Chemical Sensitivity and Sick-Building Syndrome

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