American College of Medical Toxicology and The American Academy of Clinical Toxicology
View all recommendations from this societyReleased March 26, 2015
Don’t order tests to evaluate for or diagnose “idiopathic environmental intolerances,” “electromagnetic hypersensitivity” or “mold toxicosis.”
These diagnoses reflect labels to indicate that patients have adverse non-allergic reactions to normal environmental stimuli. These diagnoses are made on the bases of self-reported symptoms or non-validated testing procedures. Although these conditions have been widely promoted, evidence-based assessments fail to support these diagnoses as disease entities. Labeling a patient with these diagnoses may adversely affect the patient’s lifestyle, obscure ascertainment of the etiology of their symptoms and promote unnecessary testing.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The American College of Medical Toxicology’s (ACMT’s) Board of Directors established a Choosing Wisely® work group in 2013 to develop a list of items for the Choosing Wisely® campaign. Members of the work group were chosen to represent various practice settings within the field of medical toxicology, including ambulatory, acute and population-based practice. Work group members included the President of the College, the Chair of the Practice Committee, the Chair of the Positions and Guidelines committee and other academic leaders within the medical toxicology community. All work group members also represented the American Academy of Clinical Toxicology (AACT). The first list was released by the work group in 2013 and in 2014, the work group reconvened to develop a second list of items for the campaign. A second preliminary list was disseminated to all members of ACMT and AACT for review, commentary and potential additions. Additional feedback was solicited from leaders within the field of medical toxicology. The work group reviewed all responses, and narrowed the list to the final five items based on a review of scientific evidence, relevance to the specialty and greatest opportunity to improve care, reduce cost and reduce harm to patients.The final list was approved by the ACMT Board of Directors and the AACT Board of Trustees.
The ACMT and AACT disclosure and conflict of interest policies and be found at www.acmt.net and www.clintox.org respectively.
Sources
Baliatsas C, VanKamp I, Lebret E, Rubin GJ. Idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF): a systematic review of identifying criteria. BMC Public Health. 2012 Aug 11;12:643.
Boyd I, Rubin G, Wessely S. Taking refuge from modernity: 21st century hermits. J R Soc Med. 2012 Dec;105:523-9.
Hausteiner C, Bornschein S, Zilker T, Henningsen P, Förstl H. Dysfunctional cognitions in idiopathic environmental intolerances (IEI) – an integrative psychiatric perspective. Toxicol Lett. 2007Jun 15;171(1-2):1-9.
Rubin GJ, Hillert L, Nieto-Hernandez R, van Rongen E, Oftedal G. Do people with idiopathic environmental intolerance attributed to electromagnetic fields display physiological effects when exposed to electromagnetic fields? A systematic review of provocation studies. Bioelectromagnetics. 2011 Dec;32(8):593-609.
Staudenmayer H, Binkley KE, Leznoff A, Phillips S. Idiopathic environmental intolerance: Part 2: causation analysis applying Bradford Hill’s criteria to the psychogenic theory. Toxicol Rev. 2003;22:247-61.
Staudenmayer H, Binkley KE, Leznoff A, Phillips S. Idiopathic environmental intolerance: Part 1: a causation analysis applying Bradford Hill’s criteria to the toxicogenic theory. Toxicol Rev. 2003;22:235-46.
