The Case of the Toxic Carpet

A 55-year old woman complained of chronic fatigue, muscle pain, memory loss, insomnia, hyperactivity, IBS-C and repeated episodes of bronchitis that progressed to pneumonia. She had positive food allergy reactions to 36 foods and had a restricted diet that was difficult for her to follow since many of these foods had been the foundation of her daily diet for most of her life. 

Many of her complaints began after she moved from Chicago to an older home in Dallas, Texas 5 years prior.  Her food intolerances developed while she was in this home, she did not remember ever having a problem with digestion or food reactions prior to that.

The insomnia started after major pelvic surgery and the removal of her appendix two years earlier. She had difficulty coming out of the anesthesia and had a high fever post-surgery that was believed to be a reaction to anesthesia. 

Two years after the surgery she had not improved and was tested for chemical exposure by an environmental medicine specialist. Labs revealed elevated levels of chlordane in her blood. The Texas Dept of Health tested her home and found high levels of chlordane, heptachlor, DDT, and diazinon (an organophosphate pesticide) in her carpet.

She had previously had the home treated for pests and termites many years prior and these pesticides were still measurable in both the home air and carpet. On the advice of her physician, she had the carpeting removed and the crawlspace ventilated. The ground in the crawlspace and around the foundation, which had been impregnated with chlordane for termite control, was sealed off so it could no longer off-gas.

 Her recurrent lung infections did not recur and the rest of her symptoms went into remission in the following two months and she was able to continue living in her home environment without health issues.

Important points in this case:

Anesthesia “reactions” point to decreased tolerance to drugs in general and may be a sign of chemical sensitivity. Multiple food allergies do as well.

Claudia Miller MD, a researcher in the field of chemical sensitivity, has created a validated 3 question screening test for chemical sensitivity with the following questions:

1. Do you feel sick when you are exposed to tobacco smoke, certain fragrances, nail polish/remover, engine exhaust, gasoline, air fresheners, pesticides, paint/thinner, fresh tar/asphalt, cleaning supplies, new carpet, or furnishings? By sick, we mean headaches, difficulty thinking, difficulty breathing, weakness, dizziness, upset stomach, etc. Yes OR No

2. Are you unable to tolerate or do you have adverse or allergic reactions to any drugs or medications (such as antibiotics, anesthetics, pain relievers, x-ray contrast dye, vaccines or birth control pills), or to an implant, prosthesis, contraceptive chemical or device, or other medical/surgical/dental material or procedure? Yes OR No

3. Are you unable to tolerate or do you have adverse reactions to any foods such as dairy products, wheat, corn, eggs, caffeine, alcoholic beverages, or food additives (such as MSG, food dye)? Yes OR No

A yes answer to any of the above should be followed by taking the longer assessment called the QEESI (Quick Environmental Exposure and Sensitivity Inventory) available for free online at: https://tiltresearch.org/qeesi-2/ 

The QEESI has four scales: Symptom Severity, Chemical Intolerances, Other Intolerances, and Life Impact. Each scale item is scored from 0 to 10 (0 = “not a problem” to 10 = “severe or disabling problem”). Total scores range from 0 to 100.

Food allergies and intolerances can result from pesticide exposures. The US National Health and Nutrition Examination Survey for 2005–2006 associated childhood exposure to dechlorophenol-containing pesticides with sensitization to one or more food allergens, and not aeroallergens. Food sensitivities were also associated with the use of home pesticides and urban living.

Older homes can have many problems (lead, mold, etc.) but homes in the southern U.S. (especially the southeast) have another issue – chlordanes (organochlorine pesticides) that were used as termiticides in residential and business building foundations and basements. Residential use of chlordane was banned in 1988. 

• Also called “technical chlordane” (heptachlor, cis-chlordane, trans-chlordane, or trans-nonachlor), chlordane is metabolized into heptachlor epoxide and oxychlordane- both metabolites measured in the blood.

• This use of chlordane in approximately 30 million homes in the U.S. has a lingering effect- a 2003 EPA study found 50-60% of homes with chlordane application had levels 4-40 times the EPA guideline for air exposure risk. Blood levels of chlordane in residents of these homes were about 25 times higher than they would have been from eating produce that had been sprayed with chlordane 

• Individuals with blood levels of heptachlor epoxide of 0.09 ng/g or above are 1.7-3.2 times more likely to have type 2 diabetes. In a large NHANES study, those with the highest blood levels of transnonachlor had an odds ratio of 37.7 for diabetes. 

• Chlordane exposure also leads to decreased cell mediated immunity- decreased killing of tumor cells by macrophages, altered NK cell activity, altered T lymphocyte responses, and enhanced survival of influenza virus infection. So, there is a plausible mechanism for increased risk for bronchitis and pneumonia as well as an explanation for the  remission of lung problems with remediation. 

As an aside— carpeting, new or old has its own problems in terms of toxicant exposure. New carpeting off-gases multiple toxicants, mostly solvents. Synthetic carpets are made from nylon fibers with a polypropylene backing. The glue that sticks to the backing is made of styrene and 4-phenylcyclohexane (4-PC)- a toxic solvent that is an eye and sinus/lung irritant. 4-PC is found in 95 percent of carpets and is responsible for “new carpet” aroma. 4-PC may also be a brain and nervous system toxicant. The adhesive used to affix the carpet to the floor typically contains benzene and toluene, additional harmful chemicals. Older carpeting, especially in homes that are water-damaged, becomes a sink for mycotoxins. 

EHQ Relevant Question: Have you lived in home built before 1988 in southern US?

While testing for home air levels of toxicants is a job for a local health department or building biologist, testing the patient’s blood is the job of her doctor. How did this expert physician (Bill Rea MD, known to many as the father of the environmental medicine movement) know to test this woman for chlordane? Dr. Rea always checked his patients for pesticide exposure, especially if they showed signs of chemical sensitivity and immune compromise. Organochlorine pesticide testing is available through Quest Diagnostics as: Organochlorine Pesticides Serum/Plasma and includes: Alpha-chlordane, DDE, DDD, DDT, Dieldrin, Gamma-chlordane, Heptachlor, Heptachlor epoxide, Hexachlorobenzene, Lindane, Methoxychlor, Oxychlordane, Trans-nonachlor. (Test Code 3529). 

References

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Whitemore RW, Immerman FW, Camann DE, Bond AE, Lewis RG, Schaum JL. Non-occupational exposures to pesticides for residents of two U.S. cities. Arch Environ Contam Toxicol. 1994 Jan;26(1):47-59. PMID: 8110023.

Patel CJ, Bhattacharya J, Butte AJ. An Environment-Wide Association Study (EWAS) on type 2 diabetes mellitus. PLoS One. 2010 May 20;5(5):e10746. PMID: 20505766.

Engelhart S, Loock A, Skutlarek D, Sagunski H, Lommel A, Färber H, Exner M. Occurrence of toxigenic Aspergillus versicolor isolates and sterigmatocystin in carpet dust from damp indoor environments. Appl Environ Microbiol. 2002 Aug;68(8):3886-90. PMID: 12147486

Yu JE, Mallapaty A, Miller RL. It’s not just the food you eat: Environmental factors in the development of food allergies. Environ Res. 2018 Aug;165:118-124. doi: 10.1016/j.envres.2018.03.028. Epub 2018 Apr 22. PMID: 29689456.