1st Edition

Chemical Sensitivity and Sick-Building Syndrome

    220 Pages 88 B/W Illustrations
    by CRC Press

    218 Pages 88 B/W Illustrations
    by CRC Press

    Written by multidisciplinary experts in medicine, chemistry, and architecture, this book examines chemical sensitivity (CS). In 15 chapters fitted to 15 lectures, it discusses not only the medical explanation, but also the environmental factors of this hypersensitive reaction, such as chemistry and architectural aspects. The book overviews pollution-induced diseases such as Minamata Disease. It also points out the similarity of modern hypersensitivity syndromes to historical pollution diseases from the viewpoints of not only natural scientific aspects, but also social understanding of the disease.

    Preface......................................................................................................................xv

    Acknowledgments...................................................................................................xvii

    Authors.....................................................................................................................xix

    Introduction..............................................................................................................xxi

    Chapter 1 Present Status of Chemical Sensitivity.................................................1

    Satoshi Ishikawa

    1.1 Background.................................................................................1

    1.1.1 Disease Registration of CS............................................2

    1.1.2 CS Studies in Europe....................................................3

    1.1.3 CS Studies in Japan.......................................................3

    1.1.4 Sick-Building/House Syndrome....................................3

    1.2 Clinical Symptoms.....................................................................3

    1.3 Psychiatric and Social Aspects...................................................4

    1.4 Chemical Agents Implicated in CS............................................5

    1.5 Why the Diagnosis of CS Is Difficult.........................................8

    1.5.1 Reasons for the Lack of Understanding of CS..............8

    Endnotes................................................................................................8

    Chapter 2 Effects of Chemical Sensitivity on Patients’ Daily Lives................... 11

    Satoshi Ishikawa

    2.1 Effects of Chemical Sensitivity................................................ 11

    2.2 Countermeasures...................................................................... 12

    2.2.1 Making Your Home, Workplace, and School

    Environment Safe........................................................ 12

    2.2.2 Food and Digestive Issues........................................... 12

    2.2.3 Caution in Use of Daily Products................................ 12

    2.2.4 Avoidance of Environmental Chemicals..................... 13

    2.2.5 Effects of Electromagnetic Waves.............................. 13

    2.2.5.1 ES and International Classification

    of Disease 10 (ICD)..................................... 14

    Endnotes.............................................................................................. 14

    Chapter 3 Promoting Understanding of Chemical Sensitivity............................ 17

    Satoshi Ishikawa

    3.1 Medical Insurance in Japan...................................................... 17

    3.2 Understanding of CS at the Judicial Level............................... 17

    3.3 Education.................................................................................. 18

    3.3.1 Specific Education of Medical Doctors....................... 18

    3.3.2 Specific Education for Dentists................................... 18

    vi Contents

    3.3.3 Specific Education for the Healthcare Team............... 19

    3.3.4 Patient Education for a Comfortable Daily Life......... 19

    3.3.5 Education of Laypersons............................................. 19

    Endnotes..............................................................................................20

    Chapter 4 Medical Facts...................................................................................... 21

    Mikio Miyata, Kou Sakabe, and Satoshi Ishikawa

    4.1 Acute Toxicology, Intermediate Syndrome.............................. 21

    4.2 Chronic Toxicology.................................................................. 21

    4.3 Animal Experiments Using Extremely Low Dosages............. 21

    4.4 Research on the Mechanism of CS..........................................23

    4.4.1 Detoxification..............................................................23

    4.4.2 Nervous Sensitivity Acquisition..................................25

    Endnotes..............................................................................................26

    Chapter 5 Diagnosis.............................................................................................29

    Satoshi Ishikawa and Mikio Miyata

    5.1 Detailed and Careful Interview................................................29

    5.2 Neuro-Ophthalmological and Neurological Examinations

    in Conjunction with Ordinary Clinical Examinations

    in Japan.....................................................................................29

    5.2.1 Tracking Eye Movement Examination........................30

    5.2.2 Pupillary Function....................................................... 31

    5.2.3 Standing Ability.......................................................... 32

    5.2.4 Contrast Sensitivity Examination of Higher

    Visual Centers............................................................. 33

    5.2.5 Accommodation Examination of Eyes........................ 33

    5.2.6 Cerebral Function Examination.................................. 33

    5.2.7 Immune Examination..................................................34

    5.2.8 Respiratory Function...................................................34

    5.2.9 Peripheral Venous Blood Oxygen Concentration........34

    5.3 Chemical Load Tests................................................................34

    5.3.1 Use of a Clean Room...................................................34

    5.3.2 Determination of Causative Chemicals

    (Challenge Test)...........................................................34

    Endnotes..............................................................................................36

    Chapter 6 Treatment of Patients with Chemical Sensitivity................................ 37

    Mikio Miyata and Satoshi Ishikawa

    6.1 Avoidance of Chemical Substances.......................................... 37

    6.1.1 Food.............................................................................37

    6.1.2 Water........................................................................... 37

    6.1.3 Air...............................................................................38

    6.1.3.1 Use of an Air Purifier..................................38

    Contents vii

    6.1.4 Clothes......................................................................... 39

    6.1.5 Medicine...................................................................... 39

    6.2 Detoxification........................................................................... 39

    6.2.1 Spa, Hot Spring, Bath, Low-Temperature Sauna........40

    6.2.2 Drug Treatment...........................................................40

    6.2.2.1 Conjugation..................................................40

    6.2.2.2 Vitamins......................................................40

    6.2.2.3 Symptomatic Therapy.................................. 41

    6.2.2.4 Minerals....................................................... 41

    6.2.2.5 EDTA, Penicillamine, PAM, and Others.... 42

    6.3 Alternative Therapy.................................................................. 42

    6.3.1 Prayer and Meditation in Zen Buddhism.................... 42

    6.3.2 Eastern Medicine and Alternative Medicine.............. 43

    6.4 Nutritional Instruction.............................................................. 43

    Endnotes..............................................................................................44

    Chapter 7 Chemical Sensitivity in Children........................................................ 45

    Kazuhiko Kakuta

    7.1 General Symptoms................................................................... 45

    7.1.1 Formaldehyde Concentration and Symptoms............. 45

    7.1.2 TVOC Concentration and Symptoms.........................46

    7.1.3 Red Cell Cholinesterase..............................................46

    7.2 Effects of Indoor Chemicals on the Intelligence

    and Cognitive Function of Children......................................... 47

    7.2.1 Evaluation of Intelligence............................................ 47

    7.2.2 WISC-III Test Results and Concentration

    of Indoor Chemicals.................................................... 47

    7.2.3 Development of Sick-House Syndrome.......................49

    7.3 Case Report of CS in a Young Boy Who Had Been Treated

    with Sumatriptan Succinate and Selective Serotonin

    Reuptake Inhibitors..................................................................50

    Endnotes.............................................................................................. 51

    Chapter 8 Multiple Chemical Sensitivity—Medical Aspects from Germany..... 53

    Klaus-Dietrich Runow

    8.1 Chemical Sensitivity.................................................................54

    8.2 Biochemical Individuality........................................................54

    8.3 Randolph’s Specific Adaptation Syndrome in Response

    to Environmental Stressors....................................................... 57

    8.4 Causes: Fire in the Body and the Brain.................................... 59

    8.5 Diagnostic Program Recommended for CS Patients................ 59

    8.5.1 Metabolic and Nutritional Status (Organic Acid

    Profiles), Toxins........................................................... 59

    8.5.2 Toxic Metals................................................................60

    viii Contents

    8.5.3 Phthalates and Parabens Profile.................................. 61

    8.5.3.1 Why Assess Phthalate and Paraben

    Levels?......................................................... 61

    8.5.3.2 Where Are Phthalates and Parabens

    Found?......................................................... 61

    8.5.4 Bisphenol A................................................................. 62

    8.5.5 Hidden Food Allergies................................................ 62

    8.5.5.1 Gluten Sensitivity Can Cause

    Neurological and Autoimmune Disease......64

    8.5.6 Stool and Digestive Analysis.......................................64

    8.5.6.1 Why Use Stool Analysis?............................65

    8.6 Therapy: The DNA Concept.....................................................65

    8.7 HEPAR-TOX Detoxification....................................................65

    8.8 Ecological Architecture and Environmental Medicine............66

    8.8.1 New Projects in Wolfhagen—The Historic City

    in the Land of the Brothers Grimm............................66

    Endnotes.............................................................................................. 67

    Chapter 9 Emission Rate of Chemical Compounds in Building Products

    and Materials.......................................................................................69

    Shin-ichi Tanabe

    9.1 Introduction..............................................................................69

    9.2 Categories of Chemical Substances.........................................69

    9.3 Building Products and Materials.............................................. 70

    9.4 Emission Tests Using a Chamber............................................. 70

    9.4.1 Small-Chamber Method.............................................. 70

    9.4.2 Large-Chamber Method.............................................. 71

    9.4.3 Desiccator Method...................................................... 72

    9.4.4 Passive Method............................................................ 72

    9.4.5 Microchamber Method for SVOCs............................. 73

    9.5 Labeling.................................................................................... 75

    9.5.1 Formaldehyde.............................................................. 75

    9.5.2 VOCs........................................................................... 76

    9.5.2.1 For VOC Standard....................................... 76

    Endnotes..............................................................................................77

    Chapter 10 Ventilation Strategies for Each Kind of Building and Statutory

    Regulations.......................................................................................... 79

    Haruki Osawa and Masaki Tajima

    10.1 History and Background of Indoor Air Pollution

    Measures in Japan....................................................................80

    10.1.1 Before the Dawn of Measures against Sick Houses....80

    10.1.2 Design Assumption and Strategy of Measures

    against the Indoor Air Pollution Problem................... 81

    Contents ix

    10.2 Statutory Regulations for Indoor Air Quality..........................83

    10.2.1 Technical Standards in the Amended Building

    Standard Law..............................................................83

    10.2.2 Regulation Regarding the Use of Building

    Materials Containing Formaldehyde

    and Installation of Ventilation.....................................83

    10.2.2.1 Restrictions on Interior Finishing................83

    10.2.2.2 Mandatory Installation of Ventilation.........83

    10.2.2.3 Restrictions Concerning Attic

    and Adjacent Concealed Spaces..................84

    10.2.3 Technical Standards in the Housing Quality

    Assurance Act.............................................................84

    10.2.4 Technical Standards of the Act on Maintenance

    of Sanitation in Buildings............................................85

    10.2.5 Indoor Air Pollution Following the Amendment

    of the Building Standard Law in 2003........................87

    10.3 Types and Features of Ventilation Systems..............................88

    10.3.1 Types of Ventilation....................................................88

    10.3.2 Methods of Selecting a Mechanical Ventilation

    System.........................................................................89

    10.4 Trends in Technology Development and Energy-Saving

    Performance.............................................................................90

    10.4.1 Mechanical Ventilation System Utilizing

    Low- Power Input Motors............................................90

    10.4.2 Demand-Controlled Ventilation..................................90

    10.4.3 Mechanical Ventilation Systems with a Heat

    Exchanger....................................................................90

    10.4.4 Hybrid Ventilation System.......................................... 91

    10.5 Important Points for Planning and Operation

    of Ventilation Systems.............................................................. 91

    10.5.1 Planning of the Ventilation Path................................. 91

    10.5.2 Notes for Calculating Pressure Drops.........................92

    10.5.3 Notes on Construction.................................................92

    10.5.4 Notes Concerning Regular Maintenance....................92

    10.5.5 Steps for Ventilation Planning.....................................93

    10.6 Ventilation Equipment in Large Buildings...............................93

    10.6.1 Ventilation in Designated Buildings...........................93

    10.6.2 Ventilation Systems Except Those Employed

    in Centrally Controlled HVAC Systems......................94

    Endnotes..............................................................................................95

    Chapter 11 Ventilation, Air-Tightness, and Air Pollution.....................................97

    Hiroshi Yoshino and Rie Takaki

    11.1 Outline of the Measurement Survey.........................................97

    11.1.1 Survey Period and Investigated Houses......................97

    x Contents

    11.1.2 Survey Points and Measurement Method....................97

    11.2 Measurement Results.............................................................. 100

    11.2.1 Air-Tightness of Houses............................................ 100

    11.2.2 Ventilation Rate of the Ventilation System............... 102

    11.3 Comparison of Air-Tightness, Ventilation System,

    and Chemical Substance Concentrations............................... 103

    11.3.1 Comparison of Air-Tightness and Chemical

    Substance Concentrations......................................... 103

    11.3.2 Comparison of Air Change Rate and Chemical

    Substance Concentrations......................................... 104

    11.4 Conclusions............................................................................. 105

    Endnotes............................................................................................ 105

    Chapter 12 Chemical Features of Indoor Pollutants and Current Regulations..... 107

    Naohide Shinohara

    12.1 Usage and Sources of Chemical Species Detected

    in Indoor Environments.......................................................... 107

    12.1.1 Artificial Wooden Boards and Adhesives................. 107

    12.1.2 Paint........................................................................... 110

    12.1.3 Fungicides, Repellents, Mothballs, Air

    Fresheners, and Disinfectants................................... 110

    12.1.4 Plasticizers and Flame Retardants............................ 111

    12.1.5 Smoking and Burning Appliances............................ 112

    12.1.6 Secondary Generated Compounds............................ 112

    12.1.7 Contaminants in Outdoor Air................................... 112

    12.1.8 Unknown Pollutants.................................................. 113

    12.2 Determination of Pollutants from the View of Health

    Effects..................................................................................... 113

    12.2.1 Target Health Effects................................................. 113

    12.2.1.1 Sick-House Syndrome................................ 113

    12.2.1.2 Asthma....................................................... 114

    12.2.1.3 Endocrine Disruption................................ 114

    12.2.1.4 Cancer........................................................ 114

    12.2.2 Field Survey of Indoor Pollution............................... 114

    12.3 Risk Assessment..................................................................... 118

    12.3.1 What Is Risk Assessment?........................................ 118

    12.3.2 Hazard Assessment................................................... 118

    12.3.3 Exposure Assessment................................................ 120

    12.3.4 Risk Assessment........................................................ 121

    12.4 Enforcement and Effect of Regulations................................. 123

    12.4.1 Time Course of Regulations...................................... 123

    12.4.2 Impact of Regulations...............................................124

    Endnotes............................................................................................124

    Contents xi

    Chapter 13 Methods for Measurement of Indoor Pollution................................. 127

    Atsushi Mizukoshi

    13.1 Methods for Measurement of Indoor Concentration.............. 127

    13.1.1 Integration Measurement.......................................... 127

    13.1.1.1 Active Method........................................... 128

    13.1.1.2 Passive Method.......................................... 128

    13.1.1.3 Subject Compounds, Carbonyl

    Compounds, VOCs, TVOCs, SVOCs........ 128

    13.1.2 Instant Measurement................................................. 130

    13.1.2.1 Subject Compounds, TVOCs,

    Formaldehyde............................................ 130

    13.1.2.2 On-Site Method of Measuring Source

    Intensity and Ventilation Rate................... 130

    13.1.3 Combined Application of Integration

    Measurement and Instant Measurement................... 130

    13.1.3.1 Peak Capture Method................................ 131

    13.2 Methods of Measuring the Emission Rate of Building

    Materials................................................................................. 131

    13.2.1 Desiccator Method.................................................... 131

    13.2.2 Chamber Method....................................................... 132

    13.2.3 On-Site Measurement Method.................................. 133

    13.2.3.1 Field and Laboratory Emission Cell.......... 133

    13.2.3.2 Passive Emission Colorimetric Sensor...... 133

    13.2.3.3 Passive Flux Sampler................................. 134

    13.2.3.4 Advanced Diffusive Sampling

    Emission Cell............................................. 135

    13.3 Methods of Measuring Personal Exposure Amount.............. 135

    13.3.1 Active Sampling–Passive Sampling Method............ 135

    13.3.1.1 Search for Causative Compound

    of Chemical Sensitivity.............................. 135

    13.3.2 Instant Measurement Method.................................... 136

    13.3.2.1 TVOCs and HRV....................................... 136

    Endnotes............................................................................................ 136

    Chapter 14 The Current Situation and Shift in Approaches to Indoor Air

    Pollution............................................................................................ 139

    Miyuki Noguchi

    14.1 Framework of Laws and Regulations..................................... 139

    14.1.1 Housing Quality Assurance Act................................ 139

    14.1.2 School Health and Safety Act................................... 139

    14.1.3 Act on Maintenance of Sanitation in Buildings........ 140

    14.1.4 Revised Building Standards Act............................... 140

    14.1.5 Indoor Density Guideline Value................................ 141

    xii Contents

    14.2 Trends after Determination of Guideline Values................... 142

    14.2.1 Advantageous Effect of Formaldehyde Labeling...... 142

    14.2.1.1 Formaldehyde Concentration in New

    Residential Housing................................... 142

    14.2.2 Composition of VOCs............................................... 143

    14.2.2.1 Significant Reduction

    of Concentrations of Guideline

    Substances................................................. 143

    14.2.2.2 High Concentration Substances

    (TVOCs, Acetaldehyde, Aliphatic

    Compounds, etc.)....................................... 143

    14.2.3 Widespread Use of Alternative Substances............... 143

    14.2.3.1 Low Formaldehyde Emission Adhesives.... 145

    14.2.3.2 Water-Based Paint and Ink........................ 145

    14.2.3.3 Increased Use of Aliphatic Compounds.... 145

    14.2.4 Temporal Change of Indoor TVOC Concentration.... 146

    14.2.5 Trends of Social Recognitions for Indoor Air

    Pollution: New and Remodeled Houses.................... 146

    14.2.5.1 Completion Checks by the Housing

    Quality Assurance Act............................... 146

    14.2.5.2 Widespread Indoor Air Pollution

    with Nonregulated Substances.................. 146

    14.2.5.3 Recognition That SHS Was Resolved........ 147

    14.2.6 Change in Social Recognition of Indoor Air

    Pollution: Routine Countermeasures......................... 147

    14.2.6.1 Air Cleaners............................................... 148

    14.2.6.2 Oxidative Decomposition.......................... 148

    14.2.6.3 Secondary Pollutants................................. 148

    14.3 Required or Recommended Countermeasures....................... 148

    14.3.1 Regulation of TVOC Concentration.......................... 148

    14.3.1.1 Enforcement of the Elimination Period..... 149

    14.3.1.2 Information Sharing Among

    the Relevant Parties................................... 149

    14.3.2 Collecting Information from Medical Doctors......... 149

    14.3.2.1 Selection Method for New Guideline

    Substances................................................. 149

    14.4 Formulation of Counseling or Inquiry Systems

    for Patients and New Occupants............................................. 150

    Chapter 15 Investigation of Indoor Environments and Occupants’ Health

    in Sick Houses................................................................................... 151

    Hiroshi Yoshino, Sachiko Hojo, and Rie Takaki

    15.1 Field Survey on Indoor Air Quality, Building

    Performance, and Occupants’ Health of 62 Sick Houses....... 151

    15.1.1 Description of the Investigation................................ 151

    Contents xiii

    15.1.1.1 Investigated Houses................................... 151

    15.1.1.2 Investigation of Building Performance

    and the Indoor Environment...................... 152

    15.1.1.3 Survey Questionnaire about Health

    Conditions.................................................. 153

    15.1.2 Results....................................................................... 153

    15.1.2.1 Results of Chemical Substance

    Concentration Measurements.................... 153

    15.1.2.2 Relationship between Formaldehyde

    Concentration and Air-Tightness

    Measurement.............................................. 153

    15.1.2.3 Relationship between Formaldehyde

    Concentration and Air Change Rate.......... 155

    15.1.2.4 Sick-House Syndrome Based

    on the QEESI® Questionnaire.................... 156

    15.1.3 Chemical Substance Concentration

    and Occupants’ Symptoms........................................ 156

    15.1.3.1 Relationship between Chemical

    Substance Concentration and SHS............ 156

    15.1.3.2 Relationship between Chemical

    Substance Concentration and Severity

    of Symptoms.............................................. 157

    15.1.4 Conclusion................................................................. 157

    15.2 Long-Term Observations Mainly for 30 Houses.................... 157

    15.2.1 Investigated Houses................................................... 159

    15.2.2 Results of the Investigation....................................... 159

    15.2.2.1 Relationship between Chemical

    Substance Concentration and Building

    Age............................................................. 159

    15.2.2.2 Yearly Changes of Occupants’ Symptoms.... 160

    15.2.3 Change of Symptoms and Chemical Substance

    Concentrations........................................................... 161

    15.2.3.1 Change of Symptoms in Response

    to Countermeasures against Mitigation

    of SHS........................................................ 161

    15.2.3.2 Decrease of Chemical Substance

    Concentration in Response

    to Countermeasures against Sick Houses..... 162

    15.2.4 Conclusions............................................................... 163

    Endnotes............................................................................................ 164

    Chapter 16 Round Table Discussion.................................................................... 165

    Yukio Yanagisawa

    16.1 The Current Situation of Indoor Air Pollution....................... 165

    16.2 Medical Correlations in Japan................................................ 167

    xiv Contents

    16.3 Government Actions............................................................... 168

    16.4 Patients’ Compensation.......................................................... 169

    16.5 Damp Buildings...................................................................... 172

    16.6 Trade-Offs.............................................................................. 173

    Epilogue................................................................................................................. 175

    Index....................................................................................................................... 177

    Biography

    Yukio Yanagisawa is Professor Emeritus in Environmental Systems at University of Tokyo, Japan.

    Satoshi Ishikawa is Professor Emeritus in Environmental Medicine at Kitasato University, Japan.

    Hiroshi Yoshino is Professor Emeritus in Architecture at Tohoku University, Japan.

    Mikio Miyata is Professor Emeritus in Environmental Medicine at Kitasato University, Japan.