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Building-related illness and building-related symptoms

Authors
Amy Ahasic, MD, MPH
Carrie A Redlich, MD, MPH
Section Editor
Mark D Aronson, MD
Deputy Editor
Anna M Feldweg, MD

INTRODUCTION

In industrialized countries, people spend more than 90 percent of their life indoors, and more than half of employed adults work in offices or similar nonindustrial environments [1-4]. Symptoms and illnesses related or attributed to indoor environments are common. A variety of factors associated with the environment and with the patient impact these symptoms, which may reflect new disorders, exacerbation of preexisting conditions (eg, rhinitis, asthma), and/or disorders caused by specific workplace exposures (eg, occupational asthma, hypersensitivity pneumonitis). Building-related symptoms can have a substantial impact on health. It is important for the clinician to recognize when symptoms are related to the patient's workplace, as these should be treated as occupational illnesses.

This topic will discuss building-related illnesses and symptoms, including epidemiology, potential exposures, host and building factors, and an approach to the patient with work-related illness. The discussion will focus on nonindustrial indoor work environments and schools, although many of the same exposures also exist in homes.

TERMINOLOGY

Several terms have been used to categorize syndromes of symptoms related to the indoor environment. Building-related symptoms or illnesses are considered work related if the indoor work exposures caused the illness or exacerbated a preexisting condition.

Building-related illnesses — Building-related illnesses (BRIs) are disorders that are associated with a particular building or indoor environment and meet diagnostic criteria for a specific illness. In some cases, a discrete causative agent can be implicated, but more often this is not possible. (See 'Building-related symptoms' below.)

BRIs can vary in severity and acuity. Examples are listed in the Table and include the following (table 1):

                                             

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Literature review current through: Nov 2016. | This topic last updated: Tue Jun 14 00:00:00 GMT+00:00 2016.
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References
Top
  1. Bernstein JA, Alexis N, Bacchus H, et al. The health effects of non-industrial indoor air pollution. J Allergy Clin Immunol 2008; 121:585.
  2. Norbäck D. An update on sick building syndrome. Curr Opin Allergy Clin Immunol 2009; 9:55.
  3. Apter A, Bracker A, Hodgson M, et al. Epidemiology of the sick building syndrome. J Allergy Clin Immunol 1994; 94:277.
  4. Menzies D, Bourbeau J. Building-related illnesses. N Engl J Med 1997; 337:1524.
  5. Godwin C, Batterman S. Indoor air quality in Michigan schools. Indoor Air 2007; 17:109.
  6. Allermann L, Meyer HW, Poulsen OM, et al. Inflammatory potential of dust from schools and building related symptoms. Occup Environ Med 2003; 60:E5.
  7. Perzanowski MS, Rönmark E, Nold B, et al. Relevance of allergens from cats and dogs to asthma in the northernmost province of Sweden: schools as a major site of exposure. J Allergy Clin Immunol 1999; 103:1018.
  8. Smedje G, Norbäck D. Irritants and allergens at school in relation to furnishings and cleaning. Indoor Air 2001; 11:127.
  9. Cartier A. The role of inhalant food allergens in occupational asthma. Curr Allergy Asthma Rep 2010; 10:349.
  10. Delclos GL, Gimeno D, Arif AA, et al. Occupational risk factors and asthma among health care professionals. Am J Respir Crit Care Med 2007; 175:667.
  11. United States Environmental Protection Agency. Respiratory health effects of passive smoking (also known as exposure to secondhand smoke or environmental tobacco smoke ETS). EPA; US Environmental Protection Agency, OoRaD, Office of Health and Environmental Assessment (Ed), Washington, DC 1992.
  12. European Public Heatlh Alliance http://www.epha.org/a/1941 (Accessed on December 19, 2013).
  13. Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev 2010; :CD005992.
  14. Madureira J, Mendes A, Teixeira JP. Evaluation of a smoke-free law on indoor air quality and on workers' health in Portuguese restaurants. J Occup Environ Hyg 2014; 11:201.
  15. Repace JL, Hyde JN, Brugge D. Air pollution in Boston bars before and after a smoking ban. BMC Public Health 2006; 6:266.
  16. Shamo F, Wilson T, Kiley J, Repace J. Assessing the effect of Michigan's smoke-free law on air quality inside restaurants and casinos: a before-and-after observational study. BMJ Open 2015; 5:e007530.
  17. Eisner MD, Smith AK, Blanc PD. Bartenders' respiratory health after establishment of smoke-free bars and taverns. JAMA 1998; 280:1909.
  18. Jaakkola MS, Piipari R, Jaakkola N, Jaakkola JJ. Environmental tobacco smoke and adult-onset asthma: a population-based incident case-control study. Am J Public Health 2003; 93:2055.
  19. Farrelly MC, Nonnemaker JM, Chou R, et al. Changes in hospitality workers' exposure to secondhand smoke following the implementation of New York's smoke-free law. Tob Control 2005; 14:236.
  20. Larsson M, Boëthius G, Axelsson S, Montgomery SM. Exposure to environmental tobacco smoke and health effects among hospitality workers in Sweden--before and after the implementation of a smoke-free law. Scand J Work Environ Health 2008; 34:267.
  21. Reijula JP, Johnsson TS, Kaleva PS, Reijula KE. Exposure to tobacco smoke and prevalence of symptoms decreased among Finnish restaurant workers after the smoke-free law. Am J Ind Med 2012; 55:37.
  22. Collaco JM, Drummond MB, McGrath-Morrow SA. Electronic cigarette use and exposure in the pediatric population. JAMA Pediatr 2015; 169:177.
  23. Fernández E, Ballbè M, Sureda X, et al. Particulate Matter from Electronic Cigarettes and Conventional Cigarettes: a Systematic Review and Observational Study. Curr Environ Health Rep 2015; 2:423.
  24. World Health Organization Framework Convention on Tobacco Control (FCTC)/Conference of Parties. Electronic nicotine delivery systems: Report by WHO. http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10Rev1-en.pdf (Accessed on May 31, 2016).
  25. Crowley RA, Health Public Policy Committee of the American College of Physicians. Electronic nicotine delivery systems: executive summary of a policy position paper from the American College of Physicians. Ann Intern Med 2015; 162:583.
  26. Schluger N. Household air quality in high-income countries: forgotten but not gone. Lancet Respir Med 2014; 2:781.
  27. Food and Drug Administration. Tobacco Products: Products, Ingredients & Components. www.fda.gov/tobaccoproducts/labeling/productsingredientscomponents/default.htm (Accessed on May 31, 2016).
  28. Mendell MJ, Mirer AG, Cheung K, et al. Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence. Environ Health Perspect 2011; 119:748.
  29. Hardin BD, Kelman BJ, Saxon A. Adverse human health effects associated with molds in the indoor environment. J Occup Environ Med 2003; 45:470.
  30. Laney AS, Cragin LA, Blevins LZ, et al. Sarcoidosis, asthma, and asthma-like symptoms among occupants of a historically water-damaged office building. Indoor Air 2009; 19:83.
  31. Newman KL, Newman LS. Occupational causes of sarcoidosis. Curr Opin Allergy Clin Immunol 2012; 12:145.
  32. Damp indoor spaces: Executive summary. Institute of Medicine, Board on Health Promotion and Disease Prevention, Committee on Damp Indoor Spaces, 2004.
  33. Gerardi DA. Building-related illness. Clin Pulm Med 2010; 17:276.
  34. Rangel KM, Delclos G, Emery R, Symanski E. Assessing maintenance of evaporative cooling systems in legionellosis outbreaks. J Occup Environ Hyg 2011; 8:249.
  35. Yu C. Building pathology, investigation of sick buildings - VOC emissions. Indoor Built Environ 2010; 19:30.
  36. Koren HS, Graham DE, Devlin RB. Exposure of humans to a volatile organic mixture. III. Inflammatory response. Arch Environ Health 1992; 47:39.
  37. Hudnell HK, Otto DA, House DE, Mølhave L. Exposure of humans to a volatile organic mixture. II. Sensory. Arch Environ Health 1992; 47:31.
  38. Hodgson M, Levin H, Wolkoff P. Volatile organic compounds and indoor air. J Allergy Clin Immunol 1994; 94:296.
  39. Gilbert NL, Gauvin D, Guay M, et al. Housing characteristics and indoor concentrations of nitrogen dioxide and formaldehyde in Quebec City, Canada. Environ Res 2006; 102:1.
  40. World Health Organization. WHO guidelines for indoor air quality: selected pollutants. WHO, Copenhagen 2010. www.euro.who.int/__data/assets/pdf_file/0009/128169/e94535.pdf (Accessed on May 31, 2016).
  41. Weschler CJ. Ozone's impact on public health: contributions from indoor exposures to ozone and products of ozone-initiated chemistry. Environ Health Perspect 2006; 114:1489.
  42. Dales R, Liu L, Wheeler AJ, Gilbert NL. Quality of indoor residential air and health. CMAJ 2008; 179:147.
  43. Centers for Disease Control and Prevention (CDC). Lead exposure from indoor firing ranges among students on shooting teams--Alaska, 2002-2004. MMWR Morb Mortal Wkly Rep 2005; 54:577.
  44. Gelberg KH, Depersis R. Lead exposure among target shooters. Arch Environ Occup Health 2009; 64:115.
  45. Demmeler M, Nowak D, Schierl R. High blood lead levels in recreational indoor-shooters. Int Arch Occup Environ Health 2009; 82:539.
  46. Abudhaise BA, Alzoubi MA, Rabi AZ, Alwash RM. Lead exposure in indoor firing ranges: environmental impact and health risk to the range users. Int J Occup Med Environ Health 1996; 9:323.
  47. Zock JP. World at work: cleaners. Occup Environ Med 2005; 62:581.
  48. Arif AA, Hughes PC, Delclos GL. Occupational exposures among domestic and industrial professional cleaners. Occup Med (Lond) 2008; 58:458.
  49. Medina-Ramón M, Zock JP, Kogevinas M, et al. Asthma, chronic bronchitis, and exposure to irritant agents in occupational domestic cleaning: a nested case-control study. Occup Environ Med 2005; 62:598.
  50. Wang J, Li B, Yang Q, et al. Odors and sensations of humidity and dryness in relation to sick building syndrome and home environment in Chongqing, China. PLoS One 2013; 8:e72385.
  51. Millqvist E. Mechanisms of increased airway sensitivity to occupational chemicals and odors. Curr Opin Allergy Clin Immunol 2008; 8:135.
  52. Shusterman D, Murphy MA. Nasal hyperreactivity in allergic and non-allergic rhinitis: a potential risk factor for non-specific building-related illness. Indoor Air 2007; 17:328.
  53. Kim KH, Pandey SK, Kabir E, et al. The modern paradox of unregulated cooking activities and indoor air quality. J Hazard Mater 2011; 195:1.
  54. Van Miert E, Sardella A, Nickmilder M, Bernard A. Respiratory effects associated with wood fuel use: a cross-sectional biomarker study among adolescents. Pediatr Pulmonol 2012; 47:358.
  55. Josyula S, Lin J, Xue X, et al. Household air pollution and cancers other than lung: a meta-analysis. Environ Health 2015; 14:24.
  56. World Health Organization. Indoor air quality guidelines: household fuel combustion. www.who.int/indoorair/guidelines/hhfc/en/ (Accessed on May 31, 2016).
  57. Spaul WA. Building-related factors to consider in indoor air quality evaluations. J Allergy Clin Immunol 1994; 94:385.
  58. OSHA Technical Manual (OTM): Indoor air quality investigation. https://www.osha.gov/dts/osta/otm/otm_iii/otm_iii_2.html (Accessed on May 31, 2016).
  59. Besch EL. Regulation and its role in the prevention of building-associated illness. Occup Med 1989; 4:741.
  60. Wargocki P, Sundell J, Bischof W, et al. Ventilation and health in non-industrial indoor environments: report from a European multidisciplinary scientific consensus meeting (EUROVEN). Indoor Air 2002; 12:113.
  61. Mendell MJ, Smith AH. Consistent pattern of elevated symptoms in air-conditioned office buildings: a reanalysis of epidemiologic studies. Am J Public Health 1990; 80:1193.
  62. Rios JL, Boechat JL, Gioda A, et al. Symptoms prevalence among office workers of a sealed versus a non-sealed building: associations to indoor air quality. Environ Int 2009; 35:1136.
  63. Bourbeau J, Brisson C, Allaire S. Prevalence of the sick building syndrome symptoms in office workers before and after being exposed to a building with an improved ventilation system. Occup Environ Med 1996; 53:204.
  64. Jaakkola JJ, Heinoneon OP, Seppänen O. Mechanical ventilation in office buildings and the sick building syndrome. An experimental and epidemiological study. Indoor Air 1991; 2:111.
  65. Sundell J. On the association between building, ventilation characteristics, some indoor environmental exposures, some allergic manifestations and subjective symptom reports. Indoor Air 1994; 4:7.
  66. Wargocki P, Wyon DP, Sundell J, et al. The effects of outdoor air supply rate in an office on perceived air quality, sick building syndrome (SBS) symptoms and productivity. Indoor Air 2000; 10:222.
  67. Seppänen OA, Fisk WJ. Summary of human responses to ventilation. Indoor Air 2004; 14 Suppl 7:102.
  68. Alberts WM. Indoor air pollution: NO, NO2, CO, and CO2. J Allergy Clin Immunol 1994; 94:289.
  69. ANSI/ASHRAE. Ventilation for Acceptable Indoor Air Quality (Standard 62-2001) and Thermal Environmental Conditions for Human Occupancy (Standard 55-204).
  70. Olesen BW. International standards for the indoor environment. Indoor Air 2004; 14 Suppl 7:18.
  71. Burge PS. Sick building syndrome. Occup Environ Med 2004; 61:185.
  72. Mendell MJ, Mirer AG. Indoor thermal factors and symptoms in office workers: findings from the US EPA BASE study. Indoor Air 2009; 19:291.
  73. Fairfax RE. Letter of interpretation: Reiteration of existing OSHA policy on indoor air quality (Standard 1910.1000). Administration, OSH (Ed), 2003.
  74. Marmot AF, Eley J, Stafford M, et al. Building health: an epidemiological study of "sick building syndrome" in the Whitehall II study. Occup Environ Med 2006; 63:283.
  75. Environmental Protection Agency. Renovations and Polychlorinated Biphenyls (PCBs) for a Healthy School Environment. www.epa.gov/schools-healthy-buildings/renovations-and-polychlorinated-biphenyls-pcbs-healthy-school-environment (Accessed on June 09, 2016).
  76. Breysse J, Jacobs DE, Weber W, et al. Health outcomes and green renovation of affordable housing. Public Health Rep 2011; 126 Suppl 1:64.
  77. Singh A, Syal M, Grady SC, Korkmaz S. Effects of green buildings on employee health and productivity. Am J Public Health 2010; 100:1665.
  78. Colton MD, Laurent JG, MacNaughton P, et al. Health Benefits of Green Public Housing: Associations With Asthma Morbidity and Building-Related Symptoms. Am J Public Health 2015; 105:2482.
  79. Paul WL, Taylor PA. A comparison of occupant comfort and satisfaction between a green building and a conventional building. Build Environ 2008; 43:1858.
  80. Allen JG, MacNaughton P, Laurent JG, et al. Green Buildings and Health. Curr Environ Health Rep 2015; 2:250.
  81. Runeson R, Wahlstedt K, Wieslander G, Norbäck D. Personal and psychosocial factors and symptoms compatible with sick building syndrome in the Swedish workforce. Indoor Air 2006; 16:445.
  82. Centers for Disease Control and Prevention (CDC). Vital signs: asthma prevalence, disease characteristics, and self-management education: United States, 2001--2009. MMWR Morb Mortal Wkly Rep 2011; 60:547.
  83. Henneberger PK, Redlich CA, Callahan DB, et al. An official american thoracic society statement: work-exacerbated asthma. Am J Respir Crit Care Med 2011; 184:368.
  84. Tice CJ, Cummings KR, Gelberg KH. Surveillance of work-related asthma in new york state. J Asthma 2010; 47:310.
  85. Massachusetts Department of Public Health. Occupational Lung Disease Bulletin. www.mass.gov/eohhs/docs/dph/occupational-health/sensor-lung-disease-bulletins/august2010.pdf (Accessed on May 31, 2016).
  86. Brooks SM. Host susceptibility to indoor air pollution. J Allergy Clin Immunol 1994; 94:344.
  87. Kanchongkittiphon W, Gaffin JM, Phipatanakul W. The indoor environment and inner-city childhood asthma. Asian Pac J Allergy Immunol 2014; 32:103.
  88. Bakke JV, Moen BE, Wieslander G, Norbäck D. Gender and the physical and psychosocial work environments are related to indoor air symptoms. J Occup Environ Med 2007; 49:641.
  89. Lahtinen M, Sundman-Digert C, Reijula K. Psychosocial work environment and indoor air problems: a questionnaire as a means of problem diagnosis. Occup Environ Med 2004; 61:143.
  90. Lahtinen M, Huuhtanen P, Reijula K. Sick building syndrome and psychosocial factors - a literature review. Indoor Air 1998; 8:71.
  91. Brasche S, Bullinger M, Morfeld M, et al. Why do women suffer from sick building syndrome more often than men?--subjective higher sensitivity versus objective causes. Indoor Air 2001; 11:217.
  92. Indoor air pollution: An introduction for health professionals. www.epa.gov/sites/production/files/2015-01/documents/indoor_air_pollution.pdf (Accessed on May 31, 2016).
  93. Redlich CA, Sparer J, Cullen MR. Sick-building syndrome. Lancet 1997; 349:1013.
  94. An office building occupant's guide to indoor air quality. www.epa.gov/sites/production/files/2014-08/documents/occupants_guide.pdf (Accessed on May 31, 2016).
  95. Environmental Protection Agency. Creating Healthy Indoor Air Quality in Schools. www.epa.gov/iaq-schools (Accessed on June 09, 2016).