Sick building syndrome

Overview

Sick Building Syndrome (SBS) is a medical condition where individuals experience a variety of acute symptoms that seem to be linked to time spent in a specific building, often an office or commercial space, without an identifiable illness or cause. The symptoms typically improve or disappear when the individual leaves the building. Unlike building-related illnesses, which have identifiable pathogens or toxins (e.g., Legionnaires' disease), SBS symptoms are nonspecific and do not point to a specific medical condition. SBS has been recognized since the 1980s and is associated with poor indoor air quality, inadequate ventilation, and environmental stressors within enclosed spaces.

Causes

Sick Building Syndrome is believed to arise from a combination of physical, chemical, and biological factors that affect indoor environmental quality. Common contributing causes include:

1. Poor Indoor Air Quality:

• Inadequate ventilation systems (low fresh air intake or recirculated air)

• High levels of carbon dioxide, dust, or particulates

2. Chemical Contaminants:

• Volatile organic compounds (VOCs) from paint, adhesives, cleaning agents, or office equipment

• Formaldehyde from furniture or building materials

• Tobacco smoke or combustion products from nearby sources

3. Biological Contaminants:

• Mold, fungi, and bacteria from damp or water-damaged materials

• Pollen and animal dander

4. Psychological and Ergonomic Factors:

• Stressful work environments or poor workspace design

• Inadequate lighting, excessive noise, or poor temperature control

Often, multiple factors interact to cause SBS, and no single source may be identified in many cases.

Symptoms

SBS symptoms are generally nonspecific and vary widely between individuals. Symptoms tend to worsen during time spent in the affected building and improve after leaving it. Common symptom categories include:

1. Respiratory Symptoms:

• Nasal congestion or runny nose

• Sore throat

• Cough

• Wheezing or shortness of breath

2. Mucous Membrane and Eye Irritation:

• Burning or dry eyes

• Itchy or watery eyes

• Dryness in the nose and throat

3. Skin Issues:

• Dry, itchy, or irritated skin

• Rashes in some cases

4. General and Neurological Symptoms:

• Headaches

• Dizziness

• Nausea

• Fatigue or difficulty concentrating

Symptoms may affect multiple occupants in the building, though severity can vary based on individual sensitivity and exposure levels.

Diagnosis

Sick Building Syndrome is a diagnosis of exclusion and requires careful evaluation to differentiate it from specific building-related illnesses or unrelated medical conditions. Diagnostic steps include:

• Clinical history: Documenting the timing, frequency, and type of symptoms, with emphasis on symptom resolution outside the building

• Environmental history: Assessment of the building environment, including HVAC systems, recent renovations, water damage, and occupancy patterns

• Occupational health evaluation: Identification of other affected coworkers and correlation with building usage

• Air quality assessment: Measurement of ventilation rates, CO2 levels, temperature, humidity, and potential pollutants

• Rule out other conditions: Allergy testing, infection screening, or blood work may be performed to exclude underlying medical causes

No specific diagnostic test confirms SBS, so diagnosis relies heavily on patterns and exclusion of other causes.

Treatment

Treatment of Sick Building Syndrome focuses on both environmental remediation and symptom relief. A combination of building management and individual-level interventions is often necessary.

Environmental Interventions:

• Improve ventilation: Increase intake of fresh outdoor air and ensure proper air exchange rates

• Identify and remove pollutants: Use low-emission furnishings and cleaning products, and eliminate sources of VOCs and biological contaminants

• HVAC system maintenance: Regular cleaning and servicing of filters, ducts, and air handlers

• Control humidity: Maintain indoor humidity levels between 30–60% to prevent mold growth

Personal Interventions:

• Symptom management: Use of over-the-counter antihistamines, eye drops, or nasal sprays

• Hydration and skin care: Drinking water and using moisturizers for dry skin

• Breaks and relocation: Spending time outdoors or rotating workspaces if possible

Organizational Measures:

• Employee education: Promote awareness of indoor environmental quality and reporting of symptoms

• Workplace flexibility: Allow affected employees to work from alternative locations during remediation

Prognosis

The prognosis for individuals with Sick Building Syndrome is generally good, especially when the underlying environmental triggers are identified and addressed. Most people experience full symptom resolution after removal from the affected environment or following environmental improvements.

In cases where SBS persists without intervention, it can lead to reduced productivity, chronic discomfort, and absenteeism. Continued exposure may also increase sensitivity to indoor pollutants. A proactive approach involving building design, maintenance, and health surveillance is key to preventing recurrence and ensuring long-term well-being for occupants.