Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter November 24, 2015

Gulf War illness: an overview of events, most prevalent health outcomes, exposures, and clues as to pathogenesis

  • Kathleen J. Kerr EMAIL logo



During or very soon after the 1990–1991 Persian Gulf War, veterans of the conflict began to report symptoms of illness. Common complaints included combinations of cognitive difficulties, fatigue, myalgia, rashes, dyspnea, insomnia, gastrointestinal symptoms and sensitivity to odors. Gradually in the USA, and later in the UK, France, Canada, Denmark and Australia, governments implemented medical assessment programs and epidemiologic studies to determine the scope of what was popularly referred to as “the Gulf War syndrome”. Attention was drawn to numerous potentially toxic deployment-related exposures that appeared to vary by country of deployment, by location within the theater, by unit, and by personal job types. Identifying a single toxicant cause was considered unlikely and it was recognized that outcomes were influenced by genetic variability in xenobiotic metabolism.


Derived from primary papers and key reports by the Research Advisory Committee on Gulf War Veterans’ Illnesses and the Institute of Medicine, a brief overview is presented of war related events, symptoms and diagnostic criteria for Gulf War illness (GWV), some international differences, the various war-related exposures and key epidemiologic studies. Possible exposure interactions and pathophysiologic mechanisms are discussed.


Exposures to pyridostigmine bromide, pesticides, sarin and mustard gas or combinations thereof were most associated with GWI, especially in some genotype subgroups. The resultant oxidant stress and background exposome must be assumed to have played a role.


Gulf War (GW) exposures and their potential toxic effects should be considered in the context of the human genome, the human exposome and resultant oxidant stress to better characterize this unique environmentally-linked illness and, ultimately, provide a rationale for more effective interventions and future prevention efforts.

Corresponding author: Kathleen J. Kerr, Department of Family and Community Medicine, University of Toronto, Ontario, Canada, E-mail:


1. Fukuda K, Nisenbaum R, Stewart G, Thompson WW, Robin L, et al. Chronic multisymptom illness affecting Air Force veterans of the Gulf War. J Am Med Assoc 1998;280(11):981–8.10.1001/jama.280.11.981Search in Google Scholar PubMed

2. Steele L. Prevalence and patterns of Gulf War illness in Kansas veterans: association of symptoms with characteristics of person, place, and time of military service. Am J Epidemiol 2000;152(10):992–1002.10.1093/aje/152.10.992Search in Google Scholar PubMed

3. Kang HK, Mahan CM, Lee KY, Magee CA, Murphy FM. Illnesses among United States veterans of the Gulf War: a population-based survey of 30,000 veterans. J Occup Environ Med 2000;42(5):491–501.10.1097/00043764-200005000-00006Search in Google Scholar PubMed

4. Kang HK, Li B, Mahan CM, Eisen SA, Engel CC. Health of US veterans of 1991 Gulf War: a follow-up survey in 10 years. J Occup Environ Med 2009;51(4):401–10.10.1097/JOM.0b013e3181a2feebSearch in Google Scholar PubMed

5. Ozakinci G, Hallman WK, Kipen HM. Persistence of symptoms in veterans of the First Gulf War: 5-year follow-up. Environ Health Perspect 2006;114(10):1553–7.10.1289/ehp.9251Search in Google Scholar PubMed PubMed Central

6. Hotopf M, David AS, Hull L, Nikalaou V, Unwin C, et al. Gulf War illness – better, worse, or just the same? A cohort study. Br Med J 2003;327(7428):1370–2A.10.1136/bmj.327.7428.1370Search in Google Scholar PubMed PubMed Central

7. Gavaghan H. NIH panel rejects Persian Gulf syndrome. Nature 1994;369(6475):8.10.1038/369008a0Search in Google Scholar PubMed

8. Beale P. Gulf iIlness. Br Med J 1994;308(6943):1574.10.1136/bmj.308.6943.1574cSearch in Google Scholar PubMed PubMed Central

9. Robinson A. Veterans worry that unexplained medical problems a legacy of service during Gulf-War. Can Med Assoc J 1995;152(6):944–7.Search in Google Scholar

10. Research Advisory Committee on Gulf War Veterans’ Illnesses. Gulf War Illness and the Health of Gulf War Veterans. Scientific Findings and Recommendations. Washington, DC: U.S. Government Printing Office, 2008.Search in Google Scholar

11. Goss Gilroy Inc. Health Study of Canadian Forces Personnel Involved in the 1991 Conflict in the Persian Gulf. In: Department of National Defence, editor. Ottawa Canada: Gulf War illness Advisory Committtee, 1998.Search in Google Scholar

12. Institute of Medicine. Gulf War and Health: Volume 4. Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press, 2006:292p.Search in Google Scholar

13. Gavaghan H. NIH panel rejects Persian-Gulf syndrome. Nature 1994;369(6475):8.10.1038/369008a0Search in Google Scholar

14. Institute of Medicine. Chronic Multisymptom Illness in Gulf War Veterans: Case Definitions Reexamined. Washington, DC: The National Academies Press, 2014:130p.Search in Google Scholar

15. Haley RW, Kurt TL, Hom J. Is there a Gulf War syndrome? Searching for syndromes by factor analysis of symptoms. J Am Med Assoc 1997;277(3):215–22.10.1001/jama.1997.03540270041025Search in Google Scholar

16. Iannacchione VG, Dever JA, Bann CM, Considine KA, Creel D, et al. Validation of a research case definition of Gulf War illness in the 1991 US military population. Neuroepidemiology 2011;37(2):129–40.10.1159/000331478Search in Google Scholar

17. Haley RW, Tuite JJ. Epidemiologic evidence of health effects from long-distance transit of chemical weapons fallout from bombing early in the 1991 Persian Gulf War. Neuroepidemiology 2013;40(3):178–89.10.1159/000345124Search in Google Scholar

18. Justice delayed: acknowledging the reality of Gulf War illness. Lancet 2008;372(9653):1856.10.1016/S0140-6736(08)61790-0Search in Google Scholar

19. Carruthers BM, Jain AK, De Meirleir KL, Peterson DL, Klimas NG, et al. Myalgic encephalomyelitis/chronic fatigue syndrome: clinical working case definition, diagnostic and treatment protocols. J Chronic Fatigue Syndr 2003;11(1):7–115.10.1300/J092v11n01_02Search in Google Scholar

20. Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 1994;121(12):953–9.10.7326/0003-4819-121-12-199412150-00009Search in Google Scholar PubMed

21. Jason LA, Brown A, Evans M, Sunnquist M, Newton JL. Contrasting chronic fatigue syndrome versus myalgic encephalomyelitis/chronic fatigue syndrome. Fatigue 2013;1(3):168–83.10.1080/21641846.2013.774556Search in Google Scholar PubMed PubMed Central

22. Reeves WC, Jones JF, Maloney E, Heim C, Hoaglin DC, et al. Prevalence of chronic fatigue syndrome in metropolitan, urban, and rural Georgia. Popul Health Metr 2007;5:5.10.1186/1478-7954-5-5Search in Google Scholar PubMed PubMed Central

23. Reyes M, Nisenbaum R, Hoaglin DC, Unger ER, Emmons C, et al. Prevalence and incidence of chronic fatigue syndrome in Wichita, Kansas. Arch Intern Med 2003;163(13):1530–6.10.1001/archinte.163.13.1530Search in Google Scholar PubMed

24. Eisen SA, Kang HK, Murphy FM, Blanchard MS, Reda DJ, et al. Gulf war veterans’ health: Medical evaluation of a US cohort. Ann Intern Med 2005;142(11):881–90.10.7326/0003-4819-142-11-200506070-00005Search in Google Scholar PubMed

25. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, et al. The American college of rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 2010;62(5):600–10.10.1002/acr.20140Search in Google Scholar PubMed

26. Meggs WJ. Gulf War syndrome, chronic fatigue syndrome, and the multiple chemical sensitivity syndrome: stirring the cauldron of confusion. Arch Environ Health 1999;54(5):309–11.10.1080/00039899909602491Search in Google Scholar PubMed

27. Bartha L, Baumzweiger W, Buscher DS, Callender T, Dahl KA, et al. Multiple chemical sensitivity: A 1999 consensus. Arch Environ Health 1999;54(3):147–9.10.1080/00039899909602251Search in Google Scholar PubMed

28. Kutsogiannis DJ, Davidoff AL. A multiple center study of multiple chemical sensitivity syndrome. Arch Environ Health 2001;56(3):196–207.10.1080/00039890109604443Search in Google Scholar PubMed

29. Kipen HM, Hallman W, Kang H, Fiedler N, Natelson BH. Prevalence of chronic fatigue and chemical sensitivities in Gulf Registry Veterans. Arch Environ Health 1999;54(5):313–8.10.1080/00039899909602493Search in Google Scholar PubMed

30. Black DW, Doebbeling BN, Voelker MD, Clarke WR, Woolson RF, et al. Multiple chemical sensitivity syndrome – Symptom prevalence and risk factors in a military population. Arch Intern Med 2000;160(8):1169–76.10.1001/archinte.160.8.1169Search in Google Scholar PubMed

31. Proctor SP, Heaton KJ, White RF, Wolfe J. Chemical sensitivity and chronic fatigue in Gulf War veterans: A brief report. J Occup Environ Med 2001;43(3):259–64.10.1097/00043764-200103000-00014Search in Google Scholar PubMed

32. Gray GC, Reed RJ, Kaiser KS, Smith TC, Gastanaga VM. Self-reported symptoms and medical conditions among 11,868 Gulf War-era veterans. Am J Epidemiol 2002;155(11):1033–44.10.1093/aje/155.11.1033Search in Google Scholar PubMed

33. Fiedler N, Giardino N, Natelson B, Ottenweller JE, Weisel C, et al. Responses to controlled diesel vapor exposure among chemically sensitive Gulf War veterans. Psychosom Med 2004;66(4):588–98.10.1097/01.psy.0000127872.53932.75Search in Google Scholar PubMed

34. Miller CS, Prihoda TJ. A controlled comparison of symptoms and chemical intolerances reported by Gulf War veterans, implant recipients and persons with multiple chemical sensitivity. Toxicol Ind Health 1999;15(3–4):386–97.10.1177/074823379901500312Search in Google Scholar PubMed

35. Reid S, Hotopf M, Hull L, Ismail K, Unwin C, et al. Multiple chemical sensitivity and chronic fatigue syndrome in British Gulf War veterans. Am J Epidemiol 2001;153(6):604–9.10.1093/aje/153.6.604Search in Google Scholar PubMed

36. Reid S, Hotopf M, Hull L, Ismail K, Unwin C, et al. Reported chemical sensitivities in a health survey of United Kingdom military personnel. Occup Environ Med 2002;59(3):196–8.10.1136/oem.59.3.196Search in Google Scholar

37. Haley RW, Billecke S, La Du BN. Association of low PON1 type Q (type A) arylesterase activity with neurologic symptom complexes in Gulf War veterans. Toxicol Appl Pharmacol 1999;157(3):227–33.10.1006/taap.1999.8703Search in Google Scholar

38. McKeown-Eyssen G, Baines C, Cole DE, Riley N, Tyndale RF, et al. Case-control study of genotypes in multiple chemical sensitivity: CYP2D6, NAT1, NAT2, PON1, PON2 and MTHFR. Int J Epidemiol 2004;33(5):971–8.10.1093/ije/dyh251Search in Google Scholar

39. Salamon R, Verret C, Jutand MA, Begassat M, Laoudj F, et al. Health consequences of the first Persian Gulf War on French troops. Int J Epidemiol 2006;35(2):479–87.10.1093/ije/dyi318Search in Google Scholar

40. Upshall DG. Gulf related illness–current perspectives. J R Army Med Corps 2000;146(1):13–7.10.1136/jramc-146-01-03Search in Google Scholar

41. Proctor SP, Heeren T, White RF, Wolfe J, Borgos MS, et al. Health status of Persian Gulf War veterans: self-reported symptoms, environmental exposures and the effect of stress. Int J Epidemiol 1998;27(6):1000–10.10.1093/ije/27.6.1000Search in Google Scholar

42. Wolfe J, Proctor SP, Davis JD, Borgos MS, Friedman MJ. Health symptoms reported by Persian Gulf War veterans two years after return. Am J Ind Med 1998;33(2):104–13.10.1002/(SICI)1097-0274(199802)33:2<104::AID-AJIM2>3.0.CO;2-YSearch in Google Scholar

43. Kang HK, Mahan CM, Lee KY, Murphy FM, Simmens SJ, et al. Evidence for a deployment-related Gulf War syndrome by factor analysis. Arch Environ Health 2002;57(1):61–8.10.1080/00039890209602918Search in Google Scholar

44. Blanchard MS, Eisen SA, Alpern R, Karlinsky J, Toomey R, et al. Chronic multisymptom illness complex in Gulf War I veterans 10 years later. Am J Epidemiol 2006;163(1):66–75.10.1093/aje/kwj008Search in Google Scholar

45. LaClair B, editor. Overview of Exposures and HEalth Conditions Reported by Countries who served in the 1990–1991 Gulf War Allied Coalition. RAC-GWVI Meeting Minutes. Washington, DC: U.S. Government Printing Office, 2005.Search in Google Scholar

46. Unwin C, Blatchley N, Coker W, Ferry S, Hotopf M, et al. Health of UK servicemen who served in Persian Gulf War. Lancet 1999;353(9148):169–78.10.1016/S0140-6736(98)11338-7Search in Google Scholar

47. Ismail K, Everitt B, Blatchley N, Hull L, Unwin C, et al. Is there a Gulf War syndrome? Lancet 1999;353(9148):179–82.10.1016/S0140-6736(98)11339-9Search in Google Scholar

48. Unwin C, Hotopf M, Hull L, Ismail K, David A, et al. Women in the Persian Gulf: Lack of gender differences in long term health effects of service in United Kingdom armed forces in the 1991 Persian Gulf War. Mil Med 2002;167(5):406–13.10.1093/miled.167.5.406Search in Google Scholar

49. Cherry N, Creed F, Silman A, Dunn G, Baxter D, et al. Health and exposures of United Kingdom Gulf war veterans. Part II: The relation of health to exposure. Occup Environ Med 2001;58(5):299–306.10.1136/oem.58.5.299Search in Google Scholar PubMed PubMed Central

50. Tuite JJ, Haley RW. Meteorological and intelligence evidence of long-distance transit of chemical weapons fallout from bombing early in the 1991 Persian Gulf War. Neuroepidemiology 2013;40(3):160–77.10.1159/000345123Search in Google Scholar PubMed

51. Sim M, Kelsall H. Gulf War illness: a view from Australia. Philos Trans R Soc Lon B Biol Sci 2006;361(1468):619–26.10.1098/rstb.2006.1821Search in Google Scholar PubMed PubMed Central

52. Kelsall HL, Sim MR, Forbes AB, Glass DC, McKenzie DP, et al. Symptoms and medical conditions in Australian veterans of the 1991 Gulf War: relation to immunisations and other Gulf War exposures. Occup Environ Med 2004;61(12):1006–13.10.1136/oem.2003.009258Search in Google Scholar PubMed PubMed Central

53. Ishoy T, Suadicani P, Guldager B, Appleyard M, Gyntelberg F. Risk factors for gastrointestinal symptoms. The Danish Gulf War Study. Dan Med Bull 1999;46(5):420–3.Search in Google Scholar

54. Suadicani P, Ishoy T, Guldager B, Appleyard M, Gyntelberg F. Determinants of long-term neuropsychological symptoms – The Danish Gulf War Study. Dan Med Bull 1999;46(5):423–7.Search in Google Scholar

55. Specter A. Report of the special investigation unit on Gulf War illnesses. In: Senate CoVAUS, editor. Washington, DC: U.S. Government Printing Office, 1998.Search in Google Scholar

56. Gackstetter GD, Hooper TI, Al Qahtani MS, Smith TC, Memish ZA, et al. Assessing the potential health impact of the 1991 Gulf War on Saudi Arabian National Guard Soldiers. Int J Epidemiol 2005;34(4):801–8.10.1093/ije/dyi008Search in Google Scholar PubMed

57. Cope SE, Schultz GW, Richards AL, Savage HM, Smith GC, et al. Assessment of arthropod vectors of infectious diseases in areas of US Troop deployment in the Persian Gulf. Am J Trop Med Hyg 1996;54(1):49–53.10.4269/ajtmh.1996.54.49Search in Google Scholar PubMed

58. Gordon JJ, Inns RH, Johnson MK, Leadbeater L, Maidment MP, et al. The delayed neuropathic effects of nerve agents and some other organo-phosphorus compounds. Arch Toxicol 1983;52(2):71–82.10.1007/BF00354767Search in Google Scholar PubMed

59. Soltaninejad K, Abdollahi M. Current opinion on the science of organophosphate pesticides and toxic stress: a systematic review. Med Sci Monit 2009;15(3):RA75–90.Search in Google Scholar

60. Terry AV, Jr. Functional consequences of repeated organophosphate exposure: potential non-cholinergic mechanisms. Pharmacol Ther 2012;134(3):355–65.10.1016/j.pharmthera.2012.03.001Search in Google Scholar PubMed PubMed Central

61. Kaufer D, Friedman A, Seidman S, Soreq H. Acute stress facilitates long-lasting changes in cholinergic gene expression. Nature 1998;393(6683):373–7.10.1038/30741Search in Google Scholar PubMed

62. Sanborn M, Kerr KJ, Sanin LH, Cole DC, Bassil KL, et al. Non-cancer health effects of pesticides – Systematic review and implications for family doctors. Can Fam Physician 2007;53:1713–20.Search in Google Scholar

63. Khan F, Kennedy G, Spence VA, Newton DJ, Belch JJ. Peripheral cholinergic function in humans with chronic fatigue syndrome, Gulf War syndrome and with illness following organophosphate exposure. Clin Sci (Lond) 2004;106(2):183–9.10.1042/CS20030246Search in Google Scholar PubMed

64. Golomb BA. Acetylcholinesterase inhibitors and Gulf War illnesses. Proc Natl Acad Sci USA 2008;105(11):4295–300.10.1073/pnas.0711986105Search in Google Scholar PubMed PubMed Central

65. Barr DB, Angerer J. Potential uses of biomonitoring data: A case study using the organophosphorus pesticides chlorpyrifos and malathion. Environ Health Perspect 2006;114(11):1763–9.10.1289/ehp.9062Search in Google Scholar PubMed PubMed Central

66. Centers for Disease Control and Prevention. Third National Report on Human Exposure to Environmental Chemicals. Atlanta (GA): CDC, 2005.Search in Google Scholar

67. Brimfield AA. Chemicals of military deployments: revisiting Gulf War syndrome in light of new information. Prog Mol Biol Transl Sci 2012;112:209–30.10.1016/B978-0-12-415813-9.00007-6Search in Google Scholar PubMed

68. Dacre JC, Goldman M. Toxicology and pharmacology of the chemical warfare agent sulfur mustard. Pharmacol Rev 1996;48(2):289–326.Search in Google Scholar

69. Defense Science Board:. Report of the Defense Science Board Task Force on Persian Gulf War Health Effects. 1994. Available from: Accessed on 16 September, 2015.10.21236/ADA275347Search in Google Scholar

70. Golomb BA. A Review of the scientific literature as it pertains to Gulf War illnesses: volume 2: pyridostigmine bromide. Santa Monica, CA: RAND Corporation, 1999.Search in Google Scholar

71. Corrigan FM, Wienburg CL, Shore RF, Daniel SE, Mann D. Organochlorine insecticides in substantia nigra in Parkinson’s disease. J Toxicol Environ Health A 2000;59(4):229–34.10.1080/009841000156907Search in Google Scholar PubMed

72. Reuveni H, Yagupsky P. Diethyltoluamide – containing insect repellent – adverse-effects in worldwide USE. Arch Dermatol 1982;118(8):582–3.10.1001/archderm.1982.01650200050015Search in Google Scholar

73. Hon Z, Oesterreicher J, Navratil L. Depleted Uranium and its effects on humans. Sustainability 2015;7(4):4063–77.10.3390/su7044063Search in Google Scholar

74. McDiarmid MA, Gaitens JM, Hines S, Condon M, Roth T, et al. Biologic monitoring and surveillance results for the department of veterans affairs’ depleted uranium cohort: lessons learned from sustained exposure over two decades. Am J Ind Med 2015;58(6):583–94.10.1002/ajim.22435Search in Google Scholar PubMed

75. Abou-Donia MB, Dechkovskaia AM, Goldstein LB, Abdel-Rahman A, Bullman SL, et al. Co-exposure to pyridostigmine bromide, DEET, and/or permethrin causes sensorimotor deficit and alterations in brain acetylcholinesterase activity. Pharmacol Biochem Behav 2004;77(2):253–62.10.1016/j.pbb.2003.10.018Search in Google Scholar PubMed

76. Friedman A, Kaufer D, Shemer J, Hendler I, Soreq H, et al. Pyridostigmine brain penetration under stress enhances neuronal excitability and induces early immediate transcriptional response. Nat Med 1996;2(12):1382–5.10.1038/nm1296-1382Search in Google Scholar PubMed

77. Tomkins O, Kaufer D, Korn A, Slielef I, Golan H, et al et al. Frequent blood-brain barrier disruption in the human cerebral cortex. Cell Mol Neurobi 2001;21(6):675–91.10.1023/A:1015147920283Search in Google Scholar

78. Heller JM, Legge WE. Final report kuwait oil fire health risk assessment. In: Army, editor. Aberdeen Proving Ground, Maryland, 1991.Search in Google Scholar

79. Lorber M, Gibb H, Grant L, Pinto J, Pleil J, et al. Assessment of inhalation exposures and potential health risks to the general population that resulted from the collapse of the World Trade Center towers. Risk Anal 2007;27(5):1203–21.10.1111/j.1539-6924.2007.00956.xSearch in Google Scholar PubMed

80. Schecter A, Birnbaum L, Ryan JJ, Constable JD. Dioxins: an overview. Environ Res 2006;101(3):419–28.10.1016/j.envres.2005.12.003Search in Google Scholar PubMed

81. Frederiksen M, Vorkamp K, Thomsen M, Knudsen LE. Human internal and external exposure to PBDEs – A review of levels and sources. Int J Hyg Environ Health 2009;212(2):109–34.10.1016/j.ijheh.2008.04.005Search in Google Scholar PubMed

82. Hill AB. Environment and disease – association or causation. Proc R Soc Med 1965;58(5):295–300.10.1177/003591576505800503Search in Google Scholar

83. Steele L, Lockridge O, Gerkovich MM, Cook MR, Sastre A. Butyrylcholinesterase genotype and enzyme activity in relation to Gulf War illness: preliminary evidence of gene-exposure interaction from a case-control study of 1991 Gulf War veterans. Environ Health 2015;14:4.10.1186/1476-069X-14-4Search in Google Scholar PubMed PubMed Central

84. Gradin VB, Perez A, MacFarlane JA, Cavin I, Waiter G, et al. Abnormal brain responses to social fairness in depression: an fMRI study using the Ultimatum Game. Psychol Med 2015;45(6):1241–51.10.1017/S0033291714002347Search in Google Scholar PubMed

85. Iversen A, Chalder T, Wessely S. Gulf war illness: Lessons from medically unexplained symptoms. Clinical Psychol Rev 2007;27(7):842–54.10.1016/j.cpr.2007.07.006Search in Google Scholar PubMed

86. Ismail K, Kent K, Brugha T, Hotopf M, Hull L, et al. The mental health of UK Gulf war veterans: phase 2 of a two phase cohort study. Br Med J 2002;325(7364):576–9.10.1136/bmj.325.7364.576Search in Google Scholar PubMed PubMed Central

87. Institute of Medicine. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press, 2010. p. 320.Search in Google Scholar

88. Research Advisory Committee on Gulf War Veterans’ Illnesses. Gulf War Illness and the Health of Gulf War Veterans: Research Update and Recommendations, 2009–2013. Boston, MA: U.S. Government Printing Office, 2014.Search in Google Scholar

89. Baraniuk JN, El-Amin S, Corey R, Rayhan R, Timbol C. Carnosine treatment for gulf war illness: a randomized controlled trial. Glob J Health Sci 2013;5(3):69–81.10.5539/gjhs.v5n3p69Search in Google Scholar PubMed PubMed Central

90. Golomb BA, Allison M, Koperski S, Koslik HJ, Devaraj S, et al. Coenzyme Q10 benefits symptoms in Gulf War veterans: results of a randomized double-blind study. Neural Comput 2014;26(11):2594–651.10.1162/NECO_a_00659Search in Google Scholar PubMed

91. Hodgson E, Rose RL. Human metabolism and metabolic interactions of deployment-related chemicals. Drug Metab Rev 2005;37(1):1–39.10.1081/DMR-200046955Search in Google Scholar PubMed

92. She Z-G, Chen H-Z, Yan Y, Li H, Liu D-P. The human paraoxonase gene cluster as a target in the treatment of atherosclerosis. Antioxid Redox Signal 2012;16(6):597–632.10.1089/ars.2010.3774Search in Google Scholar PubMed PubMed Central

93. Rose RL, Tang J, Choi J, Cao Y, Usmani A, et al. Pesticide metabolism in humans, including polymorphisms. Scand J Work Environ Health 2005;31:156–63.Search in Google Scholar

94. De Luca C, Gugliandolo A, Calabro C, Curro M, Ientile R, et al. Role of polymorphisms of inducible nitric oxide synthase and endothelial nitric oxide synthase in idiopathic environmental intolerances. Mediators Inflamm 2015;2015:245308.10.1155/2015/245308Search in Google Scholar PubMed PubMed Central

95. Kroenke K, Koslowe P, Roy M. Symptoms in 18,495 Persian Gulf War veterans – Latency of onset and lack of association with self-reported exposures. J Occup Environ Med 1998;40(6):520–8.10.1097/00043764-199806000-00004Search in Google Scholar PubMed

96. Brimfield AA, Mancebo AM, Mason RP, Jiang JJ, Siraki AG, et al. Free radical production from the interaction of 2-chloroethyl vesicants (mustard gas) with pyridine nucleotide-driven flavoprotein electron transport systems. Toxicol Appl Pharmacol 2009;234(1):128–34.10.1016/j.taap.2008.10.002Search in Google Scholar PubMed PubMed Central

97. Brimfield AA, Soni SD, Trimmer KA, Zottola MA, Sweeney RE, et al. Metabolic activation of sulfur mustard leads to oxygen free radical formation. Free Radic Biol Med 2012;52(4):811–7.10.1016/j.freeradbiomed.2011.11.031Search in Google Scholar PubMed

98. Centers for Disease Control and Prevention. Recognition of Illness Associated With Exposure to Chemical Agents – United States, 2003. Morbidity and Mortality Weekly Report: U.S. Department of Health and Human Services, 2003:938–40.Search in Google Scholar

99. Carpenter DO, Arcaro K, Spink DC. Understanding the human health effects of chemical mixtures. Environ Health Perspect 2002;110:25–42.10.1289/ehp.02110s125Search in Google Scholar PubMed PubMed Central

100. De Rosa CT, El-Masri HA, Pohl H, Cibulas W, Mumtaz MM. Implications of chemical mixtures in public health practice. J Toxicol Environ Health B Crit Rev 2004;7(5):339–50.10.1080/10937400490498075Search in Google Scholar PubMed

101. Needham LL, Barr DB, Calafat AM, editors. Characterizing children’s exposures: beyond NHANES2004 Feb 10–14; Honolulu, HI.Search in Google Scholar

102. Wild CP. The exposome: from concept to utility. Int J Epidemiol. 2012;41(1):24–32.10.1093/ije/dyr236Search in Google Scholar PubMed

103. Wild CP. Complementing the genome with an “exposome”: the outstanding challenge of environmental exposure measurement in molecular epidemiology. Cancer Epidemiol Biomarkers Prev 2005;14(8):1847–50.10.1158/1055-9965.EPI-05-0456Search in Google Scholar PubMed

104. Rappaport SM, Smith MT. Epidemiology. Environment and disease risks. Science 2010;330(6003):460–1.10.1126/science.1192603Search in Google Scholar PubMed PubMed Central

105. Sexton K. Cumulative risk assessment: an overview of methodological approaches for evaluating combined health effects from exposure to multiple environmental stressors. Int J Environ Res Public Health 2012;9(2):370–90.10.3390/ijerph9020370Search in Google Scholar PubMed PubMed Central

Received: 2015-9-27
Accepted: 2015-11-2
Published Online: 2015-11-24
Published in Print: 2015-12-1

©2015 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 5.6.2023 from
Scroll to top button