Diagnosis of IEI.
The diagnosis of IEI is most often made by the combination of an extensive environmental history and a battery of provocation-neutralization tests. The patient’s self-report of symptoms occurring after presumed exposure to environmental odors and fumes or after ingestion of particular foods usually suffices to make the diagnosis. The provocation-neutralization test, described below, consists of exposing the patient to a particular test substance to elicit symptoms, followed by exposure at a lower or higher dose to cause disappearance of those symptoms. Testing is done without controls, and specific sensitivities are diagnosed by the appearance or disappearance of subjective symptoms.
Many clinical ecologists supplement the provocation-neutralization testing with various laboratory tests. These include quantitation of serum immunoglobulins and complement components; detection of circulating autoantibodies and immune complexes; quantitative counts of lymphocyte subsets; quantitative measurement of a variety of environmental chemicals in blood, urine, fat, and hair samples; and assays for levels of circulating hormones, amino acids, and mediators.
Data from the clinical ecology literature and from independent review of series of patients with IEI lend no support to the diagnostic usefulness of any of these tests. Levels of serum immunoglobulins and complement components; blood levels of total lymphocytes and various subsets; circulating hormones or other natural body constituents; and quantities of xenobiotics in various body fluids are not consistently abnormal.
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