No smoking is allowed, and this rule is strictly enforced. Signs to this effect are posted not only in the waiting room but in the bathroom as well, where confirmed tobacco addicts may be tempted to depart from the rule. Care has been taken in the selection of office furniture. Wood and leather are used extensively, not plastic or synthetics. Office machinery is kept to a minimum in order to avoid the kinds of fumes and odors which frequently foul the air indoors. Almost all of the typewriters, for instance, are manual, not electric. The copying machine was chosen because it emits the least amount of environmental pollutants. In fact, it is rarely used. Even the partitions are made of hardwood and not of any building material which gives off gases, as plastics often do. Nurses, secretaries, and other employees are instructed to refrain not only from smoking but also from the use of perfumes, scents, and after-shave lotions. We have little trouble in this regard, however, for almost all office personnel themselves have food and chemical susceptibilities, and are chosen with this fact in mind. Because of their own experience, they can provide more help and understanding to patients than those who are not aware of environmental disease in a personal way.

The office is located high above Lake Michigan, and the air is about as good as one is likely to find in a big city like Chicago. For heat, we employ portable electric heaters. In a sense, then, a patient’s treatment begins as soon as he enters the office itself, since the environment is conducive to recovery.

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If the inflammation is more serious, then the blood vessels can become much more leaky and even break open, so that red and white blood cells escape into the surrounding tissue, as well as fluid. This condition is known as vasculitis and it may affect larger blood vessels as well as capillaries.

The first noticeable sign of vasculitis is usually swelling, or oedema, due to water leaking from the blood into the surrounding tissues. If there is generalized oedema – a reaction that affects the whole body – there will be a marked gain in weight, as much as 5 kg (over 11 lb) in 24 hours. There may also be aches and pains, especially in the legs, that tend to come and go.

As the condition gets worse, the blood vessels become more leaky and eventually rupture. Red blood cells start to seep into the tissues and are noticeable externally as tiny reddish spots, which then turn purple or black, and finally yellowish before disappearing – the same sort of colour changes as are seen in a bruise. The condition is known as purpura. Larger escapes of blood produce spontaneous bruising.

If vasculitis is allowed to continue unchecked, more serious damage to the vessel wall may occur, and this can eventually lead to a vein becoming permanently inflamed or even completely blocked. Such damage is serious and often irreversible, so it is important to treat vasculitis at an early stage.

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It is possible to become sensitive to creams and ointments used in this way, which can aggravate the condition. Sensitivity is moreover highly personal – one person will tolerate one product but not another – so it is difficult to give general advice about what to use, or how and when.

Aqueous cream is used for moisturising and soothing. It is not occlusive, i.e. it does not shut out or prevent anything entering or touching the affected site. ‘Simple aqueous cream’ contains only phe-noxyethanol held in boiled and cooled purified water: ask a pharmacist for this. Some aqueous creams contain wool fat, including lanolin, and preservatives which cause some people to react. These may suit you but Patch Test (>CHEMICALS for method) before widespread use.

Occlusive ointments usually have a greasy ingredient, such as soft paraffin, to put a film over the affected skin and protect it. Some such as Unguentum Merck wash off readily in water.

Some creams and ointments come in combinations of emollient and moisturiser, and some can be used in the bath to soothe.

The National Eczema Society offers an excellent advisory service for choosing emollients and moisturisers, together with a computerised database of product ingredients, if you know you react to a specific chemical. Their address and telephone number are in CHARITIES.

Ultraviolet light treatment can also help eczema, as can a stay at the seaside. Trials are under way of therapy with evening primrose oil, and of traditional Chinese herbal remedies which have shown results in some people with eczema.

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Independent tests have shown that KDF filters remove over 90 per cent of metals, 100 per cent of chlorine, and reduce nitrates by over 75 per cent. Another benefit of KDF filters is that contaminants do not adhere to any filter medium as they do in activated carbon filters, and do not flush back into the system. Minerals are not removed, so that the water has a more acceptable taste than reverse osmosis water.

KDF filters can be plumbed in under a sink to supply one tap. They provide water at normal tap flow-rates, and, this plus the taste of the water, are a significant advantage over RO water. KDF filters can be installed by a skilled DIYer and can be bought at a price comparable to medium-range activated carbon filters – £105-165 before any plumbing. Cartridges need replacing every six to twelve months and cost between £25 and £50. An extra nitrate-reducing filter can be added to one version to remove virtually all nitrates.

There are no independent test results which compare KDF filtered water to activated carbon (AC) filtered water. Suppliers believe that KDF water is purer than AC water but have no precise evidence.

A showerhead version of a KDF filter is available for £50 which screws into the showerhead and needs replacing every 18 months or so. Chlorine is significantly, but not totally, reduced by this filter. It has no sediment or carbon filters.

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If you are allergic to pollens, travelling by InterCity train or air can be an advantage for a long journey, being air-conditioned.

If you are extremely sensitive to anything, and do not mind people staring, wear a face mask. Alternatively, clasp a dampened handkerchief firmly over your nose – it does not stop all fumes, but is of some help.

Some tips which are helpful are to avoid smoking areas, or sit as far from them as you can. On trains or buses, sit away from engines or power units, or from doors which can allow fumes in. Trams are being reintroduced in some British cities – these are electrically powered and often better to travel on, if you have the choice. Spend as little time as you can in underground transport systems.

Advice for Pedestrians

If you have to walk in traffic, choose a route through parallel back streets or pedestrian areas if possible, which avoids having to walk on busy streets. Do not cross the road by walking between stationary vehicles. Hang back from the edge of the road, and cross quickly, at pedestrian crossings or lights if traffic is heavy. Wear a face mask, if you can cope with the stares (>FACE MASKS), or carry a damp handkerchief to clasp over your nose.

If you have a baby who is chemically sensitive, do not push a buggy between vehicles with exhausts at the baby’s nose level. Cross at crossings or lights, or where the traffic is light. Choose a pram or buggy in which the baby sits relatively high up.

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If you are chemically sensitive, it is probably better to avoid tampons unless you absolutely have to use them. The vagina, being a mucosal area of the body, absorbs chemicals very readily. You are more likely to react to a tampon than to a sanitary towel. Boots own brand are not treated with glycerol and may be a better choice if you have to wear tampons.

Some brands of sanitary towels are better tolerated than others by chemically sensitive women. Try using Simplicity towels to see if they suit you, or Boots own brand towels.

The Green Catalogue (address above) sell disposable sanitary towels in non-chlorine-bleached pulp, and 100 per cent cotton non-chlorine-bleached tampons. They also sell re-usable sanitary towels in unbleached cotton with absorbent felt of viscose and polyester and a waterproof backing. These may not be tolerated by some women but could be worth a try.

If you can use none of these, try using a pure cotton muslin nappy, usually sold for babies. These are usually non-chlorine bleached. Fold the nappy, and pin it to your pants if necessary. Cut the nappy in half or smaller if it is too bulky. Boots and Mothercare sell these.

Some other women successfully use vaginal sponges if they have a light flow. Buy a tiny natural sponge – sold usually for applying cosmetics – and place high in the vagina. Remove and rinse several times a day. Rinse it thoroughly and keep very clean between periods.

Another option is to use a contraceptive cap to collect the blood. You will need your doctor to fit a cap for you. Insert the cap without spermicide and empty it frequently. This works well if you have a light flow, unless you are sensitive to the latex of the cap.

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Taking Boots Cream of Magnesia Liquid by mouth is an effective mild laxative. Use Epsom Salts if you need a stronger laxative. Dissolve one teaspoonful in a glass of water and drink.

Mouthwash

You can use sodium bicarbonate (one teaspoonful in a glass of water) as a mouthwash. It kills smells very effectively.

Painkillers

For painkillers (analgesics), use paracetamol. Paracetamol is a powerful pain-reliever and will be adequate for home medication.

Piles

External piles can be relieved by sitting on, or applying an ice pack. You can also apply a solution of Witch Hazel but it stings mightily. Piles can be a symptom of food intolerance or allergy.

Rashes and Itchy Skin

If you have eczema, or dermatitis, take your doctor’s advice about emollients and moisturizers. The National Eczema Society is an invaluable source of counselling and advice.

For nettle rashes, other fleering rashes, sunburn, insect bite swellings, chicken pox and itchy skin, dab the affected area with Boots Cream of Magnesia Liquid and allow to dry. It is wonderfully soothing.

Urtica Urens, a homeopathic tincture or ointment, can also relieve nettle rash and other rashes. Some allergies tolerate it well, but use with care.

Sore Throats and Coughs

A steam inhalation will soothe sore throats and ease coughs; see Blocked Nose. Leaving a just-boiled kettle to steam gently in a room can ease severe coughing, especially at night.

If you tolerate lemons and a sweetener such as honey or sugar, squeeze fresh lemon juice, dilute with hot water and add honey or sugar to taste.

Unless you are chemically sensitive, a spoonful of Glycerin (from your pharmacy) will soothe coughs. If you are chemically sensitive, do not use it.

Spots and Pimples

Maintain scrupulous cleanliness to keep spots, blackheads and pimples at bay. Wash with a soap that you tolerate and plenty of water. Dab dry with a towel. You can use Rosewater and Witch Hazel as a cleanser, or Witch

Hazel solution on its own as an astringent. Your pharmacist will make these up for you. You can be sensitive to these; sniff both before using to see whether they affect you, and use with care. Witch Hazel may sting a little on use. Do not use it on skin with any deep cuts, where it will sting badly.

Sunburn

Apply Boots Cream of Magnesia Liquid liberally on skin and allow to dry. Very soothing! Apply an ice pack to very hot, angry areas.

Toothache

Apply oil of cloves directly to the tooth. Sniff it first, or take care, as you can be sensitive to the natural oils in cloves.

Wind

Take a few drops of peppermint oil in a glass of water to relieve severe wind. Again the oil can cause sensitivity, so take care to sniff and use prudently.

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Permitted Foods

All fresh meat, poultry and game (except chicken and smoked, salted or pickled foods)

All fresh vegetables

All fresh fruit, except citrus. Do not eat: Orange Citron

Buckwheat, Sago, Tapioca, Quinoa Olive oil

Sea salt or Pure Salt BP Black pepper, white pepper Herbs Spices

To drink: Water (preferably filtered or bottled Buxton, Evian, or Malvern)

Some versions of the diet also permit the following foods, unless you already know that you are sensitive to them. Free-range chicken

All fresh fish (not smoked, salted, pickled or canned) All nuts and seeds

All beans and pulses (not canned, nor manufactured, processed

e.g. not baked beans or soya milk) Vegetable, fruit and nut oils (not corn oil, or rice oil) Honey

It is preferable to eat organic foods and field-fed meat and free-range poultry, if you can possibly manage it (>pages 166-7 for sources).

Grapefruit Lemon

Tangelo

Pomelo

Ugli

Satsuma

Tangerine

Clementine

Kumquat Lime

Foods to Avoid All eggs

Milk (cow, goat, sheep) and its products (butter, yogurt, cream, cheese)

Grains and cereals (wheat, oats, rice, corn, barley, millet) and all their products (e.g. bread, cakes, biscuits, crackers, crispbreads, pies, pastry, oils, malt, pasta, bakery etc)

All sugars (cane, beet, maple, fructose) and their products (treacle, syrup, molasses) ”

Citrus fruits (see list above)

Salted, smoked and pickled meat, poultry and fish (e.g. bacon, ham, kippers)

Coffee, tea, cocoa, chocolate and beverages

Alcohol

Vinegar

Yeast and yeast extract

All manufactured and processed foods

Do not eat: Canned food and drink

Fruit juices, drinks and squashes Dried fruit

Sweets and chocolate

Chewing-gum

Margarine

Jams, marmalades and spreads Pickles

Sauces and mustard Bread and baked foods Snack foods, nuts and crisps Cooked meats, sausages and pies Pastes and spreads Prepared dishes, cook-chill foods

Organising the Diet

You can eat as much of the permitted foods as you want and at any time of day. You follow the diet for five to seven days to see if symptoms clear, and then start to reintroduce foods to test them.

Most people find that they get very hungry on this diet and need to eat large amounts of the permitted foods to keep going. Root vegetables, such as potatoes, sweet potato, carrot, swedes, parsnip or turnip can be very useful to fill you up, as can buckwheat. If you are able to eat nuts, seeds and beans and pulses, these are also filling. You may also have to eat unconventional meals – a grilled chop for breakfast, say, or a baked potato as a mid-morning meal to keep you going.

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Sublingual testing for food sensitivity can be ineffective, especially if the food concerned has not been consumed within the previous 48 hours, so it is rarely used. Sublingual testing for chemical sensitivity, however, is more effective and can be useful in identifying chemicals to which you react. It is less effective when carried out in an environment with a high level of chemicals in the air, which can affect results. Best results are obtained in a chemical-free or carefully controlled environment.

Your doctor can refer you to have any of the above medical and laboratory tests if you ask for them, but they may not be available on the National Health Service, or in the area where you live. If you want further advice on where to go for testing, the British Society for Allergy and Environmental Medicine and The British Society for Allergy and Clinical Immunology can give you the names of doctors.

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If a garment lining causes discomfort, cut it out and see if the trouble goes away. Cut off lace and trims if necessary. Elastic or sewing thread next to the skin can be a severe problem, where the sensitivity is often exacerbated by sweat and friction. To avoid problems with elastic or sewing thread, try any of the following:

• Look for underclothes or nightwear with cased elastic bands which will protect the skin

• Wear underwear inside out so that fabric is next to the skin

• Wear a thin silk vest under bras or close-fitting underwear

• Place cotton handkerchieves or silk scarves under the elastic to protect the skin

• Dust sodium bicarbonate or magnesium carbonate gently on the areas of friction to relieve the reaction

• Swab those areas with Boots Cream of Magnesia liquid to calm symptoms

• Avoid cotton clothes containing Lycra or Elastane

Silk clothes and underwear can be useful because they are often sewn with silk thread.

Look out for waddings, paddings and shoulder pads. Remove them if you have to. Be careful with cotton interlinings, which can be treated with formaldehyde resin to strengthen them. Watch out for pocket linings and zips. To protect against metal fastenings or buttons, use any of the protection methods suggested for elastic and thread above.

If you cannot work out what is causing a contact skin reaction, bear in mind that contact reactions to things like fastenings and trimmings do not necessarily occur at the site where the offending object makes contact. Contact reactions can occur at other parts of the body. They can also occur with a delayed reaction – sometimes a few days later. You may have to experiment carefully with clothing to establish a pattern.

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