Handeln statt diskutieren: Die umweltmedizinische Praxisleitlinie

Introduction: Since the early eighties scientists have been discussing causes for symptoms in patients with environmental medicine related illnesses - without a relevant progress. Since the estimated prevalence rate is up to 5% of the population an environmental medicine guideline, which takes into consideration the daily requirements of a family physician's medical practice, was long overdue and will be introduced hereafter with its key-statements. Methods: The "Practice Guidelines in Environmental Medicine" have been worked out by an interdisciplinary group of authors. The literature has been systematically analysed, grades of evidence have been determined and consensus as to the key-standards has been developed with the help of a multistage process. Results: In addition to stepwise environmental medicine related diagnostics a history of susceptibility and comorbidity including multifactorial syndromes and bio-psychosocial stress factors is recommended. The grade of severity of illness depends on type, extent and duration of exposures to noxious substances as well as susceptibility and comorbidity of the individual patient. The main treatment option is to stop or reduce relevant exposures. Often this is not sufficient when treating a chronical course of the disease or multifactorial syndromes. Rather an adjuvant treatment is necessary for a significant improvement of health and function. A quick reduction of exposures has a substantial influence on the course of environmental medicine related illness. Conclusions: Standardized evaluation of environmental health related illness established by toxicologists often fails due to different exposure situations and individually very different susceptibility. It is recommended to evalu-ate, diagnose and treat environmental medicine related illness based on detailed and open-minded anamnesis, clinical parameters and clinical course of illness.