After that, her triggers was increased such as the smell of city gas, burning, and exhaust gas. This case is the first reported in Korea of MCS due to environmental exposure after ruling out other diseases.

Citations

Citations to this article as recorded by

Multiple chemical sensitivity triggered by an automobile mechanic's indirect exposure to volatile organic compounds in the Republic of Korea: a case report
Dong-Hoon Cheon, Yoon-Ji Kim, Dongmug Kang, Youngki Kim, Eun-Soo Lee, Ki-Hun Kim, Se-Yeong Kim
Annals of Occupational and Environmental Medicine.2026; 38: e7. CrossRef
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PLOS ONE.2020; 15(9): e0238296. CrossRef
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International Journal of Environmental Research and Public Health.2020; 17(18): 6551. CrossRef

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Review

Multiple Chemical Sensitivity: Hong Jae Chae, Byoung Gwon Kim, Hwan Cheol Kim, Mi Young Lee, Jong Han Leem; Korean Journal of Occupational and Environmental Medicine 2012;24(4):328-338. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.328

Abstract PDF

This article reviews newly available knowledge on multiple chemical sensitivity (MCS), a chronic medical condition characterized by symptoms in multiple organ and caused by exposure to low levels of common chemicals. Although various pathophysiological models have been proposed (including toxicological, immunological or behavioral models), the causes and underlying mechanisms of MCS are still not fully understood. Most patients with MCS were women between the ages of 30 and 50 years. The most frequently reported trigger was a newly constructed home or job site. The common symptoms are vague, non-specific complaints: fatigue, difficulty concentrating, poor memory, sneezing/runny nose, headache, and muscle pain. There are no laboratory markers or specific investigative findings for MCS. The Quick Environmental Exposure and Sensitivity Inventory (QEESI)(c) has been used as a screening questionnaire. Treatment focuses on assisting patients at the earliest possible opportunity to reduce their exposure to unique symptom triggers and known hazardous chemicals. Early comprehensive assessment, medical management, and social and financial support might avoid the deterioration of functions associated with prolonged illness.

Citations

Citations to this article as recorded by

MCS/IEI Prevalence Rate of Workers Around an Accidental Release of Hydrogen Fluoride in Gumi Industrial Complex
Hye-Ji Han, Kuck-Hyeun Woo, Sung-Yong Choi, Byoung-Hak Jeon, Sangjun Choi
Journal of Korean Society of Occupational and Environmental Hygiene.2015; 25(4): 534. CrossRef

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Original Article

A Validation of the Korean Version of QEESI(c) (The Quick Environmental Exposure and Sensitivity Inventory): Byoung Hak Jeon, Se Hoon Lee, Hyoung Ah Kim; Korean Journal of Occupational and Environmental Medicine 2012;24(1):96-114. Published online March 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.1.96

Abstract PDF

OBJECTIVES
A standardized questionnaire is not available for use as a screening tool to assess individuals with MCS/IEI in Korea. The QEESI(c), originally developed by Miller & Prihoda in 1998, helps researchers, doctors, and their patients identify individuals with MCS/IEI. Therefore, this study was conducted in order to create a Korean version of the QEESI(c) and evaluate whether this Korean version could be used as an effective MCS/IEI screening tool in Korea.
METHODS
The Korean version of the QEESI(c) was developed using a six-step approach: permission, forward translation, the first quality control, backward translation, cognitive debriefing and the second quality control, final proof reading. In order to collect data, we have done a sample survey in certain parts of Korea. A household was used as the sampling unit; we extracted random samples in each survey cluster and then interviewed two adults over 19 years of age living in each sampled household. A total of 300 subjects were recruited from the general population in local community. The factor structure in the Korean version of the QEESI was analyzed with 40 items on four sub-scales except for the 10 items in masking index using principal components analysis with Varimax rotation. A convergent validity test two sub-scales: chemical intolerance and symptom severity. We carefully compared the chemical intolerance with Nordin's chemical sensitivity scale and the symptom severity with Cho's subjective symptom score.
RESULTS
The results showed that the 40 items on the four sub-scales,' chemical intolerances',' symptom severity', 'life impact', and 'other intolerances', were consistent with those reported for the US population by Miller and Prihoda. The convergent validity wes very good (r=0.4; p<0.001, r=0.5; p<0.001, respectively). A good internal consistency (Cronbach' alpha=0.86~0.96) and test-retest reliability (r=0.87~0.90) were found in all scales, except for the internal consistency in the masking index.
CONCLUSIONS
The Korean version QEESI(c) showed a good reliability and validity. It should be necessary to conduct a MCS/IEI study adopting Korean version QEESI(c).

Citations

Citations to this article as recorded by

Multiple chemical sensitivity triggered by an automobile mechanic's indirect exposure to volatile organic compounds in the Republic of Korea: a case report
Dong-Hoon Cheon, Yoon-Ji Kim, Dongmug Kang, Youngki Kim, Eun-Soo Lee, Ki-Hun Kim, Se-Yeong Kim
Annals of Occupational and Environmental Medicine.2026; 38: e7. CrossRef
What initiates chemical intolerance? Findings from a large population-based survey of U.S. adults
Claudia S. Miller, Raymond F. Palmer, David Kattari, Shahir Masri, Nicholas A. Ashford, Rodolfo Rincon, Roger B. Perales, Carl Grimes, Dana R. Sundblad
Environmental Sciences Europe.2023;[Epub] CrossRef
Does improving indoor air quality lessen symptoms associated with chemical intolerance?
Roger B. Perales, Raymond F. Palmer, Rudy Rincon, Jacqueline N. Viramontes, Tatjana Walker, Carlos R. Jaén, Claudia S. Miller
Primary Health Care Research & Development.2022;[Epub] CrossRef
Disease comorbidities associated with chemical intolerance
RaymondF Palmer, Tatjana Walker, RogerB Perales, Rodolfo Rincon, CarlosRoberto Jaén, ClaudiaS Miller
Environmental Disease.2021; 6(4): 134. CrossRef
Three questions for identifying chemically intolerant individuals in clinical and epidemiological populations: The Brief Environmental Exposure and Sensitivity Inventory (BREESI)
Raymond F. Palmer, Carlos R. Jaén, Roger B. Perales, Rodolfo Rincon, Jacqueline N. Forster, Claudia S. Miller, Wen-Jun Tu
PLOS ONE.2020; 15(9): e0238296. CrossRef
MCS/IEI Prevalence Rate of Workers Around an Accidental Release of Hydrogen Fluoride in Gumi Industrial Complex
Hye-Ji Han, Kuck-Hyeun Woo, Sung-Yong Choi, Byoung-Hak Jeon, Sangjun Choi
Journal of Korean Society of Occupational and Environmental Hygiene.2015; 25(4): 534. CrossRef
Allergic Diseases and Multiple Chemical Sensitivity in Korean Adults
Inchul Jeong, Inah Kim, Hye Jung Park, Jaehoon Roh, Jung-Won Park, Jae-Hyun Lee
Allergy, Asthma & Immunology Research.2014; 6(5): 409. CrossRef

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