It has been difficult to confirm that a given building is responsible for allergic symptomatology, exacerbation of asthma, or immunological dysfunction. In fact, in most studies, few objective immunological parameters have been studied and only rarely has there been any quantitation of IgE or secondary mediators. Furthermore, although many studies deal with rhinitis or respiratory tract irritation, there is a misconception that all such symptoms are allergic in nature, and studies attempting to prove that allergies are caused by buildings frequently neglect to prove that these are indeed true allergic responses. In addition, many of the symptoms that people attribute to sick building syndrome (SBS) or building-related illness, such as headaches, dizziness, fatigue, nausea, cough, and eye irritation, are subjective, and studies often fail to take into account other possible causes that may be inherent in the subjects, such as sinusitis, hyperventilation syndrome, or psychosomatic illness. Unfortunately, most clinical studies on SBS pay little attention to the preexisting conditions that a subject may have and discount the possibility that the inciting agent does not cause symptoms, but merely exacerbates a preexisting condition. Moreover, they offer no information about the nature of the mechanisms of action or pathophysiological relationships. Clearly, further studies are necessary to further explain the complexity of complaints that currently exist. Indeed, SBS might properly be paraphrased as "what is it?--if it is!"
The sick building syndrome has been widely discussed from epidemiological perspectives. Although there is considerable difference in opinion regarding the concrete and objective evidence to support a distinct sick building syndrome and/or building-related illness, much data indicates that numerous variables within buildings can potentially influence human health. In this paper, we discuss in detail not only the potential and unique infectious diseases caused by Legionella, Pontiac fever, Q fever, and influenza, but also the data implicating noninfectious etiologies of sick building syndrome and building-related illnesses. In addition, the role of psychological factors, mass hysteria, and indoor pollution is discussed with respect to the nature of associations between exposure and symptoms. Finally, comparisons are made in different building construction types of old versus new buildings to highlight changes in modern construction that may have led to a putative increase in work-related symptomatology.
Indoor air pollution is closely associated with health problems and exacerbation of asthmatic symptoms. However, it is difficult to find objective data regarding the nature of these illnesses and the degree of exposure necessary to elicit symptoms in building occupants. Clinicians must be encouraged to take seriously, and without bias, workers' complaints about their work environment. However, this is often a problem because of subjective complaints, potential malingerers, mass hysteria, and lack of impartial clinical and laboratory findings. Clearly, in any building, a major priority must be to provide and maintain an environment conducive to occupant health and well-being. Allowable levels of air pollutants must be scientifically determined by health investigators based on government regulations. Unfortunately, regulations are often ill defined, unenforceable, and burdened by a void as to who is responsible for achieving a healthful indoor environment. The elucidation of the multiple causes of illnesses secondary to indoor air pollution can be addressed by greater attention to design, construction, and operation of buildings where people live and work. Finally and most important, the federal government should bear the responsibility for funding the necessary research to solve the nation's indoor air quality problems.
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