Annals of Occupational and Environmental Medicine

Case Report

Multiple chemical sensitivity triggered by an automobile mechanic's indirect exposure to volatile organic compounds in the Republic of Korea: a case report: Dong-Hoon Cheon, Yoon-Ji Kim, Dongmug Kang, Youngki Kim, Eun-Soo Lee, Ki-Hun Kim, Se-Yeong Kim; Ann Occup Environ Med 2026;e7. Published online February 26, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e7 [Accepted]

Abstract PDF: Background
Multiple chemical sensitivity (MCS) lacks definitive biomarkers, making differential diagnosis reliant on exclusion and symptom reproducibility. In automobile repair shops, volatile organic compounds (VOCs) from cleaning agents pose risks not only to primary users but also to co-workers via indirect exposure. We report a case of MCS suspected to be triggered solely by bystander VOC exposure, highlighting the clinical significance of uncaptured peak exposures in Korea.
Case presentation
A 23-year-old mechanic experienced recurrent headaches, throat irritation, and nausea immediately after co-workers used aerosolized cleaners in a poorly ventilated workspace. Symptoms consistently improved when he was away from work. Routine clinical evaluations were unremarkable. Although the patient underwent surgery for chronic rhinosinusitis, the symptoms persisted specifically upon re-exposure, effectively ruling out structural otorhinolaryngologic causes. Mental health screening indicated only mild depressive symptoms, insufficient to account for the severity of the physical symptoms. The Quick Environmental Exposure and Sensitivity Inventory (QEESI) scores were in the "suggestive" range for MCS. While routine workplace monitoring (8-hour time-weighted average [TWA]) showed non-detectable solvent levels, the nature of aerosol application suggested uncaptured short-term peak exposures. Based on the distinct temporal relationship, the patient was placed under medical observation and assessed as fit for work with restrictions on solvent exposure.
Conclusions
This case highlights the role of indirect VOC exposure as a trigger for MCS symptoms even when routine TWA monitoring indicates minimal concentrations. The discrepancy likely stems from the brief peak exposures triggering central sensitization, underscoring the limitations of standard monitoring. Management strategies must focus on peak-exposure control and fitness-for-work assessments that mandate strict avoidance of organic solvents, regardless of average ambient concentrations.

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Cohort Profile

Occupational and Environmental Health Screening Cohort of Yangsan Korea (OEC-YK): 2012–2023: Dongmug Kang, Eun-Soo Lee, Se-Yeong Kim, Youngki Kim, Youn Hyang Lee, Yoon-Ji Kim; Ann Occup Environ Med 2025;37:e32. Published online September 5, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e32

Abstract Abstract in Korean PDF: The Occupational and Environmental Health Screening Cohort of Yangsan Korea (OEC-YK) was established to monitor long-term health outcomes in workers and environmental high-risk citizens through systematic periodic health examinations. The cohort integrates 623,402 examination instances from 105,768 participants at Pusan National University Yangsan Hospital (2012–2023), encompassing general health checkups, occupational exposure surveillance, cancer screenings, and others including asbestos-related surveillance. Examination types included general health examination (32.4%), cancer screening (20.6%), special health examination (16.2%), night-shift work examination (16.0%), chronic disease screening (4.8%), pre-placement examinations (2.1%), and asbestos-related surveillance (3.6%). At baseline, 59.0% were male and 75.5% were aged between 20 and 59 years. Follow-up rates reached 35.0% at 1 year, 31.9% at 2 years, and 3.2% at 11 years. Notably, the inclusion of systematic asbestos examinations, combined with a national asbestos job exposure matrix, allows detailed study of long-latency occupational diseases. This large-scale longitudinal dataset supports exposure-disease linkage analysis, job-exposure integration, and time-series modeling of worker health trajectories in Korea.; 양산 지역 직업 환경 건강검진 코호트(OEC-YK) : 2012-2023년
양산 지역 직업환경건강검진 코호트(Occupational and Environmental Health Screening Cohort of Yangsan Korea, OEC-YK)는 체계적이고 주기적인 건강검진을 통해 근로자와 환경적 고위험군 시민의 장기적인 건강 영향을 모니터링하기 위해 구축되었다. 본 코호트는 2012년부터 2023년까지 양산부산대학교병원에서 수행한 105,768명의 수검자로부터 수집한 623,402건의 검진 자료를 통합하였으며, 여기에는 일반건강검진, 직업적 노출 감시, 암 검진과 석면 관련 감시를 포함한 기타 사항이 포함되었다. 검진 유형으로는 일반건강검진(32.4%), 암검진(20.6%), 특수건강검단(16.2%), 야간 교대근무 작업자 건강진단(16.0%), 만성질환 검진(4.8%), 배치 전 건강진단(2.1%), 석면 관련 건강검진(3.6%) 등이 포함되었다. 기초 조사 시점에서 남성이 59.0%였고, 20세에서 59세 사이의 연령대가 75.5%를 차지하였다. 추적 관찰률은 1년 시점 35.0%, 2년 시점 31.9%, 11년 시점 3.2%에 도달하였다. 특히, 국가 단위 석면 직업 노출 매트릭스(Job Exposure Matrix)와 연계된 체계적인 석면 건강검진의 도입은 잠복기가 긴 직업성 질환에 관한 정밀한 연구를 가능하게 한다. 이러한 대규모 종단자료는 한국에서의 직업성 노출과 질병 간의 연관성 분석, 직업-노출 정보 통합, 근로자의 건강 경과에 대한 시계열 분석 등을 수행할 수 있는 유용한 자원을 제공한다.

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