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;e7. Published online February 26, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e7 [Accepted]

Abstract 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.

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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

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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

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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