title: Gulf War illness: an overview of events, most prevalent health outcomes, exposures, and clues as to pathogenesis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Kerr
mesh_terms: D001315:Australia / Q000453:epidemiology; D002619:Chemical Warfare Agents / Q000633:toxicity*; D002800:Cholinesterase Inhibitors / Q000633:toxicity*; D004781:Environmental Exposure; D005060:Europe / Q000453:epidemiology; D047830:Gulf War; D006801:Humans; D009151:Mustard Gas / Q000633:toxicity; D018923:Persian Gulf Syndrome / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics; D010575:Pesticides / Q000633:toxicity*; D015995:Prevalence; D011729:Pyridostigmine Bromide / Q000633:toxicity; D012524:Sarin / Q000633:toxicity; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data
chemical_list: D002619:Chemical Warfare Agents; D002800:Cholinesterase Inhibitors; D010575:Pesticides; D012524:Sarin; D011729:Pyridostigmine Bromide; D009151:Mustard Gas