Sick building syndrome (SBS) is a term coined for a set of clinically recognizable symptoms and ailments without a clear cause reported by occupants of a building. In the 1990s the term “functional somatic syndromes” was applied to several syndromes, including SBS, multiple chemical sensitivity, repetition stress injury, the side effects of silicone breast implants, the Gulf War syndrome (GWS), chronic fatigue syndrome, the irritable bowel syndrome, and fibromyalgia. Recently, Shoenfeld and Agmon-Levin suggested that four conditions—siliconosis, macrophagic myofascitis, the GWS, and post-vaccination phenomena—which share clinical and pathogenic resemblances, may be included under a common syndrome entitled the “autoimmune (auto-inflammatory) syndrome induced by adjuvants”. Comparison of the clinical manifestations, symptoms, and signs of the four conditions described by Shoenfeld and Agmon-Levin with those described for SBS shows that nine out of ten main symptoms are present in all 5 conditions. Shoenfeld and Agmon-Levin further propose 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”.
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Fanger PO. Hidden olfs in sick buildings. ASHRAE. 1988;30:40–3.
WHO. Indoor air quality research. EURO Rep Stud. 1986;103:1–64.
Norback D. An update on sick building syndrome. Curr Opin Allergy Clin Immunol. 2009;9:55–9.
Finnegan MJ, Pickering CA, Burge PS. The sick building syndrome: prevalence studies. Br Med J (Clin Res Ed). 1984;289:1573–5.
Brasche S, Bullinger M, Morfeld M, Gebhardt HJ, Bischof W. Why do women suffer from sick building syndrome more often than men? Subjective higher sensitivity versus objective causes. Indoor Air. 2001;11:217–22.
Stenberg B, Wall S. Why do women report ‘sick building symptoms’ more often than men? Soc Sci Med. 1995;40:491–502.
Burge S, Hedge A, Wilson S, Bass JH, Robertson A. Sick building syndrome: a study of 4373 office workers. Ann Occup Hyg. 1987;31:493–504.
Bardana EJ Jr, Montanaro A, O’Hollaren MT. Building-related illness. A review of available scientific data. Clin Rev Allergy. 1988;6:61–89.
Israeli E, Agmon-Levin N, Blank M, Shoenfeld Y. Adjuvants and autoimmunity. Lupus. 2009;18:1217–25.
Nancy AL, Shoenfeld Y. Chronic fatigue syndrome with autoantibodies—the result of an augmented adjuvant effect of hepatitis-B vaccine and silicone implant. Autoimmun Rev. 2008;8:52–5.
Shoenfeld Y, Agmon-Levin N. “ASIA”—autoimmune (auto-inflammatory) syndrome induced by adjuvant. J Autoimmun. 2010; [Epub ahead of print].
Chang CC, Ruhl RA, Halpern GM, Gershwin ME. Building components contributors of the sick building syndrome. J Asthma. 1994;31:127–37.
Ruhl RA, Chang CC, Halpern GM, Gershwin ME. The sick building syndrome. II. Assessment and regulation of indoor air quality. J Asthma. 1993;30:297–308.
Assoulin-Daya Y, Leong A, Shoenfeld Y, Gershwin ME. Studies of sick building syndrome. IV. Mycotoxicosis. J Asthma. 2002;39:191–201.
Schutze N, Lehmann I, Bonisch U, Simon JC, Polte T. Exposure to mycotoxins increases the allergic immune response in a murine asthma model. Am J Respir Crit Care Med. 2010;181:1188–99.
Straus DC. Molds, mycotoxins, and sick building syndrome. Toxicol Ind Health. 2009;25:617–35.
Meggs WJ. RADS and RUDS—the toxic induction of asthma and rhinitis. J Toxicol Clin Toxicol. 1994;32:487–501.
Steerenberg PA, Withagen CE, Dormans JA, van Dalen WJ, van Loveren H, Casee FR. Adjuvant activity of various diesel exhaust and ambient particles in two allergic models. J Toxicol Environ Health A. 2003;66:1421–39.
Diaz-Sanchez D, Tsien A, Fleming J, Saxon A. Combined diesel exhaust particulate and ragweed allergen challenge markedly enhances human in vivo nasal ragweed-specific IgE and skews cytokine production to a T helper cell 2-type pattern. J Immunol. 1997;158:2406–13.
Li N, Wang M, Bramble LA, Schmitz DA, Schauer JJ, Sioutas C, et al. The adjuvant effect of ambient particulate matter is closely reflected by the particulate oxidant potential. Environ Health Perspect. 2009;117:1116–23.
Schober W, Lubitz S, Belloni B, Gebauer G, Lintelmann J, Matuschek G, et al. Environmental polycyclic aromatic hydrocarbons (PAHs) enhance allergic inflammation by acting on human basophils. Inhal Toxicol. 2007;19(Suppl 1):151–6.
Barsky AJ, Borus JF. Functional somatic syndromes. Ann Intern Med. 1999;130:910–21.
Kipen HM, Fiedler N. Environmental factors in medically unexplained symptoms and related syndromes: the evidence and the challenge. Environ Health Perspect. 2002;110(Suppl 4):597–9.
Binder LM, Campbell KA. Medically unexplained symptoms and neuropsychological assessment. J Clin Exp Neuropsychol. 2004;26:369–92.
Chang C, Gershwin ME. Indoor air quality and human health: truth vs mass hysteria. Clin Rev Allergy Immunol. 2004;27:219–39.
Chang CC, Ruhl RA, Halpern GM, Gershwin ME. The sick building syndrome. I. Definition and epidemiological considerations. J Asthma. 1993;30:285–95.
Mahmoudi M, Gershwin ME. Sick building syndrome. III. Stachybotrys chartarum. J Asthma. 2000;37:191–8.
Tsai YJ, Gershwin ME. The sick building syndrome: what is it when it is? Compr Ther. 2002;28:140–4.
Garabrant DH, Dumas C. Epidemiology of organic solvents and connective tissue disease. Arthritis Res. 2000;2:5–15.
Molina V, Shoenfeld Y. Infection, vaccines and other environmental triggers of autoimmunity. Autoimmunity. 2005;38:235–45.
Kanazawa A, Kishi R. Potential risk of indoor semivolatile organic compounds indoors to human health. Nippon Eiseigaku Zasshi. 2009;64:672–82.
Koren HS, Graham DE, Devlin RB. Exposure of humans to a volatile organic mixture. III. Inflammatory response. Arch Environ Health. 1992;47:39–44.
Agmon-Levin N, Paz Z, Israeli E, Shoenfeld Y. Vaccines and autoimmunity. Nat Rev Rheumatol. 2009;5:648–52.
Bar-Meir E, Eherenfeld M, Shoenfeld Y. Silicone gel breast implants and connective tissue disease—a comprehensive review. Autoimmunity. 2003;36:193–7.
Zandman-Goddard G, Blank M, Ehrenfeld M, Gilburd B, Peter J, Shoenfeld Y. A comparison of autoantibody production in asymptomatic and symptomatic women with silicone breast implants. J Rheumatol. 1999;26:73–7.
Campbell AW, Thrasher JD, Madison RA, Vojdani A, Gray MR, Johnson A. Neural autoantibodies and neurophysiologic abnormalities in patients exposed to molds in water-damaged buildings. Arch Environ Health. 2003;58:464–74.
Cooley JD, Wong WC, Jumper CA, Hutson JC, Williams HJ, Schwab CJ, et al. An animal model for allergic penicilliosis induced by the intranasal instillation of viable Penicillium chrysogenum conidia. Thorax. 2000;55:489–96.
Gray MR, Thrasher JD, Crago R, Madison RA, Arnold L, Campbell AW, et al. Mixed mold mycotoxicosis: immunological changes in humans following exposure in water-damaged buildings. Arch Environ Health. 2003;58:410–20.
Lander F, Meyer HW, Norn S. Serum IgE specific to indoor moulds, measured by basophil histamine release, is associated with building-related symptoms in damp buildings. Inflamm Res. 2001;50:227–31.
Meggs WJ. Neurogenic switching: a hypothesis for a mechanism for shifting the site of inflammation in allergy and chemical sensitivity. Environ Health Perspect. 1995;103:54–6.
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Israeli, E., Pardo, A. The sick building syndrome as a part of the autoimmune (auto-inflammatory) syndrome induced by adjuvants. Mod Rheumatol 21, 235–239 (2011). https://doi.org/10.1007/s10165-010-0380-9