The Sick Building Syndrome as a Part of the Autoimmune (Autoinflammatory) Syndrome Induced by Adjuvant

Abstract

Most people of all ages spend most of their days indoors. Today's lifestyle increases people's exposures to their indoor environments, which are sometimes of poor quality and result in adverse health effects. Sick building syndrome (SBS) is defined as a set of several clinically recognizable symptoms and ailments having no clear cause, reported by occupants of a building. The symptoms and discomfort experienced by building occupants correlate with times of their presence in the building and often interfere with their normal functioning. The syndrome has been prevalent in office buildings and evidenced in health care premises, schools, and other public and official buildings. Poor indoor environmental quality (IEQ) and especially that of indoor air quality (IAQ) appear to cause transient and long-lasting health effects among building occupants. Respiratory, skin, and eye irritation, an onset of allergies, asthma and skin rashes, nonspecific neurological symptoms such as headache and fatigue, and even multiple chemical sensitivity – all and more have been reported to be associated with SBS and poor IAQ. Many sources and conditions inherent in indoor environments have been seen as possible causal factors and triggers for the development of SBS. These have been categorized as chemical, physical, biological, psychosocial, and ergonomic. Emission of contaminants into the indoor environment, including organic and inorganic volatiles as well as particulate matter, may result from construction materials, infiltration of outdoor air pollution, combustion processes, outdoor air, the content of the building, occupants' activity inside a building, ventilation systems, and water supplies. Thermal discomfort and poor lighting and acoustics, while not related to specific morbidity, are believed to contribute to the development of SBS. Inadequate mechanical ventilation and flaws in the heating, ventilation and air conditioning (HVAC) system have been considered as key reasons for the development of SBS. Scientists regard indoor bioaerosols and especially fungal spores originating in molds as contributing factors to SBS, although evidence for a clear causality between bioaerosols and the abovementioned outcomes is not strong in the context of SBS. Researchers have suggested that personal factors and job satisfaction as well as stress and burnout, job strain, and anxiety and depression may also be associated with symptoms of SBS. Ergonomics, the interaction between the human mind and body, and the physical environment inside the building must also be considered contributing factors to the overall well-being and satisfaction of a building's occupants. The trend toward environmental sustainability and energy conservation and the emergence of green buildings have raised hopes that these will bring a decline in the incidence of SBS. Yet while less pronounced in frequency and intensity, dissatisfaction of occupants and building-related symptoms and illnesses in green buildings have continued to emerge. With technological advances and lifestyle changes, new, additional risk factors continue to develop, and the assessment of their occurrence and prevalence is warranted for different indoor environments. Unfortunately, despite the significant prevalence of poor IAQ and SBS, there is a remarkable worldwide paucity of assigned regulatory standards and provisions covering the different aspects of the issue. Shoenfeld et al. suggested that four conditions – siliconosis, macrophagic myofaciitis (MMF), the Gulf war syndrome (GWS), and postvaccination phenomena, which share clinical and pathogenic resemblances – may be included under a common syndrome entitled the "Autoimmune (Autoinflammatory) Syndrome Induced by Adjuvants" (ASIA). Comparison of the clinical manifestations, symptoms, and signs of the 4 conditions described by Shoenfeld et al. with those described for SBS shows that 9 out of 10 main symptoms are in correlation in all 5 conditions, namely myalgia, arthralgias, chronic fatigue, neurological cognitive impairment, fever, gastrointestinal and respiratory symptoms, skin manifestations, and appearance of autoantibodies. The authors further proposed several major and minor criteria, which, although requiring further validation, may aid in the diagnosis of this newly defined syndrome. We propose here that SBS may also be included as a part of " Shoenfeld's syndrome ."

Symptom Clusters