[PubMed] [Google Scholar] 17. therapies for Gulf War Illness. high symptom self-reporting, the botulism vaccine was associated Neurod1 with increased reporting of symptoms whereas all other vaccines were not significant, particularly when analyzed with respect ML604440 to PB use and chemical exposure. Concerns were raised against the use of pertussis and squalene as adjuvants for the anthrax vaccine without sufficient a priori research testing. Some studies have suggested that squalene in the anthrax vaccine may have also contributed to GWI, as antibodies ML604440 against squalene were more prevalent among veterans with GWI compared to healthy GW veterans.11,12 Another study showed no association between the presence of squalene antibodies and the diagnosis of GWI.13 A recent case-control study of GWI showed that even though cases appeared to have a higher rate of vaccination compared to controls, adverse effects reported by GWI patients were more strongly associated with pesticide exposure.14 Both 2008 and 2016 reports by the Research Advisory Committee on GW Veterans Illnesses concluded that potential contributions of vaccines to GWI remain unconfirmed.1,2 Furthermore, in the absence of animal studies that evaluate GWI-related neurobehavioral changes and neuropathology following combined vaccine administration, a possible causal role of multiple vaccination in GWI pathogenesis remains to be determined. Among GW chemical exposures, PB has been widely accepted as one of the key contributors to GWI. Soldiers were instructed to take PB tablets as an anti-nerve agent at a dose of 90 mg per day.2 However, variations in use occurred as some troops took up to 3 times more than the recommended dosage.2 Use of PB among GW veterans has also been associated with a higher rate of motor and cognitive impairment when compared to soldiers who did not consume PB.15 Some studies showed that an increase in the severity of symptom reporting by GW veterans was associated with an increase in days of PB consumption. A higher prevalence of GWI diagnosis was associated with consumption of ?21 pills of PB compared to those who consumed 21 pills.8,16 However, many of these studies were unable to detect an independent effect of PB alone and suggested potential interactions with stress and other GW chemicals as additional key contributors to the etiology of GWI.1,2 According ML604440 to the 2003 Environmental Exposure Report by the Department of Defense (DoD), it was estimated that 15 different pesticides, including 13 insecticides used by GW soldiers, were of significant concern due to their overuse in the theatre.17 These included pyrethroids, DEET (N,N-diethyl-3-methylbenzamide) and organophosphate (OP) AChE inhibitors.17 Permethrin (PER), a pyrethroid, was either provided as a 0.5% spray or was imbedded in their uniforms.17 In addition to commonly available 33% DEET as cream, during the GW, soldiers were also provided a liquid form which contained 75% DEET.2 Among ground troops, 62% reported using PER or DEET ranging from 20 to 30 times per month. Gulf War veterans who reported using PER or DEET experienced symptoms consistent with GWI diagnosis compared to those who did not use these chemicals.2 Organophosphate pesticides (eg, chlorpyrifos [CPF], ML604440 dichlorvos, and malathion) have also been described as contributors to GWI since these were used as fogs and sprays during GW by pesticide applicators who reported chronic health problems after returning from the conflict.2,18 In contrast to chronic GWI presentation, acute OP poisoning symptoms generally develop immediately after exposure and range from mild tremors to severe muscle contractions, dizziness, headaches, abdominal cramps, nausea, vomiting, and blurred vision.19 In some circumstances, OP-induced delayed neuropathy (OPIDN)2 develops several weeks later and consists of distal weakness and sensory loss.20 The DoD reported that munitions containing 8.5 metric tons of sarin/cyclosarin were destroyed by U.S personnel at Khamisiyah in Iraq and exposed about 20.