Are You Chemically Intolerant?

Share With Your Doctor

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.

Track Changes Over Time

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.

Identify Your Triggers

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.

QEESI — Quick Environmental Exposure and Sensitivity Inventory

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).

BREESI — Brief Environmental Exposure and Sensitivity Screener

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.

CSS-SHR — Chemical Sensitivity Scale for Sensory Hyperreactivity

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.

Self-Completion Timeframes

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.

From Screener to Clinical Interpretation

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.

From Clinical Interpretation to Disability Documentation

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.