TO THE EDITOR:
The article by Simon and colleagues [1] on multiple chemical sensitivity reported an absence of significant immunologic abnormalities in the study patients. This conclusion was based on autoantibody testing combined with an analysis of lymphocyte subset numbers and function.
We have seen at least three patients with multiple chemical sensitivity associated with IgG subclass deficiency, specifically, a lack of IgG2 or IgG3. Because IgG subclass, IgA, and complement deficiencies have each been associated with asthma and recurrent upper respiratory infections that may mimic chemical sensitivity [2-4], failure to test for such deficiencies significantly weakens the study. If the authors have banked serum from their patients and controls, perhaps this deficiency could be remedied.
1. Simon GE, Daniell W, Stockbridge H, Claypoole K, Rosenstock L. Immunologic, psychological, and neuropsychological factors in multiple chemical sensitivity: a controlled study. Ann Intern Med. 1993; 119:97-103.
2. Bjorkander J, Bengtsson U, Oxelius VA, Hanson LA. Symptoms in patients with lowered levels of IgG subclasses, with or without IgA deficiency, and effects of immunoglobulin prophylaxis. Monogr Allergy. 1986; 20:157-63.
3. Hanson LA, Soderstrom R, Nilssen DE, Theman K, Bjorkander J, Soderstrom T, et al. IgG subclass deficiency with or without IgA deficiency. Clin Immunol Immunopathol. 1991; 61:S70-7.
4. Spinozzi F, Cimignoli E, Gerli R, Agea E, Bertotto A, Rondoni F, et al. IgG subclass deficiency and sinopulmonary bacterial infections in patients with alcoholic liver disease. Arch Intern Med. 1992; 152:99-104.
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