Symptom-checking test for environmental intolerances now online

Quick Environmental Exposure and Sensitivity Inventory (QEESI) can identify overlooked sensitivities

SAN ANTONIO (March 4, 2014) — An estimated 20 percent of chronically ill patients have some form of chemical or environmental intolerance, causing them to suffer from a variety of symptoms stemming from their exposures, said Claudia S. Miller, M.D., M.S., an occupational and environmental health expert with UT Medicine San Antonio. Yet, as common as the intolerances are, they rarely are diagnosed by physicians. A 2012 study by Dr. Miller and three other researchers found that few people know what is making them sick.

Dr. Miller seeks to change that and today announced the online posting of a questionnaire called the Quick Environmental Exposure and Sensitivity Inventory (QEESI). This inventory is the only one that has been validated in several countries and different languages and that comprehensively assesses symptom severity, severity of intolerances and life impact before and after a major exposure. Now, those who think they may have chemical intolerance can take the QEESI on their own computers and handheld devices. It generates a summary of the users’ responses that they can print out to keep and/or take to their doctors.

UT Medicine is the clinical practice of the School of Medicine at The University of Texas Health Science Center at San Antonio, where Dr. Miller has conducted research and taught physicians in training for two decades. In her past work, Dr. Miller, an experienced allergist and immunologist, unveiled a critical but previously unrecognized disease process called Toxicant-Induced Loss of Tolerance, or TILT. The QEESI can help identify this condition in people who suffer from intolerance to everyday chemicals in the home, workplace or outdoors.

What is the QEESI?

“I developed this test as a screening mechanism for multiple chemical intolerances,” or MCIs, Dr. Miller said. “The instrument is an online mechanism that measures sensitivities through a questionnaire on four scales: Symptom Severity, Chemical Intolerances, Other Intolerances and Life Impact.” Each scale contains 10 items, scored from zero equals “not a problem” to 10 equals “severe or disabling problem.”

Another 10-item tool called the “Masking Index” gauges ongoing exposures and overlapping symptoms that hide responses, blocking one’s awareness of their intolerances, and the intensity of their responses to exposures.

The QEESI helps people evaluate and understand their own responses to everyday exposures, many of which are found indoors, where Americans spend 90 percent of their time, especially children and pregnant women. The test queries patients on their responses to things such as tobacco smoke, paint or paint thinner, disinfectants, bleach, bathroom cleansers or floor cleaners, nail polish, nail polish remover, hairspray, certain perfumes, air fresheners or other fragrances, new furnishings such as carpeting or shower curtains, or the interior of a new car. Outdoor exposures include various types of air pollution, diesel or gas engine exhaust, insecticides and other chemicals.

“Web delivery of the test is ideal for two reasons,” Dr. Miller said. “Public acceptance of Web-based symptom checkers has grown sharply in recent years, and patients who otherwise would suffer in silence can now measure whether chemical exposures contribute to their illnesses.”

The QEESI is also effective for people whose symptoms began or intensified after a certain event, such as a pesticide exposure or moving into a new home or office.

In a study of 421 people, the QEESI offered sensitivity of 92 percent and specificity of 95 percent in discerning between those with multiple chemical intolerances and the general population. Sensitivity and specificity are statistical terms that describe how well a test discriminates between people with and without disease.

Diagnosing TILT

Only certain individuals are prone to TILT, Dr. Miller said. Many experience long-lasting and diverse symptoms, including memory and concentration problems, fatigue, headaches, weakness and mood changes such as extreme irritability and depression. They often report gastrointestinal, respiratory and skin problems, and some victims develop depression, addiction or violent behavior. The QEESI is a simple, patient-friendly way to understand a complex picture, she said.

“TILT has all the hallmarks of a new theory of disease,” Dr. Miller said. The “germ theory” emerged just after the Civil War, followed by the “immune theory” in the 1930s, which explained how people develop allergies or autoimmunity via exposure to biological antigens such as dust mites, pollen or poison ivy. Such exposures create antibodies against a specific substance, and re-exposure to the same antigen produces symptoms in the sensitized person.

“TILT can be thought of as the 21st century theory of disease,” Dr. Miller said. “Instead of germs or biological proteins, TILT implicates synthetic chemicals or chemical mixtures.”

It’s a two-step process: first comes an initial exposure, followed by a cascade of intolerances to chemically unrelated substances. “This is the toxic tipping point,” Dr. Miller said, “and it can come from low-level repeated exposures, or a single high-level exposure.”

Multiple uses

People can now visit and take the QEESI test to determine if they are suffering from TILT and which substances are causing their problems. Treatment involves avoidance or elimination of the offending chemicals.

Significantly, for individuals affected by events such as the recent disaster in West Virginia, where thousands of gallons of toxic chemicals leaked into the local water supply, or the Gulf of Mexico oil spill, the QEESI will serve as an invaluable tool to gauge the severity of responses to these exposures and to track symptoms over time.

Dr. Miller is a professor in the Department of Family and Community Medicine and an assistant dean in the School of Medicine at the UT Health Science Center. She is noted for her years of research into effects of environmental exposures on human health. She is the co-author of the professionally acclaimed book “Chemical Exposures: Low Levels and High Stakes.”

The QEESI is copyrighted through the UT Health Science Center at San Antonio and there is no charge for it. QEESI is for research and clinical purposes only; Dr. Miller prohibits commercial uses of it and makes no money from it, she said. A printed version is available through the Department of Family and Community Medicine website at


UT Medicine San Antonio is the clinical practice of the School of Medicine at the UT Health Science Center San Antonio. With more than 700 doctors – all School of Medicine faculty – UT Medicine is the largest medical practice in Central and South Texas. Expertise is in more than 100 medical specialties and subspecialties. Primary care doctors and specialists see patients in private practice at UT Medicine’s flagship clinical home, the Medical Arts & Research Center (MARC), located at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and UT Medicine physicians also practice at several local and regional hospitals. Call (210) 450-9000 to schedule an appointment, or visit for a list of clinics and phone numbers.

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