Sick Building Syndrome

oPatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

Sick building syndrome (SBS) describes a situation whereby people experience symptoms of ill health that seem to be linked to spending time in a building but where no specific cause can be identified.

The term building-related illness (BRI) refers to recognised diseases, often infections (eg, Legionnaires' disease), caused by being in a building. The cause of SBS is thought to be at least in part due to changes in building and ventilation design triggered by the energy crisis in the 1970s.

One large study found no significant relation between most aspects of the physical work environment and symptom prevalence.[1]

  • Greater effects were found with features of the psychosocial work environment including high job demands and low support.
  • The report concluded that the physical environment of office buildings appears to be less important than features of the psychosocial work environment in explaining differences in the prevalence of symptoms.

A subsequent study, found that whilst SBS was associated with poor supervisor support and perception of poor physical environmental conditions at work, an association with poor air quality was also present, even when allowances were made for the psychosocial environment.[2] 

Research has shown that SBS shares several symptoms common in other conditions thought to be caused be external factors. The umbrella term 'autoimmune (auto-inflammatory) syndrome induced by adjuvants' has been suggested. Other members of the suggested group include:[3] 

  • Siliconosis.
  • Macrophagic myofascitis.
  • The Gulf War syndrome
  • Post-vaccination phenomena.

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SBS is related to both personal and environmental risk factors. Risk factors for SBS include:

  • Poor ventilation.
  • High room temperature.
  • Ineffective cleaning routines.
  • Poor lighting.
  • Smoking in the workplace.
  • Air conditioning.
  • Low humidity.
  • Psychological factors such as stress or poor staff morale.
  • Internal chemical contaminants: usually air pollutants:
    • Initial emissions from components and fittings of a building - the 'new smell' generally dissipates over a short period but can last years.
    • Volatile organic compounds, including formaldehyde, cleaning products, and manufactured plastic and wood products.
    • Ozone from photocopiers and printers.
    • Carbon monoxide, carbon dioxide and other inorganic oxides given off as combustion products in heating systems.[4] 
    • Small fibres from furnishings, regularly agitated into the air by frequent sweeping. Also, asbestos in older buildings.
    • Tobacco smoke.
  • External contaminants - outside air entering a building:
    • Vehicle exhaust fumes: from streets/underground car parks.
    • Recycling of the building's own exhaust back in through poorly positioned vents/windows.
    • Other external air pollution or airborne particles (eg, pollen, moulds) have been postulated but the evidence is unconvincing.[5] 
    • The prime suspect in most cases is inadequate ventilation. The factors leading to poor ventilation include insufficient outside air, poor filtration of internal and external air, contaminated duct work, dirty heating, ventilating and air conditioning units, poor planning and placement of vents.

General tiredness is often the most common symptom. It usually starts within a few hours of arriving at work and improves within minutes of leaving the building. Symptoms may be worse in the winter months in northern climates:[6]

  • Headaches and dizziness; headaches are usually non-migrainous, rarely throbbing, and usually described as dull and often as a pressure on the head.[6]
  • Tiredness, loss of concentration.
  • Eye problems.
  • Skin problems - eg, dry or itchy skin.
  • Nausea.
  • Coughing, shortness of breath, wheezing.
  • Ear, nose or throat irritation.[7] 
  • Guidance from the Health and Safety Executive (HSE) recommends that employers should:
  • Carry out an employee survey to see if the occurrence of symptoms is higher than expected.
  • Check the general cleanliness of the building, the state of all cleaning machinery (eg, vacuum cleaners) and the usage and storage of cleaning materials.
  • Check the heating, ventilation and air conditioning system.
  • After any initial steps to resolve the problem have been implemented, it may be necessary to repeat the employee survey and it may be necessary to carry out a more detailed assessment of the workplace environment.
  • Education and recognition of the problem.
  • Addressing relevant psychosocial issues - eg, high job demands and low support.
  • Removal of the pollution source if possible.
  • Improved planning of building ventilation.
  • Maintenance of indoor air quality by regular servicing and quality measurements.
  • Discouragement of smoking.
  • Increasing the number of live plants in buildings.

Further reading & references

  1. Marmot AF, Eley J, Stafford M, et al; Building health: an epidemiological study of "sick building syndrome" in the Whitehall II study. Occup Environ Med. 2006 Apr;63(4):283-9.
  2. Runeson-Broberg R, Norback D; Sick building syndrome (SBS) and sick house syndrome (SHS) in relation to psychosocial stress at work in the Swedish workforce. Int Arch Occup Environ Health. 2013 Nov;86(8):915-22. doi: 10.1007/s00420-012-0827-8. Epub 2012 Nov 11.
  3. Israeli E, Pardo A; The sick building syndrome as a part of the autoimmune (auto-inflammatory) syndrome induced by adjuvants. Mod Rheumatol. 2011 Jun;21(3):235-9. doi: 10.1007/s10165-010-0380-9. Epub 2010 Dec 29.
  4. Norback D, Nordstrom K; Sick building syndrome in relation to air exchange rate, CO(2), room temperature and relative air humidity in university computer classrooms: an experimental study. Int Arch Occup Environ Health. 2008 Oct;82(1):21-30. doi: 10.1007/s00420-008-0301-9. Epub 2008 Feb 2.
  5. Terr AI; Sick Building Syndrome: is mould the cause? Med Mycol. 2009;47 Suppl 1:S217-22. doi: 10.1080/13693780802510216. Epub 2009 Mar 2.
  6. Burge PS; Sick building syndrome. Occup Environ Med. 2004 Feb;61(2):185-90.
  7. Renner B, Mueller CA, Shephard A; Environmental and non-infectious factors in the aetiology of pharyngitis (sore throat). Inflamm Res. 2012 Oct;61(10):1041-52. doi: 10.1007/s00011-012-0540-9. Epub 2012 Aug 14.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Dr Colin Tidy
Current Version:
Peer Reviewer:
Dr John Cox
Last Checked:
29/08/2014
Document ID:
1131 (v23)
© EMIS