Could environmental exposures be affecting your child’s health

UT Health San Antonio develops tool to track symptoms, exposures, patterns

Contact: Steven Lee, (210) 450-3823, [email protected]
Content provided by Cliff Despres

SAN ANTONIO, June 11, 2026 - Many children experience headaches, fatigue, mood changes, muscle aches or other health problems that are difficult to explain by routine clinical evaluation alone.

In some cases, these symptoms may vary in relation to environmental exposures, including foods, medications, fragrances, pesticides, cleaning products, mold, combustion products or other triggers.

The PediQEESI™ (the Pediatric Quick Environmental Exposure and Sensitivity Inventory) is a new structured screening and documentation tool to help parents and clinicians recognize patterns among a child's symptoms, exposures and daily functioning.

The PediQEESI™ was developed by the TILT Research Program for Chemical Intolerance at UT Health San Antonio, the academic health center of The University of Texas at San Antonio. It is a pediatric adaptation of the Quick Environmental Exposure and Sensitivity Inventory (QEESI®) - an internationally validated questionnaire used globally in research and clinical settings to assess chemical intolerance in adults.

"Parents might see their child having a severe adverse reaction to fragrances or foods. The PediQEESI™ can help the parent determine if their child has chemical intolerance, and then give that information to their doctor to help avoid future exposure," said Claudia S. Miller, MD, allergist/immunologist and professor emeritus of the Department of Family and Community Medicine at UT San Antonio's Joe R. and Teresa Lozano Long School of Medicine, which houses the TILT Research Program she leads.

TAKE THE PediQEESI™

What is chemical intolerance?

Chemical intolerance can impact children and adults, Miller said.

The condition stems from Toxicant-Induced Loss of Tolerance (TILT). TILT is a two-stage disease process characterized by an initial exposure event, which can be acute, repeated or chronic. Once a toxic exposure has altered and sensitized an individual's mast cells - the body's first line of defense against foreign substances - it triggers TILT.

After that, exposure to small amounts of structurally unrelated substances can trigger multisystem health symptoms.

TILT-initiating exposures may include mold, pesticides, solvents, combustion products, fires, oil spills, fracking chemicals, indoor air contaminants, implants or other toxicants. Later triggers may include fragrances, cleaning products, traffic exhaust, new furnishings, fabrics, foods, caffeine, medications and other common exposures.

Learn more in this TILT Tutorial.

How does the PediQEESI™ connect a child's symptoms to chemical intolerance?

Miller said it is important to document a careful environmental exposure history when evaluating children with chronic, fluctuating or unexplained symptoms.

The PediQEESI™ can help in three steps:

1. Complete the PediQEESI™ symptom and exposure questionnaire.
2. Use the QEESI Symptoms Star to score and visualize symptom severity.
3. Complete the brief exposure history to help identify possible environmental contributors.

Repeated use of the PediQEESI™ over time can help families and clinicians track whether symptoms improve or worsen in relation to changes in exposures, environments, diet, medications or daily activities.

The QEESI Symptoms Star helps quickly visualize symptom patterns over time.

"The PediQEESI™ is a new pediatric innovation that provides a structured method for capturing and documenting symptom patterns and exposure relationships." Miller said. "It allows families and clinicians to also evaluate potential contributors to Autism and ADHD symptoms."

Elizabeth O'Nan, founder of Protect All Children's Environment (PACE) and advocate whose child's disability was linked to pesticide exposure, helped Miller adapt the QEESI questionnaire to accommodate children.

"The PediQEESI™ may be especially useful for families," O'Nan said. "Children who have persistent or unexplained symptoms, or health changes following a known exposure event, often face a lack of understanding from their doctors and others."

Miller said she hopes parents will bring their PediQEESI™ results to their doctor to help parents explain the issue to the provider.

"For each child, we encourage you to print and complete this PediQEESI™, share it with each of your child's doctors and ask that it be placed in their medical records," Miller said. "This is an important exposure history to take."

The PediQEESI™ is available free of charge to individual patients and practitioners at https://bit.ly/pediqeesi.

Those interested in research use or any profit-making undertakings must contact and receive written permission from the TILT Research Program for Chemical Intolerance at UT Health San Antonio.

UT Health San Antonio is the academic health center of The University of Texas at San Antonio (UT San Antonio), offering a comprehensive network of inpatient and outpatient care facilities staffed by medical, dental, nursing and allied health professionals who provide more than 2.5 million patient visits each year. It is the region's only academic health center and one of the nation's leading health sciences institutions, supported by the schools of medicine, nursing, dentistry, health professions, graduate biomedical sciences and public health that are leading change and advancing health-related fields throughout South Texas and the world. To learn about the many ways "We make lives better®," visit UTHealthSA.org.

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