Saf Health Work.  2019 Sep;10(3):362-369. 10.1016/j.shaw.2019.06.003.

Clinical Characteristics of Disability in Patients with Indoor Air–Related Environmental Intolerance

• Vuokko A
• Karvala K
• Suojalehto H
• Lindholm H
• Selinheimo S
• Heinonen-Guzejev M
• Leppämäki S
• Cederström S
• Hublin C
• Tuisku K
• Sainio M

• KMID: 2459750
• DOI: http://doi.org/10.1016/j.shaw.2019.06.003

Abstract

BACKGROUND
Chronic nonspecific symptoms attributed to indoor nonindustrial work environments are common and may cause disability, but the medical nature of this disability is unclear. The aim was to medically characterize the disability manifested by chronic, recurrent symptoms and restrictions to work participation attributed to low-level indoor pollutants at workplace and whether the condition shares features with idiopathic environmental intolerance.
METHODS
We investigated 12 patients with indoor air-related work disability. The examinations included somatic, psychological, and psychiatric evaluations as well as investigations of the autonomic nervous system, cortisol measurements, lung function, and allergy tests. We evaluated well-being, health, disability, insomnia, pain, anxiety, depression, and burnout via questionnaires.
RESULTS
The mean symptom history was 10.5 years; for disabling symptoms, 2.7 years. Eleven patients reported reactions triggered mainly by indoor molds, one by fragrances only. Ten reported sensitivity to odorous chemicals, and three, electric devices. Nearly all had co-occurrent somatic and psychiatric diagnoses and signs of pain, insomnia, burnout, and/or elevated sympathetic responses. Avoiding certain environments had led to restrictions in several life areas. On self-assessment scales, disability showed higher severity and anxiety showed lower severity than in physician assessments.
CONCLUSION
No medical cause was found to explain the disability. Findings support that the condition is a form of idiopathic environmental intolerance and belongs to functional somatic syndromes. Instead of endless avoidance, rehabilitation approaches of functional somatic syndromes are applicable.

Keyword

Building-related intolerance; Disability evaluation; Environmental intolerance; Functional somatic syndromes; Indoor air

MeSH Terms

Anxiety
Autonomic Nervous System
Depression
Disability Evaluation
Fungi
Humans
Hydrocortisone
Hypersensitivity
Lung
Multiple Chemical Sensitivity
Odors
Rehabilitation
Self-Assessment
Sleep Initiation and Maintenance Disorders
Weights and Measures
Hydrocortisone