The TILT Self-Assessment is a free, scientifically validated evaluation created by the TILT Research Program for Chemical Intolerance at UT Health San Antonio. It helps identify and understand potential connections between symptoms and exposures for diagnosis, prevention, and treatment.
If you have never been able to put a number on what is happening to you, this is where you can. The QEESI is a free, validated questionnaire developed by researchers at UT Health San Antonio, used in studies and clinics in more than a dozen countries. It measures how much chemicals affect you, how severe your symptoms are, and how much of your life the condition has taken — and it produces a score, not an opinion.
That matters for a specific reason. Most people with chemical sensitivity walk into appointments with a story and walk out dismissed. A completed QEESI turns your experience into standardized data a clinician can compare against published reference ranges. It is free, you take it at home in about fifteen minutes, and you can hand the results to your doctor. It is not a diagnosis on its own — but it is the single most useful piece of paper most patients can bring to one.
The complete assessment takes about 15-20 minutes and gives you a detailed picture of your chemical intolerance status. Share the results with your doctors.
The Brief Environmental Exposure and Sensitivity Inventory asks three simple yes/no questions that quickly identify whether further assessment is warranted. It screens for reactions to common chemicals, drug/medication intolerances, and food sensitivities. If you answer yes to any of the three questions, the full QEESI is recommended.
The Quick Environmental Exposure and Sensitivity Inventory is the reference standard for assessing chemical intolerance. This 50-question tool uses a 0-to-10 severity scale to assess five domains: chemical intolerances, other intolerances, symptom severity, life impact, and the masking index. The QEESI Symptom Star provides a visual representation of your most problematic health concerns.
Seven questions help you document specific exposures that may have contributed to your symptoms and intolerances. This is particularly valuable for identifying the initiating event — the chemical exposure that may have started the TILT process for you. Reflecting on this history is essential for conversations with healthcare professionals.
The TILT Self-Assessment is available as a free downloadable PDF. Complete it at home, print the results, and take them to your doctor or healthcare provider.
Free — provided by UT Health San Antonio’s TILT Research Program for Chemical Intolerance
After completing the TILT Self-Assessment, you will have quantitative scores for symptom severity, life impact, and chemical, food, and drug intolerances. The QEESI Symptom Star provides a visual summary that is immediately interpretable by healthcare professionals.
Bring the completed assessment to your next appointment. The QEESI gives your doctor objective data to work with rather than subjective descriptions. Many physicians find this tool helpful for understanding the scope and severity of chemical intolerance in their patients.
Complete the QEESI at intervals to follow progress or setbacks. Before and after comparisons are particularly useful — for example, before and after removing a trigger, before and after a move, or before and after starting a treatment. The Hayward Score QEESI Symptom Star tool can help document your TILT over time.
The exposure history section helps connect your symptoms to specific chemical, food, or drug exposures. Once you understand your personal trigger profile, avoidance strategies become much more targeted and effective. See our Triggers & Avoidance guide for practical strategies.
Three peer-reviewed instruments are validated for measuring chemical intolerance: the QEESI, the BREESI, and the CSS-SHR. Each has published diagnostic thresholds and sensitivity data — making scores defensible in clinical, insurance, and legal settings.
Self-assessment is an important first step, but formal diagnosis and disability documentation require validated clinical tools. The instruments below are accepted in peer-reviewed literature and are designed to produce scored, referenceable clinical findings rather than subjective symptom descriptions.
The QEESI is the most widely validated instrument for measuring chemical intolerance. Developed by Miller & Prihoda (1999), it contains 50 items across five subscales: Chemical Intolerance, Other Intolerances, Life Impact, Masking Index, and Symptom Severity. A score of 40 or higher on the Chemical Intolerance subscale, combined with a high Masking Index score, indicates clinically significant chemical intolerance. The QEESI is free, self-administered, and takes approximately 15 minutes. It has been validated in multiple countries and populations. Published reference ranges allow clinicians and examiners to compare an individual score against population norms. QEESI results are the most commonly accepted chemical intolerance measurement in VA disability claims and Social Security documentation.
Miller & Prihoda, 1999. Toxicology and Industrial Health, 15(3–4).
The BREESI is a validated 3-question screener for rapid clinical identification of chemical intolerance. A score of 1 or higher indicates probable chemical intolerance and warrants full QEESI assessment. Palmer et al. (2022) validated the BREESI against physician-diagnosed MCS in a UK population and found high sensitivity for identifying true cases. Its brevity makes it practical in primary care, emergency intake, and any setting where a 50-item instrument is not feasible. Three questions and a threshold score produce a defensible initial screening result that can trigger appropriate referral or follow-up.
Palmer et al., 2022. International Journal of Environmental Research and Public Health.
The CSS-SHR is an 11-item instrument developed to measure chemical sensitivity with a focus on airway and upper respiratory reactivity — the symptom cluster most frequently encountered by ENT and pulmonary physicians. A score of 43 or higher indicates clinically significant sensory hyperreactivity to chemicals. Developed and validated by Söderholm et al., the CSS-SHR is particularly useful when airway symptoms dominate the presentation. It complements rather than replaces the QEESI: the QEESI captures the full multi-system picture; the CSS-SHR provides a sharper signal specifically on the airway component.
Söderholm et al., 2011. International Archives of Occupational and Environmental Health.
The BREESI takes under two minutes. The QEESI takes 10–15 minutes. Receiving a formal clinical interpretation and any associated disability documentation takes days to weeks depending on provider availability.
The BREESI is a 3-question screener — most people complete it in under two minutes. The QEESI is 50 items across five subscales and takes most people 10 to 15 minutes. The CSS-SHR is 11 items and takes approximately five minutes. All three are self-administered with no appointment required. Scores are available immediately upon completion. The instruments are free and available online through their respective research programs.
Completing a self-administered instrument produces a score, not a diagnosis. A clinician familiar with MCS and the QEESI reference ranges must interpret that score in clinical context. Finding an MCS-literate physician and scheduling an appointment typically takes days to several weeks depending on location and provider availability. Telehealth options have substantially reduced this timeline for many patients — a physician experienced with TILT and chemical intolerance can review QEESI results remotely and provide a clinical interpretation without an in-person visit.
Once a clinician has reviewed your scores and confirmed the diagnosis, producing supporting documentation for a VA claim or Social Security filing typically takes one to four weeks. A nexus letter for a VA claim requires the physician to draft a specific legal statement connecting in-service exposure to current diagnosis. Complex cases involving multiple conditions or appeals may take longer. Having your QEESI scores, symptom history, and exposure timeline organized before the appointment significantly shortens the documentation process.
Is your home making you sick? The Hayward Score identifies major issues in your home that can impact health and gives personalized recommendations to fix them. Covers indoor air quality, moisture, chemical storage, ventilation, and more.
A practical guide from the TILT Research Program for reducing chemical exposures in your home environment. Available as a free download from tiltresearch.org/resources.
Research from UT Health San Antonio demonstrated that improving indoor air quality reduces symptoms of chemical intolerance. The study assessed homes for TILT triggers and provided targeted recommendations. Learn more about indoor air quality.
If the QEESI confirms chemical intolerance, the next question is not “how do I avoid everything?” — it is “what is driving this, and can it be treated?” For patients where mold or water-damaged-building exposure appears to be a factor, HLA-DR genotyping is one avenue some clinicians explore to evaluate biotoxin susceptibility — it is a selective tool relevant when the clinical picture suggests it, not a universal first step for all MCS patients. Mast cell activation and detoxification impairment are also worth discussing with a practitioner when the symptom pattern fits. Save your QEESI scores as a baseline and retake every 3 months during any treatment to track objective improvement. Read the full recovery pathways guide →
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