The problems can be localized, for instance experienced by workers in only one section of an office or factory; or they may be widespread and experienced throughout an entire building.
SBS has been reported in various settings such as hospitals, schools, industrial and art business, and care homes, or any building or home with off gassing carpets, paints, and fumes, as well as buildings with ventilation problems and concentration of vapors, gases, solvents, or other airborne agents toxic to the skin, lungs or nervous system.
In fact, sick building syndrome is a condition related to poor ventilation in some of America’s schools. People who have SBS generally experience symptoms related to the eyes, nose, throat, and skin. They also may complain of overall symptoms such as feeling very tired. When caused by SBS, these symptoms have no other known cause or explanation.
Other similar symptoms are related to SBS and may be confused with the syndrome. For instance, “building-related illness” (BRI) is the term used for a diagnosed illness attributed to contaminants that can be identified in a building.
Often, the contaminants come from the ventilation system. Legionnaire’s disease is a well-known example of BRI. Multiple chemical sensitivity (MCS) is another closely related condition; however, it is not caused by SBS.
People with MCS have high sensitivity or allergy to many chemicals and other substances in the environment. They may experience symptoms in many organs and systems of their bodies from low levels of exposure to chemicals.
Like MCS, SBS is largely a modern phenomenon, first recognized by the World Health Organization (WHO) as a medical condition in 1982.
When building designers sought to save energy during the 1970s oil embargo, they began creating virtually airtight buildings. However, the new energy-efficient structures reduced ventilation, even to the point of reducing health and comfort for occupants.
SBS has resulted in lost productivity among affected workers and increased costs for those who own and operate the buildings with poor air quality and other problems. An entire industry has developed around producing air filters and other products, as well as engineering and design consulting.
Causes and symptoms
People who complain of SBS report symptoms of acute discomfort such as eye, nose, and throat irritation, a dry cough, and dizziness or nausea.
Many also report dry, itchy skin. Some will have difficulty concentrating of experience sensitivity to odors, fatigue, and headaches. While many of these symptoms are common to other conditions, their relation to time spent in a specific building suggests the possibility of SBS.
The specific causes of SBS are unknown, but several factors may contribute to the condition. The most notable factor is poor indoor air quality. If air is not properly ventilated, it may become too dry or too humid. Also, chemicals or biological contaminants (molds, pollen, viruses, etc.) may collect in the air.
The World Health Organization (WHO) estimates that up to 30% of office buildings worldwide have significant indoor air quality problems. A 1995 study found that about one-half of schools in the United States had poor ventilation and sources of pollution inside the buildings.
More than 700,000 chemicals are in common use today. Chemical contaminants can enter indoor air from the outside or from the inside. For example, vehicle exhaust can enter a building through windows or through poorly located air intake vents. However, most chemical contaminants come from indoor sources.
Commonly used materials for construction and cleaning emit byproducts that can cause acute health effects in people when concentrated at high levels. Even low or moderate levels of these contaminants can cause health effects in some people with certain sensitivities.
Called volatile organic compounds (VOCs), the contaminants come from carpet glues, copy machines, manufactured wood products, cleaning agents, pesticides, and tobacco smoke. Formaldehyde is one of the most common VOCs.
Radon, a radioactive gas that forms when radium breaks down in certain rock formations, can be found in homes in several states. It enters the home through foundation cracks. Radon is colorless and odorless and can go undetected, building up to dangerous levels that can lead to lung cancer.
Biological contaminants can enter a building’s ventilation system. They are formed in standing water from humidifiers, drain pans, or ducts. They also may form where water has collected on wet ceiling tiles, carpet, or insulation. Some biological contaminants are pollen, bacteria, viruses, and molds.
Dust also has been found to contribute to SBS. Dust irritates the mucous membranes. A study showed that improved methods of office cleaning reduced symptoms for at least two months after cleaning.
Diagnosis
Diagnosing SBS differs from diagnosing many other medical conditions. First, the diagnosis is made by patient history, physical and clinical finding. Rarely do laboratory or imaging tests confirm abnormalities.
Second, the diagnosis involves a thorough review of the building and its occupants as much as an individual’s symptoms. Finally, the medical community has debated for many years about whether or not SBS is a “real medical condition.”
Because many of the symptoms are self–reported and can’t easily be measured, and since some reported cases of sick buildings have shown no signs of chemicals or other problems, some professionals dispute whether the syndrome exists. In addition, there are people who are more sensitive to low levels of VOCs who may experience symptoms even though other people in the building experience no symptoms.
For these reasons, SBS often remains undiagnosed or misdiagnosed. Schools may blame such other diseases as winter flu outbreaks or perhaps assign a child’s symptoms to a condition such as attention deficit hyperactivity disorder.
When a patient goes to a physician with symptoms typical of SBS — headache, fatigue, dizziness, nausea, runny or stuffy nose, a dry cough, dry and itchy skin, itchy or watery eyes, and difficulty concentrating — a complete history is critical.
If no other medical condition can explain these symptoms, the physician needs to ask questions that might lead to a diagnosis of SBS. The trigger will come in questions involving time.
For instance, if a child’s symptoms worsen when he or she enters the school building, SBS is likely to blame. If an office worker didn’t start having these symptoms until changing jobs or office locations, the office building could be the culprit.
To diagnose a “sick building,” trained occupational health or industrial experts will perform a “walkthrough” to survey building occupants for common SBS symptoms and to check the building for signs of problems.
If a number of occupants have these symptoms and there are problems in the building such as overcrowding, poor cleaning, poor ventilation, or water damage, the surveyor may recommend work that done to improve the building’s indoor air quality.
Treatment
No specific treatment has proven effective at eliminating SBS. Many experts agree that the best treatment for SBS is prevention — removing the contaminants or other identified sources that are causing SBS.
Individuals with SBS may be encouraged to avoid the building that is making them sick. However, this is not always possible and can lead to isolation or job loss.
A person with suspected SBS may ask that a building be inspected for possible contaminants. A course of detoxification under the guidance of a qualified practitioner can be helpful. This includes stimulating lung, liver, kidney and skin expulsion and release of toxic compounds, some of which are stored in fat tissues.
If the affected individual cannot leave the building or if the source is not removed, treating the symptoms of SBS may help ease some discomfort. In this case, it is wise to see an environmental medicine specialist and other providers who can help with detoxification and symptom relief (acupuncture, massage, etc.)
However, these therapies should be coordinated by a physician, since treating multiple symptoms with multiple remedies may possibly create additional interactions. And even herbal remedies may interact with the various chemical substances that are producing the sensitivities; they should be started in small doses and recommended only by trained practitioners.
Some patients with MCS will test for allergies to determine the sources of their sensitivities; similar testing might prove helpful for SBS patients who do not know the exact source of their symptoms. Efforts to relieve stress also may help deal with or lessen SBS symptoms. Aromatherapy, yoga, biofeedback, and massage may be helpful.
Allopathic treatment
Again, tests have shown that among those with chemical sensitivities, avoiding chemicals has proven to be the most effective treatment. If the environmental problem is not corrected, the individual must decide how to best avoid the SBS source. Clinicians will aim their treatment at easing patients’ symptoms while trying to help them avoid or adapt to triggers.
Like many conditions that are difficult to pinpoint, physicians must listen respectfully to patients and should not prematurely label symptoms as psychological. Once SBS is suspected, the building that is likely the source of trouble should be evaluated and improvements made as needed.
Expected results
Avoiding the source of SBS or making necessary environmental improvements to the building should improve most symptoms of SBS in a short time. No permanent complications of SBS have been reported as of 2004.
Prevention
Preventing SBS begins with the proper design and maintenance of buildings. In particular, attention should be paid to the heating, ventilation, and air conditioning (HVAC) systems.
WHO has set guidelines for proper management of building ventilation systems that include avoiding introduction of biological contaminants as well as conducting regular inspection and maintenance. In late 2003, a medical journal reported that use of ultraviolet light irradiation in cooling coils and drip pans could kill the germs that cause SBS.
In addition, designing buildings to minimize introduction of contaminants or inspecting older buildings for possible VOCs and correcting potential problems can prevent SBS in building occupants. Education and communication are essential for effective air quality management in any building.
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