Diseases

The vast majority of clinicians, whether they agree or disagree that sick building syndrome exists as a medical entity, agree on one major point; there are no tests that can reliably diagnose the alleged sick building syndrome. However, there are tests for specific causes of illnesses that are related to the local environment. For example, tests for formaldehyde, radon gas, asbestos, lead, and other components such as black mold are available.

It is difficult to prevent a syndrome if its cause(s), diagnostic tests, treatments, and its existence is not clear to a large segment of doctors. However, people may be able to prevent some of their nonspecific symptoms by working with their doctors to treat symptoms.There is still another view of prevention taken by a U.S. government agency, the Environmental Protection Agency. Although the EPA considers sick building syndrome to be a term to serve as an indicator of an unknown illness, it uses the term "building related illness," or BRI, as a term to describe known causes of problems such as toxic gasses and molds, mildew, bacteria, plants, and other known compounds found in buildings (and elsewhere) that can cause complaints, negative health effects, and result in lawsuits. They are related to indoor air quality or indoor air pollution. The EPA cites World Health Organization (WHO) statistics that indicate as many as 30% of all buildings worldwide that are new or refurbished have air-quality problems. In contrast to sick building syndrome, these problems are identifiable and most can be remedied by such methods as using HEPA filters to reduce or eliminate most airborne particles, avoiding building air intakes located near sources of vehicle exhaust fumes or other irritants, and avoiding fungal and bacterial contamination of air conditioning or other air circulating methods. According to the EPA, some people who are termed as having sick building syndrome are actually in a situation where they have a building-related illness that has not been investigated or the source identified. However, that does not make their problem a new syndrome. Appropriate building materials and construction, along with good maintenance techniques can prevent most instance of BRI; some investigators suggest that, in turn, the "sick building syndrome" diagnoses will decrease.

The complications of this alleged syndrome include increasing symptoms, interference of job productivity, job loss, necessity of relocation, extensive and expensive building testing (materials and airflow testing), and many medical tests to try to achieve a definitive diagnosis.

Individuals who believe sick building syndrome is real consider the following as some of the major risk factors, but individual people may have only a few of these risk factors:

• Spending time in a building (such as office workers) that causes some or many of the nonspecific symptoms listed below
• Heightened sensitivity to environmental antigens
• Have one or more diagnosed medical problems (for example, asthma)
• Heightened sensitivity of smell
• Females are more likely to develop symptoms
• Gulf War veteran
• Depression
• Anxiety

However, proponents of the opposing view suggest these are general risk factors for many already-defined medical problems and offer little to clinicians who treat patients with the nonspecific symptoms (see symptoms section below) others attribute to this disease.

Proponents of the sick building syndrome agree that people considered to have the syndrome may exhibit any number of nonspecific symptoms that may be increased when the person is associated with certain buildings. The symptoms are as follows:

• Headache
• Nausea
• Diarrhea
• Hoarseness or cough
• Bloating
• Gas
• Dizziness
• Fatigue
• Muscle discomfort (stiffness, pain, cramps, aches)
• Congestion
• Sneezing
• Nosebleeds
• Itching
• Skin rash
• Eye irritation
• Sore throat
• Swelling of legs, trunk, and/or ankles
• Shortness of breath
• Chest pains
• Cardiac arrhythmias
• Mental changes (problems with concentration, memory, moods)

There is no pattern or clear set of symptoms that fit criteria for a new syndrome in the opinion of many clinicians and investigators; these symptoms are often part of symptoms of many other diagnosable medical conditions.

As stated above, there is controversy about sick building syndrome and the controversy is demonstrated by the medical literature about its cause(s). Those who believe it is a true disease syndrome have only speculated that the cause(s) are multiple and depend on the patient's medical condition (for example, asthma, COPD) and how the compounds in the building (cigarette smoke, chemical outgassing from structural components such as formaldehyde, paint odor, and radon, or biologics such as bacteria and fungi, black mold, or indoor houseplants) interact with the person. Proponents further speculate that patients with the syndrome may be more sensitive to low concentrations of some compounds and may have heightened immune response to such compounds. Further, proponents suggest depression and anxiety may play a role in this syndrome.Others who say there is no evidence for this syndrome agree that certain chemicals, biologics, and physical agents found in some buildings can cause disease, but once these are identified (for example, lead, Legionnaires' disease, asbestos), then the disease is identified and is not a new "syndrome." The proponents of the "there is no such thing as sick building syndrome" say evidence for a new syndrome is simply nonexistent. A few individuals consider "sick building syndrome" to be a psychological problem.

Sick building syndrome (also termed environmental illness, building-related illness [BRI], or multiple chemical sensitivity [MCS]) is considered by some clinicians to be an illness in some people after they are exposed to as yet undefined chemical, biological, or physical agents that are thought to be found in building(s). The term was first used in 1986 and has been controversial ever since. BRI (building-related illness) is becoming the more accepted term used in medical literature.

Because there is no known cause(s), no way to perform a definitive diagnosis, and doubt by many professionals that a sick building syndrome even exists, in general, the prognosis is unclear. However, some people who have had their symptoms treated may have a prognosis that ranges from fair to good.

There are no proven treatments for this proposed disease. However, some doctors report reduction of patient's nonspecific symptoms by prescribing antidepressants (for example, fluoxetine [Prozac], paroxetine [Paxil]) or medications for anxiety or medications to help individuals sleep better. In addition, symptomatic treatment, while not treating the unknown cause(s), may provide individual symptom reduction or relief (for example, medication for nausea or headaches).There may be known conditions in buildings that are related to this proposed syndrome that can be remedied by following building codes and other practices suggested by the EPA and OSHA; some of the major mechanisms are cited in the Prevention section below.

Usually, if there is a problem with a building in which patients are becoming ill, the problems can be first referred to individuals in Occupational Safety and Health Administration (OSHA), the Environmental Protection Agency (EPA), or in some problems like Legionnaires' disease, the Centers for Disease Control and Prevention (CDC). Primary-care physicians and pediatricians usually treat symptoms that are attributed to the air quality in buildings, but other specialists may become involved. For example, allergists, immunologists, specialized building inspectors, and others may be called in to help determine the cause of the problems and ways to solve them.

Sick building syndrome is controversial. Although many people and some clinicians believe there is a disease "syndrome" related to buildings and their internal environment, especially the indoor air quality, many other clinicians and medical organizations say there is no convincing clinical evidence that such a medical syndrome exists. The controversy exists because a number of people have a constellation of nonspecific symptoms that have no proven etiology (cause), yet believe they occur from sources inside building(s). Medical organizations such as the American Medical Association (AMA) and many experts say without any defined symptoms and no convincing evidence of a given source or cause, no test to diagnose the syndrome, and no treatment for the syndrome, there is no such medical syndrome.