Italian Expert Consensus on Clinical and Therapeutic Management of Multiple Chemical Sensitivity (MCS)

Int J Environ Res Public Health. 2021 Oct 27;18(21):11294. doi: 10.3390/ijerph182111294.


Multiple chemical sensitivity (MCS) is a multisystem, recurrent, environmental disorder that flares in response to different exposures (i.e., pesticides, solvents, toxic metals and molds) under the threshold limit value (TLV) calculated for age and gender in the general population. MCS is a syndrome characterized by cutaneous, allergic, gastrointestinal, rheumatological, endocrinological, cardiological and neurological signs and symptoms. We performed a systematic review of the literature to summarize the current clinical and therapeutic evidence and then oriented an eDelphi consensus. Four main research domains were identified (diagnosis, treatment, hospitalization and emergency) and discussed by 10 experts and an MCS patient. Thus, the first Italian MCS consensus had the double aim: (a) to improve MCS knowledge among healthcare workers and patients by standardizing the clinical and therapeutic management to MCS patients; and (b) to improve and shed light on MCS misconceptions not supported by evidence-based medicine (EBM).

Keywords: chemical intolerance; environmental exposure; multiple chemical sensitivity (MCS); neurogenic inflammation; threshold limit value.

Publication types

  • Systematic Review

MeSH terms

  • Consensus
  • Humans
  • Hypersensitivity*
  • Italy / epidemiology
  • Multiple Chemical Sensitivity* / diagnosis
  • Multiple Chemical Sensitivity* / epidemiology
  • Multiple Chemical Sensitivity* / therapy
  • Solvents


  • Solvents