1-Minute Screening Tool Helps ID Those at Risk of Allergies, Intolerances

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Up to 33 percent of individuals already experience intolerance to specific chemicals, foods and drugs. And now—amid the California wildfires and COVID-19 pandemic—leading researchers at UT Health San Antonio are even more concerned for the health of susceptible people.

Despite a relatively high population prevalence rate, chemical intolerance often goes undiagnosed since the mechanisms underlying the “disease,” have never been identified or understood. For physicians, diagnosing intolerance is time-consuming—definitely not something that can be taken care of in a routine well visit. But, given the events of 2020, that’s exactly what physicians should be doing.

Addressing this critical gap, the UT research group developed and validated a 3-question screening survey that can be completed in less than one minute during any routine visit. The survey, called the Brief Environmental Exposure and Sensitivity Inventory, or BREESI, can also be used by researchers and patient groups, and for epidemiological studies in exposed populations.

BREESI is an adaptation of QEESI, or Quick Environmental Exposure and Sensitivity Inventory, which the researchers debuted in 2014. The 50-question survey has since become the standard for measuring chemical intolerance; however, it takes more than an hour to complete. BREESI, on the other hand, takes just a minute to complete with three yes-or-no questions pertaining to chemical, food and drug intolerances that were directly derived from QEESI:

  • Do you feel sick when you are exposed to tobacco smoke, certain fragrances, nail polish/remover, engine exhaust, gasoline, air freshners, pesticides, paint/thinner, fresh tar/asphalt, cleaning supplies, new carpet or furnishings?
  • Are you unable to tolerate or do you have adverse or allergic reactions to any drugs or medications, or to an implant, prosthesis, contraceptive chemical or device, or other medical/surgical/dental material or procedure?
  • Are you unable to tolerate or do you have any food such as dairy products, wheat, corn, eggs, caffeine, alcoholic beverages, or food additives?

“Although the QEESI chemical exposure scale is designed to assess adverse reactions to 10 specific chemical exposures, the BREESI compresses this scale into a single ‘yes’ or ‘no’ question,” the researchers explain in their paper, published in PLOS ONE. “Similarly, the BREESI compresses items on the QEESI Other Intolerances Scale that pertain to food and drug intolerances into one ‘yes’ or ‘no’ question for foods, and another for drugs.”

In their study to validate BREESI as a screening tool, the researchers show it exhibits predictive validity of 90 to 95% when compared to the QEESI reference standard. Ninety percent (90%) of respondents who answered yes to all three questions on BREESI fit the QEESI criteria for being "very suggestive" to chemical intolerance. Likewise, 95% of those who said no to all three BRESSI questions were classified as "not suggestive." Numbers were similar for respondents in the middle. Ninety-three (93) percent of individuals who answered yes to two out of three questions were classified as either very suggestive (39%) or suggestive (54%). For those who answered yes to only one question, 13% were classified as very suggestive while 70% were classified as suggestive.

To that end, the researchers suggest using one “yes” as the cutoff for determining if a patient needs to take the full QEESI survey. Those who respond positively to two or three BREESI items may be at an enhanced risk of developing additional intolerances or adverse reactions to exposures or medications. The risk of endangering susceptive people is higher than usual right now, according to Claudia Miller, MD, professor emeritus at UT Health San Antonio and co-author of the study. The misuse of disinfectants to combat COVID-19 paired with the wildfires raging on the West Coast have the doctor more concerned than usual about volatile organic chemicals triggering symptoms.

The UT Health San Antonio team is further replicating and validating BREESI’s performance in larger, population-based studies both in the U.S. and internationally.