intolerances signal gastrointestinal involvement. Often Raynaud’s-type vascular constriction resulting in cold hands and feet, easy bruising, or phlebitis signal chemically- induced peripheral vascular disease. Arthritis and myalgias indicate musculoskeletal involvement. Recurrent, sterile urinary tract inflammation, auto-immune endocrine involvement, and peripheral nerve weakness, paresthesias, and sensory deficits are also found. In fact, the hallmark of chemical sensitivity is that patients present with multisystem disease. This is because, once the chemicals enter the body, they enter the bloodstream and circulate to all parts of the body, even the brain.

Two important phenomena to understand are "spreading" and "switching." Spreading occurs when additional organ systems are involved, or when a patient additionally becomes sensitive to inhalants, foods, dust, animal danders, or other environmental exposures. Switching occurs when the same exposure produces entirely different organ involvement (i.e. photocopier fumes initially caused headache, and subsequently caused no headache but wheezing).

The main mechanism for chemical sensitivity is the failure of the body’s enzyme detoxification pathways to adequately clear chemical compounds. Both immune and non-immune processes have been involved. Chemical sensitivity can develop after a massive chemical exposure (i.e. Bhopal), after specific non-chemical events (massive trauma, childbirth, surgery), after severe infections (viral, bacterial, parasitic) or with no identifiable cause (60% in one large study). Approximately 28% of patients diagnosed with chemical sensitivity have employment-related exposures.