What is "Sick Building Syndrome"?
In the 1970s, health care
providers were faced with increasing numbers of people having headaches and
allergic-like reactions to unspecified stimuli. Some of the reactions included
lethargy, fatigue, headache, dizziness, nausea, irritation of mucous membranes,
eye and/or nasopharyngeal irritation, and sensitivity to odors. Through
exploration over several years, these reactions were linked to common symptoms
of people in specific buildings and a lack of symptoms when these people were
not in the buildings. This spectrum of specific and non-specific health and
when tied to a particular building, became known as the "sick building
syndrome." It is important to note that "sick building syndrome" is not the same
as "building related illness" which refers to a specific airborne building
contaminant. One well known example of this is Legionnaires' Disease.
"Sick building syndrome" is
often more prevalent among asthmatics among whom there is a large percentage of
allergies to common indoor allergens. Indoor air pollution also
disproportionately affects some populations, such as African Americans living in
inner city homes that are not modernized. For these populations, there is a
three to five times greater risk of asthma mortality than Caucasians, which may
be compounded by a variety of sources including rat/cockroach infestations,
sanitary conditions, and education as well as indoor air pollution
the Sources of Pollution?
are four broad
categories of contributors to "sick building syndrome." Other
fact sheets in this series address some of these sources.
Malfunctioning or inappropriate, inefficient use of heating devices can produce
pollutants at harmful levels. Carbon monoxide (CO), which is an asphyxiant, and
nitrogen dioxide (NO2) and sulfur dioxide (SO2), which are irritants, are three
of the more common products of combustion pollutants in the home. Methelyne
chloride, which is in some household products such as paint strippers, can also
be metabolized to form CO.
everywhere, dander, molds, dust mites, and other biologicals are carried by
animals and people into and throughout homes and buildings. High relative
humidity, flooding, inadequate exhaust of bathrooms or kitchens, humidifiers,
dehumidifiers, air conditioners, drip pans under cooling coils, pets, and
components of heating, ventilation, and air conditioning (HVAC) systems are all
sources of biological air pollutants. Three types of human disease can come from
these biological pollutants: infections in which pathogens invade human tissue;
hypersensitivity diseases which involve specific activity of the immune system;
and toxicosis in which biologically produced chemical toxins cause direct toxic
effects. In many cases, "sick building syndrome" may be related to microbial
contamination in buildings.
temperature, volatile organic compounds, or VOCs, are emitted as gases from
certain solids and liquids. These include formaldehyde, pesticides, solvents,
cleaning agents, benzene, and perchloroethylene. In some EPA studies, indoor
levels of some VOCs can be up to ten times greater than outdoors. A wide array
of potential sources of VOCs exists in the home and in the office. Scents and
hair sprays, household products such as finishes, rug and oven cleaners, paints,
thinners, dry cleaning fluids, some copiers and printers, some glues and
adhesives, markers, and photo solutions are among some of the common products
that may emit VOCs. One of the major irritants in "sick building syndrome" is
formaldehyde. Although urea-formaldehyde foam insulation is no longer used,
buildings which had the blown foam in the 1970s may still have VOCs from the
insulation. Formaldehyde is also found in resins in finishes, in plywood,
paneling, fiberboard and particle board, and in some of the backings and
adhesives for carpets. New installations, carpet, wall coverings, paint, or
construction can all heighten problems with VOCs.
the past several decades, the potential for casual exposure to heavy metals in
buildings has been significantly reduced. Lead was removed as an ingredient in
paints starting in the 1940s and was completed banned in 1978. In August 1990,
mercury (threat in the vapor, not in the paint) was removed from indoor latex
paints and in 1991 from outdoor latex paints and was replaced with a different,
less toxic chemical to extend shelf-life and kill mold and mildew. Although
still a concern, the likelihood of inhalation of heavy metals in most buildings
is minute. The concern about heavy metals as an indoor air pollutant is greatest
in older, deteriorating housing or during rehab or reconstruction projects of
How Can I
Know if a Health Reaction is Due to a Sick Building?
are two components to identifying a sick building. The first is that the
reactions or types of reactions are shared by several or many of the people who
also inhabit the building. The second is that the reactions are triggered when
in the building and are not triggered when not in the building. Individuals,
however, may have greater sensitivities to some stimuli than do other people.
For these individuals, something or things in the building may be triggering a
reaction, but the building may not be "sick." This is often the case when a
certain office or part of a building is rehabbed or reconfigured and decorated.
That particular area of the building may create reactions in individuals, but
the building itself is not problematic.
What Can I
best way to deal with potential reactions to a sick building, is to understand
the reasons a building may be "sick." The predominant culprit in most buildings
is the flow of air. Fresh air and air movement patterns keep a building
"flushed." As buildings become sealed or an interior is redesigned and changes
the air flow, air may not move as freely and the contaminants can accumulate in
the closed space. Poorly designed or maintained ventilation systems (HVAC) can
also create problems, especially in situations where the pollutants can
"buildup" over time due to poor air exchange.
second cause can be a synergistic or combination interaction among low levels of
specific pollutants. In these cases, when the specific pollutants are
identified, the contributing factors are removed or altered to minimize the
effect. For individuals, specific causes may be traced through "histories" of
other situations in which the individual has had similar reactions.
factors that can contribute to the symptoms associated with "sick building
syndrome" are some that can be relatively easily maintained. Too low or too high
a humidity level or changes in relative humidity in a building can aggravate
individuals. Too low humidity can increase dust and particulate indoor
pollution, and too high humidity can provide a breeding ground for molds and
fungi. Poor lighting can increase eye strain and result in symptoms similar to
"sick building syndrome." Extreme temperature fluctuations in a building can
serve to release VOCs and molds/fungi.
suspect a building of "making you sick," first track your reactions. What types
of reactions, what are the triggers for the reaction, and do the reactions abate
when you are not in the building? Next, examine the building for things you can
control. Can you open windows or doors to improve air flow? Many types of
adjustments that could alleviate sick building symptoms require major structural
changes in building infrastructure. So, as an individual, you will have to find
the things that you can control. Can you minimize the temperature changes within
the building? Are there individual activities, such as the use of colognes or
perfumes, soaps, shampoos, deodorants, perfumes in detergents, and air
fresheners that can be controlled by individuals within the building? Finally,
if you believe it is a building that is sick, gather the evidence from multiple
occupants of the building - and if possible have all occupants meet with one or
a few health care providers - and contact the owner of the building and your
local health department.
educational programs conducted by Ohio State University Extension are available
to clientele on a nondiscriminatory basis without regard to race, color, creed,
religion, sexual orientation, national origin, gender, age, disability or
Vietnam-era veteran status.
Keith L. Smith, Associate
Vice President for Ag. Adm. and Director, OSU Extension.
TDD No. 800-589-8292 (Ohio
only) or 614-292-1868
Building Syndrome is a general category for a number of ailments, allergies, and
complaints, all due to some physical aspect of a building, usually related to
the ventilation system. The existence of low levels of pollutants, synthetic
irritants, fungi or other microorganisms, or simply a lack of adequate fresh
air, are sufficient factors to cause reactions in a percentage of building
occupants. Sometimes extremely low levels of several different pollutants or
irritants is sufficient to incapacitate certain sensitive individuals.
diversity of both causes and effects of Sick Building Syndrome have led some to
claim its nonexistence and nothingness, but the problem continues to occur. The symptoms may be
different for different people and can vary considerably in degree, but this
shouldn't be too surprising considering the genetic diversity of the human race
and the incredible array of potential contaminants humans encounter daily. Sick
Building Syndrome exists even if it defies specific diagnosis.
Often, the only common
denominator is insufficient
ventilation air to remove the contaminants. Sometimes the source of the problem
is microbial growth inside wet ductwork or other air-handling equipment. The
solution here is to clean the ductwork and equipment with a strong disinfectant
and adjust the system to better control humidity. If the microbial growth is
suspected but not observed, cell culturing should be performed on the supply air
to first determine the existence of microorganisms before disassembling any
some new buildings the problem can be the use of synthetic materials (such as
insulation or carpeting) which release hydrocarbons or other vapors into the air
at a very low rate. The solution in this case may be to remove the offending
material and replace it with an acceptably innocuous alternative.
rare instances the outside air intakes may draw in foul air from waste storage
or processing areas, or from parking areas heavily laden with auto exhaust.
These cases represent bad ventilation system design and the solutions are
Components that can improve the problem include HEPA filters (for dust and
bioaerosols), carbon adsorbers (for gases) and electrostatic precipitators (for
dust and bioaerosols). Boosting outside airflow can be an effective solution,
but can be costly in summer and winter.
Joe E. Heimlich
Ohio State University Fact
700 Ackerman Road, Columbus,
Zamm, A.V. and R. Gannon.
1980. Why Your House May Endanger Your Health. New York, Simon and Schuster.
Burge, P.S., A. Hedge,
S.Wilson, J.H.Bass and A. Robertson. 1987. Sick building syndrome : A study of
4373 office workers. Ann. Occ. Hyg. 31:493-504
Kriess, K. 1989. The
epidemiology of building-related complaints and illness. Occup. Med. 4:575-592.
Norback, D., I.Michel and J.
Widstrom. 1990. Indoor air quality and personal factors related to sick building
syndrome. Scand. J. Work Environ. Health 16:121-128.
Berglund, B., T.Lindvall and
J.Sundell. 1984. Indoor Air, Vol.3, Sensory and Hyperreactivity Reactions to
Sick Buildings. Stockholm: Swedish Council for Building Research.
ASHRAE, IAQ 93 : Operating
and Maintaining Buildings for Health, Comfort and Productivity
ASHRAE, IAQ 94 : Engineering
Godish, T. (1995). Sick
Buildings : Definition, Diagnosis and Mitigation. Boca Raton, Lewis Publishers.
Lundin, L. (1991). On
Building-related Causes of the Sick Building Syndrome. Stockholm, Almqvist &
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