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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Original Article

Effects of Volatile Organic Compounds, and Formaldehyde on Heart Rate Variability among Elderly People in Seoul: Jeong Cheol Seo, Mo Yeol Kang, Soo Hun Cho, Youn Hee Lim, Jin Hee Kim, Jong Ryeul Sohn, Yun Chul Hong; Korean Journal of Occupational and Environmental Medicine 2011;23(3):253-260. Published online September 30, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.3.253

OBJECTIVES
The purpose of the present study was to investigate the effects of volatile organic compounds, and formaldehyde on heart rate variability among elderly people who are vulnerable to ambient pollution.
METHODS
From May to August of 2009, 57 subjects older than 60 years were recruited in this study. Indoor air pollutants (volatile organic compounds and formaldehyde) were measured by a personal passive sampler. Heart rate variability (HRV) was measured in the sitting position for five minutes and assessed by time-domain and frequency-domain.
RESULTS
Multiple linear regression analysis showed significantly less low-frequency (LF) and high-frequency (HF) associated with elevated benzene levels. Exposure to toluene was associated with decreases in the Standard deviation of the NN intervals (SDNN) and LF. SDNN and LF were negatively associated with the increment of ethylbenzene levels.
CONCLUSIONS
An adverse effect on cardiovascular function caused by volatile organic compounds was observed among the elderly people of Seoul even though indoor air pollutant levels were lower than the yearly average guideline for indoor air quality in Korea.

Citations

Citations to this article as recorded by

Estimating Benzene Exposure Level over Time and by Industry Type through a Review of Literature on Korea
Donguk Park, Sangjun Choi, Kwonchul Ha, Hyejung Jung, Chungsik Yoon, Dong-Hee Koh, Seunghun Ryu, Soogeun Kim, Dongmug Kang, Kyemook Yoo
Safety and Health at Work.2015; 6(3): 174. CrossRef

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Original Article

Health Effect Assessment on Volunteers Involved in the Cleanup Operation Following the Hebei Spirit Oil Spill Along the Taean Coast, Korea: Chul Ho Lee, Kyung Hwa Park, Min Jung Lee, Wook Hee Choi, Heon Kim, Choong Hee Park, Dae Seon Kim, Seung Do Yu; Korean Journal of Occupational and Environmental Medicine 2010;22(1):11-19. Published online March 31, 2010; DOI: https://doi.org/10.35371/kjoem.2010.22.1.11

Abstract PDF

OBJECTIVE: The objetive of this study is to assess the level of oxidative stress by the exposure to volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs) in volunteers who cleaned up the crude oil spilled from the Hebei Spirit on the Coast of Taean County, Korea.
METHODS
The study subjects were 46 volunteers and 37 controls from the National Institute of Environmental Research. A self-administered questionnaire was used for volunteers to examine their working environment and health effects. Urinary concentrations of hippuric acid, 1-hydroxypyrene, and 2-naphthol were measured as exposure markers for VOCs and PAHs, and urinary thiobarbituric acid reactive substances (TBARS) and 8-hydroxydeoxyguanosine (8-OHdG) levels were measured as oxidative stress markers.
RESULTS
Sixty-four percent of the respondents presented a variety of symptoms, including sore eyes and throat, nausea, dizziness, headache, low back pain, and leg pain after participating in the cleanup operation. Urinary 2-naphthol and TBARS concentrations appeared higher in the volunteers. Univariate and multivariate analyses showed that urinary TBARS and 8-OHdG levels were positively correlated with urinary 2-naphthol and 1-hydroxypyrene concentrations respectively, especially among the volunteers.
CONCLUSIONS
The result implies that participating in cleanup work of oil spills may have a possibility to induce oxidative damage by exposure to PAHs in crude oil.

Citations

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Evaluation of performance of hybrid fiber-reinforced self-compacting concrete using non-destructive testing techniques
Shailja Bawa, Pravez Alam, Shivam Saini
Innovative Infrastructure Solutions.2023;[Epub] CrossRef
Survey of airborne organic compounds in residential communities near a natural gas compressor station: Response to community concern
Kaitlin A. Vollet Martin, Elizabeth Z. Lin, Timothy J. Hilbert, Krystal J. Godri Pollitt, Erin N. Haynes
Environmental Advances.2021; 5: 100076. CrossRef
Human health and ecological assessment programs for Hebei Spirit oil spill accident of 2007: Status, lessons, and future challenges
Dawoon Jung, Jung-Ah Kim, Myung-Sook Park, Un Hyuk Yim, Kyungho Choi
Chemosphere.2017; 173: 180. CrossRef
Health Effect Assessment on Cleanup Workers of an Oil Spill in Yeosu
Geunbae Kim, Tack Shin Kang, Mira Yoon, Hyejung Jo, Youngkyung Joo, Seung Do Yu, Bo Eun Lee
Korean Journal of Environmental Health Sciences.2016; 42(6): 385. CrossRef
Association between Metabolic Syndrome and Participation in Clean-up Work at the Hebei Spirit Oil Spill
Ik-Jin Lee, Bong-Ki Jang, Jong-Wha Lee, Bu-Soon Son, Hae-Kwan Cheong, Mina Ha, Young-Hyun Choi, Myungsook Park
Korean Journal of Environmental Health Sciences.2015; 41(5): 335. CrossRef
Changes of Eating Habits of the Residents of Taean, Korea after the Herbei Oil Spill Accident Based on Focus Group Interviews
Ji Hyun Park, Sung Ok Kwon, Woo Cheol Jeong, Jong Il Huh, Se-Young Oh
Korean Journal of Community Nutrition.2011; 16(4): 466. CrossRef

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Original Article

Hematological Changes and Immunological Function in Children Living Near the Petrochemical Estate in Ulsan: Choong Ryeol Lee, Cheol In Yoo, Ji Ho Lee, Hun Lee, Yang Ho Kim; Korean Journal of Occupational and Environmental Medicine 2001;13(2):127-140. Published online June 30, 2001; DOI: https://doi.org/10.35371/kjoem.2001.13.2.127

Abstract PDF: OBJECTIVES
To evaluate the hematological changes and the immunological function of children living near the petrochemical estate in Ulsan.
METHODS
The study subjects comprised of 238 children who consisted of 143 children living near the petrochemical estate and 95 children living in a suburban area. We conducted the hematological examination 3 times, in April, July and October. Also we evaluated the immunological function of some children in July. To confirm differences between schools repeated measures ANOVA of generalized linear model was done controlling age and sex as covariates.
RESULTS
The blood cell counts of children showed differences between schools in accordance with the survey month. The total WBC, neutrophil, and lymphocyte counts of children living in a suburban area decreased in July and increased in October again, but those of some children living near the petrochemical estate did not changed distinctly. The RBC counts of children living in a suburban area decreased in July and increased in October again, but those of some children living near the petrochemical estate decreased as time passed. The changes of the amount of hemoglobin of all study subjects were similar with those of RBC. The platelet counts of all study subjects decreased in July and increased in October again. In the generalized linear model, school was a significant independent variable for the total WBC, RBC, and platelet counts, and sex was a significant independent variable for the RBC counts. Age was a significant independent variable for the lymphocyte and platelet counts. P values of all blood cell were statistically significant in interaction variable between the survey month and school, and those of the total WBC, neutrophil, and lymphocyte counts were statistically significant in interaction variable between the survey month and age. The immunological function showed no significant difference between study groups.
CONCLUSIONS
The total WBC and RBC counts which would be easily affected by volatile organic compounds(VOCs) in the atmosphere showed differences between schools in accordance with the survey month. This suggests that the amounts of exposure to VOCs are different among each school children in different months. To ascertain the hematological changes by VOCs, an additional study evaluating the concentrations of atmosphere of VOCs and biological monitoring of some VOCs is needed.

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