Environmental Illness

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Overview

What is an environmental illness?

Chemicals, fumes, pollution, allergens, and other health hazards are common in our environment, and sometimes they can make us sick. Maybe you have mysterious headaches that only occur on weekends. Or you develop nausea and a rash after moving into a newly built home. Such symptoms can be caused by exposure to toxins commonly found in our homes, workplaces, and communities. For example:

• Those weekend headaches may be caused by a faulty furnace leaking carbon monoxide. Using a fireplace could create a back draft of furnace gases that can cause headaches. Replacing the furnace could make the headaches go away.
• Building materials in new homes—insulation, particleboard, carpet adhesive—emit formaldehyde, which can cause nausea and rashes. Also, the paper that makes up the outside layers of drywall provides the right conditions for the growth of mold. Exposure to these molds may cause respiratory problems and allergylike symptoms and may provoke asthma attacks.

You and your doctor may not know what is causing your illness, or it may be mistaken for another problem. Environmental hazards can cause or aggravate a wide range of common medical problems. A thorough evaluation of the environments in which you work, live, and play could reveal what is causing your illness.

What causes environmental illnesses?

Short- and long-term exposure to hazards such as chemicals, allergens, pollution, and other toxins can cause environmental illnesses. Chemicals in cigarettes are known to cause lung cancer. Exposure to asbestos, a common insulating material that can be found in older buildings, can cause tumors in the linings of the chest and abdomen, lung cancer, and other diseases. Wood-burning stoves and improperly vented gas ranges can cause respiratory problems. Drinking water from a rural well contaminated with pesticides or solvents from a nearby industrial plant could cause cancer or neurological problems. Inhalation of spores from molds that grow on building materials can cause respiratory problems and may make asthma more severe. Exposure to certain chemicals in the workplace may cause sterility, especially in men.

But often we don't know such exposures are causing our sickness. We don't know the types or amounts of chemicals to which we've been exposed, especially when the symptoms of disease or illness don't develop for years. For example, most cancers have a latent, or silent, period that can last a decade or more before symptoms develop.

What symptoms do environmental illnesses cause?

Symptoms depend on the environmental cause of the illness or disease. Common symptoms include headaches, cough, fatigue, and nausea. In some cases, you may not have any symptoms for years, until a disease progresses far enough for you to notice signs of it. In other instances, exposure may cause immediate allergic reactions, such as when contact with dust mites, cockroaches, pollen, or pets triggers an asthma attack. Or symptoms may emerge more gradually and become worse as the time of exposure continues.

For some people, going to work in a building with poor indoor air quality may cause headaches, coughs, dizziness, fatigue, and nausea. The building may be improperly ventilated, causing exposure to fumes from cleaning solvents or cigarette smoke. New buildings or new carpets emit formaldehyde, which is known to cause symptoms such as nausea, respiratory problems, dry or inflamed skin, and eye irritation. Buildings may have bacteria, molds, or viruses that have built up in heating and cooling ducts, carpets, ceiling tiles, or insulation and can cause fever, chills, muscle aches, cough, and other respiratory symptoms.

Symptoms of environmental illness are difficult to diagnose and may be mistaken for other medical problems. If you suspect exposure to toxins could be making you sick, it is important that you discuss your thoughts with a doctor.

What are the symptoms of environmental illness?

You or your doctor may not know your illness is related to a toxic exposure unless your symptoms won't go away or they appear only at specific times or places. Good detective work by you and your doctor will be needed to diagnose an environmental illness. For example, if you keep a log of your symptoms, you may discover that you feel nauseous and sluggish throughout your workweek, but you feel better on weekends and vacations. Poor indoor air quality, which some people call "sick building syndrome," may then be suspected as the cause of your illness. Your symptoms may go away when you are out of the environment that is making you sick, for example, a recent remodel of a room in your house or a new office building at work. But unless you discuss the variations in your symptoms with your doctor, it will be difficult for him or her to make such a connection.

Checking the walls of your home or workplace for efflorescence—a white, powdery or crystalline substance that accumulates on the surface of concrete, plaster, or masonry—can be a good first indicator of the presence of molds or moisture that can lead to molds. Air sampling, in which trained professionals analyze a sample of the air in a building, is another way to find out if molds are present.

Often, solving the mystery isn't so simple. A more serious illness may be caused by something to which you were exposed decades ago. Perhaps in the past you lived near a hazardous waste site, or you had a job remodeling old homes, which exposed you to asbestos. Before talking to your doctor, think about your history, previous jobs, homes, and activities.

How are environmental illnesses diagnosed?

Doctors and other health professionals can diagnose an environmental illness by taking an exposure history, which is a lengthy set of questions about your home, workplace, habits, occupations, lifestyle, family, and other matters. Your answers to the questions can help identify chemicals or other hazards to which you've been exposed recently or in the past and help your doctor decide whether you need specific tests to diagnose your illness.

How are environmental illnesses treated?

Initial treatment for an environmental illness includes eliminating or reducing your exposure to what is making you sick. For example, one of the most effective ways to improve air quality is to get rid of the source of the pollution. Gas stoves can be adjusted to reduce emissions or replaced with electric stoves. You can also increase the amount of fresh air coming into your home, change furnace and air-conditioning filters often, and make sure exhaust fans in the kitchen and bathroom are working. Furnaces can be placed outside of your main living areas or even in the garage.

One of the first and best steps you can take to clean the air in your house is to not allow smoking in your house—if smokers live in or visit your home, have them smoke outside.

Treatment beyond these first steps varies based on your symptoms, the cause of the illness, and what part of your body is affected.

The health effects of mold exposure are best treated by preventing or restricting further mold growth. Maintaining a dry environment indoors can help restrict the growth of molds. Humidity should be kept at less than 50%.¹ Though it may be difficult to do, it is important to eliminate exposure to molds that have already infected your home or workplace or your child's school. Molds should be removed from buildings by trained professionals, and you or your children should not return to the building until the removal process is complete.

Last updated:	November 01, 2007
Author:	Caroline Rea, RN, BS, MS
Reviewed By:	Kathleen Romito, MD - Family Medicine, Peter Rabinowitz, MD, MPH - Occupational and Environmental Medicine
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC