Building-related illnesses are disorders that affect the lungs as well as other parts of the body and are caused by exposure to substances within modern airtight buildings.

• Building-related illnesses are caused by exposure to substances within airtight buildings that have poor ventilation.
• Symptoms vary depending on the cause but may include fever, difficulty breathing, runny nose or congestion, headaches, skin problems, and difficulty concentrating.
• Diagnosis usually includes evaluating the air quality of the building and determining how many people experience building-related symptoms.
• Treatment is usually removal from the building or improving air quality within the building.

Building-related illnesses are a group of disorders whose cause is linked to the environment of modern airtight, energy-efficient buildings. Such buildings are characterized by sealed windows and dependence on heating, ventilation, and air conditioning systems for circulation of air. Most cases occur in nonindustrial office buildings, but illnesses can occur in apartment buildings, single-family homes, schools, museums, and libraries.

Building-related illnesses can be specific or nonspecific.

Specific Building-Related Illnesses

Specific building-related illnesses are those illnesses for which a link between building-related exposure and illness is proved. Examples include Legionnaires' disease (see Pneumonia: What is Legionnaires' Disease?), occupational asthma (see Environmental Lung Diseases: Occupational Asthma), hypersensitivity pneumonitis (see Allergic and Autoimmune Diseases of the Lungs: Hypersensitivity Pneumonitis), and inhalational fever.

Inhalational fever is a fever caused by exposure to organic (made of materials that contain carbon and are part of living organisms) aerosols or dusts. Metal fumes and polymer fumes can also produce fever.

In nonindustrial buildings, humidifier fever occurs as a consequence of humidifiers or other types of ventilation units serving as a reservoir for the growth of bacteria or fungi and as a method of aerosolizing these contaminants. People with humidifier fever have a low-grade fever, malaise, cough, and shortness of breath. Improvement that occurs when exposure stops (for example, after a weekend away from the building) is often an indication of the cause. The condition starts abruptly and usually lasts a few days. Symptoms may be absent or subtle. Clusters of cases are common. Disease can occur after initial exposure. Acute episodes do not generally require treatment apart from removal from the contaminated environment and drugs to reduce the fever. If symptoms persist, testing may be required to determine if infection or another condition is causing symptoms. Sampling to detect airborne organisms can be costly and time consuming but is necessary in some cases to document the source of contaminated air. Inhalational fevers are usually prevented by good maintenance of ventilation systems.

Nonspecific Building-Related Illnesses

Nonspecific building-related illnesses are those for which a link between building-related exposure and illness is difficult to prove. The term sick building syndrome has been used to refer to illnesses that occur in clusters within a building. The symptoms are often very general and may include the following:

• Itchy, irritated, dry, or watery eyes
• Runny nose or nasal congestion
• Throat soreness or tightness
• Dry itchy skin or unexplained rashes
• Headache, lethargy, or difficulty concentrating

Some building-related factors, including higher building temperature, higher humidity, and poor ventilation, typically with a failure to incorporate sufficient fresh air from outdoors, appear to account for symptoms in some instances. Women, people with allergies, people who have increased sensitivity to body sensations or worry about the meaning of symptoms, and some people with anxiety or depression are more likely to experience building-related symptoms.

No specific clinical tests can be used to diagnose a building-related illness. Testing the air quality of the building and finding high rates of symptoms among the building occupants can allow doctors to surmise that building-related factors may be causing the problems. Treatment involves reducing exposure to the building or improving building ventilation and conditions. Depending on the illness, recovery may require a prolonged period of time.

Last full review/revision April 2008 by Lee S. Newman, MD, MA