Automobiles represent an important source of environmental problems. It has been pointed out in the case of Nora Barnes and other patients that some individuals react to even supposedly “harmless” amounts of automotive exhaust fumes (Chaps. 3 and 7). For this reason, the consumer should think ecologically when buying an automobile. There are five basic rules to follow when purchasing a car:

1.    The car should have a valve which turns off the air intake. This is

important, since one may run into unexpected sources of fumes on

the road: a garbage dump, freshly tarred road, airport, driving through

tunnels or unusually heavy traffic.

2.    Choose the car upholstery with forethought. The best kind of upholstery

is leather, although this has become very difficult to find in American cars. The next best choice is rayon, a fabric made from cellulose, itself a wood by-product. Nylon is less objectionable than the newer synthetic fabrics such as vinyl.

3. The car should have push-button windows, to allow the driver to simultaneously raise all the windows when approaching a major source of pollution.

4. All rubber mats should be removed from the floor of the car and the trunk and should be replaced with carpeting, preferably made from natural fibers.

5. The car should be equipped with an activated carbon filter to clean up fumes which have accumulated on the inside. This is particularly important for those who are known to have a moderate-to-severe form of chemical susceptibility. Sources for such filters are given in the Colos book.

In general, one should be most careful when purchasing a car. It should be driven on the highway first, to see if unpleasant health symptoms develop when riding in it. There may be an undetected leak in the exhaust system, and any prepurchase inspection should pay careful attention to this part of the automobile. The car should preferably be tried out on a sunny, warm day, for plastic car upholstery can cause problems when heated. One should never buy a car which is a source of environmental problems or which causes or perpetuates symptoms.

Once a car is purchased, it is necessary and important to keep car fumes out of the living quarters. If there is a choice, avoid a house whose garage is located under or adjacent to the living area. The case of Sister. Francesca, who fell asleep after being exposed to fumes from a still-hot car engine, illustrates the potential for reactions.

Detached garages are best. If the car must be stored in an adjacent garage, it should be allowed to cool completely, away from the house, before it is put away.

In choosing a house site, one should make sure that it is not located too close to any major road or highway, especially one on which busses travel. The direction of the prevailing winds should be taken into account as well. Check to find out if a new highway is planned for the neighborhood. Patients sometimes choose an ideal country spot for building an ecologically sound house, only to wake one morning to the sound of highway-building equipment.

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In the face of all these difficulties, it is reasonable to ask why anyone bothers with such studies. But they do, in the interests of establishing scientifically valid forms of diagnosis and treatment. Attempts to do this in relation to food intolerance are many and varied, and we will not try to cover them all. What matters in such studies is the care with which they are designed and the details of how they are carried out. To assess a trial properly, one must look carefully at the details and we will therefore concentrate on five trials – two dealing with rheumatoid arthritis, two dealing with irritable bowel syndrome, and one dealing with migraine. These trials are the main ones carried out in Britain within the last eight years, and they are among the most scientific attempts to evaluate the food-intolerance concept.

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Try preparing food in different ways to see if you tolerate it better. Cooking food modifies its chemical structure. As an example, some people tolerate cooked food where they cannot eat it raw. Try baking or stewing fruit, for instance, if you cannot eat it raw. (Or, conversely, try food raw rather than cooked if it upsets you.) Prepare purees of gently cooked meat or vegetables – this can make foods easier to digest.

Do not bum or char foods when cooking. This can alter the chemical composition of foods and make you react to them. Burning meat when grilling or roasting produces the chemical acrolein which, even in tiny traces, can irritate. Do not bum toast.

If you have been eating whole grains in the form of wholewheat or brown rice, and cannot tolerate them, it is worth trying white wheat and white rice. These are sometimes better tolerated than whole grains, and may make you able to eat them.

Try different varieties of apples to see if you tolerate certain ones better. Some people find that they can tolerate one variety of apple and not another, so test Granny Smiths separately from Golden Delicious, and so on.

Some people tolerate processed and canned foods, such as canned fish or canned or dried fruit, better than their fresh equivalents. Some chemically sensitive people do not respond well to canned foods, however, so take care if you are sensitive to chemicals.

Some people find that they tolerate foods better if they add salt when eating. Other people find, conversely, that this makes things worse. Test this out to see. Use Pure Salt BP (available from Foodwatch International, address below) to avoid any additives in salt.

Some people are generally sensitive to alcohol, whatever the food or foods from which it is made. Other people can tolerate alcohol of different types, being able to tolerate the base foods. Ciders are based on apples. Wine, port, sherry and champagne are based on grapes. Most spirits are derived from various grains and cereals of the grass family (wheat, rye, oats, barley, corn, cane sugar) or from vegetables such as potato. Beers are brewed from grains and cereals, and hops; lagers are usually from grains and cereals only. Fruit wines and liqueurs are derived from various fruits.

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Residues from tobacco smoke impregnate many surfaces in places where people smoke regularly, and can give persistent problems for some time after, even if smoking has been banned. These may trouble you if you have just given up smoking, or recently banned it from your home, or if you have just moved to a house where smokers lived before. It helps to clear out and remove the residues as far as you can.

Wash and clean anything you can. Wash curtains, rugs, soft toys, pets’ bedding, all clothing – anything you see. Steam-clean carpets, upholstered furniture, cushions. Wipe down toys, storage jars and kitchen utensils – anything that has been exposed. Wash down all surfaces thoroughly – walls, windows, furniture, skirtings, bare floors, doors, ceilings. Wash inside the vacuum cleaner. Even clean inside cupboards if smoking has been heavy.

Washing surfaces with a Borax solution can help neutralise fumes. Put 1 dessertspoonful of Borax in a bowl of warm water and wipe down. Domestic Borax is available from chemists.

If you dry-clean things to remove tobacco fumes, air them well in a shed or spare room, or on a washing line, before using again.

Put things to air. Washing and cleaning may not be enough, so air everything as much as you can – put furniture outside, or in a shed or spare room with plenty of ventilation. Remember to air duvets, cushions and soft furnishings. Put books and paper outside in the wind and sun to air. Open up windows as much as you can and let the air through. Do this for as long as it takes.

Do not forget to clean and air cars. Scrub out used car ashtrays and open them to air off.

If these measures do not go far enough, redecorate to cover up walls and building surfaces.

You may also eventually have to replace things – furniture, furnishings, carpets and curtains, even lampshades and bedding, if residues still give you trouble. (See the relevant sections for suggestions for replacements.)

If you cannot manage to do the whole home, do just one room thoroughly to give you somewhere free of tobacco residues.

If you get stuck halfway through any of the above strategies, and get confusing results, either start from scratch and follow the radical clean-out programme (below), or go to page 98 and follow the long-term avoidance measures.

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If you are exceptionally sensitive to synthetic fibres, you may have to avoid using them in curtains, furnishings and upholstery. Your choices then come down to pure cotton, wool, linen or silk. Pure cotton is for most people the best choice, for reasons of cost, practicality and the fact that it is usually washable. However, pure cotton furnishing fabrics are commonly treated with three types of chemical finishes which can cause sensitivity:

• Formaldehyde resins

• Fire retardant treatments

• Stain resistant finishes

Dyes and other fabric treatments rarely cause reactions.

Formaldehyde resins protect the fabric against stains, grease, water and creasing. They restrict dyes fading, and improve the feel and body of the fabric. Formaldehyde is a common sensitiser and irritant.

Most major manufacturers of pure cotton furnishing fabrics in the UK apply fire retardant finishes to most or all their fabrics. Fire retardant treatments are of two basic kinds. The first, more common, are proprietary chemicals applied to cotton fabrics at the final stage of production. Two of the most widely used in the UK, Pyrovatex and Proban, release formaldehyde and have been known sometimes to cause irritation and reactions. The second kind of fire retardant treatment is to apply a thin backing layer of a rubber-like chemical.

Stain resistant treatments are not so widely applied to cotton fabrics. The fabric is usually labelled with a proprietary name, or is called ’stain-resistant’.

If you are not sure whether you react to fabric finishes on a piece of fabric, you can use the Iron Test to help you find out. You can do this on a sample of fabric before you buy it to see if you react.

If you want to find out whether Pyrovatex, Proban, other chemicals or back coating have been applied to any fabric you want to buy, ring the fabric manufacturers to find out. They are invariably courteous and helpful.

Pure wool fabrics are not treated with formaldehyde resins, nor with fire retardant chemicals since they meet fire safety regulations without treatment. They are sometimes treated with stain protection chemicals. Wool furnishing fabric may therefore be a good option for the chemically sensitive, if you are confident you do not react to wool.

If you are very sensitive to fabric treatments and synthetics, and are allergic to cotton and wool, wooden shutters or roller blinds of wood, rushes or paper may be an alternative to curtains.

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The basic components of any paint are resins which form the protective coating or film that any paint gives to its surface; solvents or liquids to hold the resins and other ingredients before and as the paint is applied; chemical driers which help the drying process; and pigments to give colour. Specialist paints contain a variety of chemicals according to their use – some external wood paints may contain fungicides, for instance, or textured paints for walls and ceiling contain fibres or grains.

The principal cause of problems are solvent- or oil-based paints which give off fumes on application, and over their life. Water-based alternatives are increasingly becoming available for most applications, and should be used wherever feasible.

Some people tolerate paints based on natural solvents and chemicals, which have some performance advantages over water-based paints.

Other components of paint vary a great deal, according to brand and type of paint, and their acceptability to people with chemical sensitivity can also vary a great deal – sensitivity can be idiosyncratic with paint, just as with other chemicals. A choice of paints is therefore given below wherever possible.

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If you are chemically sensitive, you will need a device with some form of activated carbon or High Efficiency Particulate Air (HEPA) filter, since ionisers, or fabric or electrostatic filters, will not make much impact on chemical vapours. You should avoid using any optional perfume or air freshener insert in a filter; these may upset you.

If you are extremely sensitive to chemicals, only the filter models with large areas of carbon or HEPA filters – for instance, the Biotech 500, Anatomia Filtaire 300 or 600S, Enviracaire and NSA 7100A – will make any real difference.

If you are very sensitive to plastics, you need to take care with choosing the casing and materials from which the filter is made. Always run and air the device for a few days before using in the same room as you. After a few days, it should give no problems.

Some people who are very highly sensitive to chemicals say that they react to the activated carbon used in the filters. This is extremely unlikely – it is more probable that this is due to sensitivity to tiny traces of contaminants in the water used to process the carbon, or to tiny traces of particles or chemicals already adhering to the filter. If you are exceptionally sensitive, take the precaution of using a machine on trial before purchase to see how you tolerate it. Ask the supplier to put in new, clean filters before the trial, so that you do not use contaminated filters. Ask for a machine that is well aired of plastic fumes.

If you find, after using a filter for a while, that you react to it, try changing, washing or vacuuming the filters to see if this helps. If you actually react to the filter while it is on in the same room, then do not use it close to you but try using it in a room before you plan to go into it – eg. run it in your bedroom before sleeping, or overnight in a living room or the place where you work. Even this may help a bit.

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