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 (R) 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
