Symptoms associated with environmental factors (SAEF) - Towards a paradigm shift regarding idiopathic environmental intolerance and related phenomena

Health conditions characterized by symptoms associated with chemical, physical and biological environmental factors unrelated to objectifiable pathophysiological mechanisms are often labelled by the general term idiopathic environmental intolerances. More specific, exposure-related terms are also used, e.g. multiple chemical sensitivities, electromagnetic hypersensitivity and candidiasis hypersensitivity. The prevalence of the conditions varies from a few up to more than 50%, depending on definitions and populations. Based on evolving knowledge within this field, we provide arguments for a paradigm shift from terms focusing on exposure and intolerance/(hyper-)sensitivity towards a term more in line with the perceptual elements that seem to underlie these phenomena. Symptoms caused by established pathophysiologic mechanisms should not be included, e.g. allergic or toxicological conditions, lactose intolerance or infections. We discuss different alternatives for a new term/concept and end up proposing an open and descriptive term, symptoms associated with environmental factors (SAEF), including a definition. Symptoms associated with environmental factors both is in line with the current knowledge and acknowledge the experiences of the afflicted persons. Thus, the proposed concept is likely to facilitate therapy and communication between health professionals and afflicted persons, and to provide a base for better understanding of such phenomena in healthcare, society and science.