Sick building syndrome

Disease Description (Causes and Symptoms)

Sick building syndrome refers to a condition in which respiratory, skin, or systemic symptoms that were not previously present develop after moving into a newly built home or indoor space. The main causes are volatile organic compounds (VOCs) and irritant gases released indoors, particularly formaldehyde; vinyl chloride, xylene, toluene, benzene, and others may also be involved. The pathophysiology is explained by these chemicals irritating the mucous membranes of the eyes, nose, airways, larynx, and skin, or worsening pre-existing allergic diseases.

Main symptoms

• Upper-airway mucosal irritation: eye stinging/itching, nasal congestion/runny nose, sore throat/hoarseness, cough
• Lower-airway symptoms: worsening asthma, shortness of breath, wheezing
• Skin: dryness/rash, worsening atopic dermatitis/eczema, hives
• Nonspecific systemic symptoms: headache, fatigue, lack of energy
• High-risk groups: symptoms may be more severe in infants and young children, older adults, and people with pre-existing allergies (asthma, atopic dermatitis, rhinitis)

Treatment Methods and Precautions

The principles of treatment are symptom management and removal of indoor pollutants (blocking exposure).

Treatment by symptom (standard approach)

• Rhinitis/eye symptoms: decongestants (short-term), topical (nasal) steroids, antihistamines (oral/eye drops)
• Asthma: inhaled beta2 agonists (short-acting), inhaled corticosteroids (controller medication), and oral steroids if necessary (in cases of severe exacerbation)
• Skin disease (atopic/contact dermatitis): moisturizers, topical steroids (short-term), and dermatology evaluation and additional treatment in severe cases
• Hives: second-generation antihistamines and specialist evaluation if necessary

Environmental management (most important)

• Remove sources of pollution: stop using or remove furniture, building materials, air fresheners, spray products, and other items containing formaldehyde or VOCs
• Ventilation: prioritize natural ventilation (opening windows and doors)—ventilate frequently when cooking, cleaning, or heating
• Pre-occupancy treatment: (recommended) there is advice to maintain indoor heating at 30℃ or higher approximately 7 days before moving in (for about 8 hours, etc.) to reduce VOC emissions
• Air purifiers: activated carbon (adsorption) filters can help remove volatile organic compounds, while HEPA filters are advantageous for removing particulate pollutants—check product performance
• Material selection: low-volatility (VOC-low) materials or materials without formaldehyde treatment, with natural materials recommended
• Lifestyle practices: do not smoke indoors, avoid using synthetic air fresheners and deodorizers, and do not place new furniture or books in the bedroom

Precautions and complications

• Continued exposure may cause chronic worsening of asthma, atopic dermatitis, and other conditions
• Emergency treatment is needed if acute severe shortness of breath or an anaphylaxis-like reaction occurs
• Improving the indoor environment is essential for long-term prevention

Checklist Before an Outpatient Visit (Items Helpful for Preparation and Medical History-Taking)

Items/records to bring

• A list of medications currently being taken (names and directions for use) and a history of allergies
• The time symptoms began and their progression (including the relationship to the moving date)—if possible, a symptom diary (situations in which symptoms worsen/improve by time of day)
• A list of recent changes in the home: new furniture, interior renovations, paint, flooring materials, carpets, air fresheners, appliances, etc.
• Lifestyle patterns: frequency of ventilation, smoking status, cooking and heating methods
• Photos: photos of skin lesions and problematic materials (furniture, wallpaper, etc.)
• Previous test results: pulmonary function tests (PFT), allergy tests (blood/skin tests), chest imaging, etc.

Additional checklist items helpful for the medical history

• Whether symptoms improve when away from home (at work, school, etc.)
• Whether symptoms worsen after specific activities (cooking, cleaning, exposure to odors, etc.)
• Patterns of symptom changes after moving furniture or going outside

Examples of General Questions to Ask the Doctor

• How can you confirm whether these symptoms are sick building syndrome? (Diagnostic criteria/need for testing)
• Which medications should I use for my current symptoms, and what are their side effects?
• What measures should I prioritize to improve indoor air quality? Are air purifiers or plants helpful?
• Do I need allergy testing or pulmonary function testing?
• If the symptoms continue, what is the prognosis and what is the risk of complications?

Examples of Condition-Specific Questions

• (For asthma patients) After moving into a new home, do I need to adjust the dose or medication of my inhaler? What emergency measures should I take if my asthma worsens?
• (For predominantly skin symptoms) What materials (plywood, solid wood, natural finishes, etc.) do you recommend when replacing furniture or flooring? How is formaldehyde measured, and are there standard values?

Additional Information

• There is no specific test for diagnosis; medical history, symptom patterns, and environmental assessment are key. If necessary, environmental exposure assessment (indoor VOC measurement), allergy testing, and pulmonary function testing may be performed.
• Environmental improvement (blocking exposure) is the most fundamental treatment, while medications are used concurrently to relieve symptoms and prevent worsening.