[Functional somatic syndromes in the treatment of allergic diseases and their related disorders].

Functional somatic syndromes (FSS) are characterized by patterns of persistent bodily complaints for which adequate examination does not reveal sufficiently explanatory structural or other specified pathology. Here we reviewed the following diseases or pathologies: nervous cough, vocal cord dysfunction, multiple chemical sensitivity and sick building syndrome. All of these often accompany co-morbid psychiatric disorders, such as anxiety disorder and depression. Therefore, bio-psycho-social understanding and approach are required for diagnosis and treatment of patients with these diseases. Specific psychotherapy may be applicable when symptoms are aggravated by psychological factors.

Decreased work ability associated to indoor air problems--An intervention (RCT) to promote health behavior.

INTRODUCTION: Indoor air problems may induce respiratory irritation and inflammation. In occupational settings, long-lasting non-specific building-related symptomatology, not fully medically explained, is encountered. The symptomatology may lead to illness, avoidance behavior and decreased work ability. In Finland, investigations of workers suspected of occupational asthma have revealed excess disability. There are no well-established clinical practices for the condition. OBJECTIVE: The aim was to develop a clinical intervention for patients with non-specific indoor air-related symptoms and decreased work ability. METHODS: A randomized controlled trial including psychoeducation and promotion of health behavior was carried out in 55 patients investigated for causal relationship between work-related respiratory symptoms and moisture damaged workplaces. Inclusion criteria for disability was the work ability score (WAS)≤7 (scale 0-10) and indoor air-related sick leave ≥14 days the preceding year. After medical evaluation and the 3-session counseling intervention, follow-up at 6-months was assessed using self-evaluated work-ability, sick leave days, quality of life, and illness worries as outcome measures. RESULTS: The mean symptom history was 55.5 months. 82% (45 out of 55) had asthma with normal lung function tests in most cases, although reporting abundant asthma symptoms. 81% of patients (39/48) had symptomatology from multiple organ systems without biomedical explanation, despite environmental improvements at work place. At the psychological counseling sessions, 15 (60%) patients of the intervention (INT, n=25) group showed concerns of a serious disease and in 5 (20%), concerns and fears had led to avoidance and restricted personal life. In the 6-month follow-up, the outcomes in the INT group did not differ from the treatment as usual group. CONCLUSION: No intervention effects were found. Patients shared features with medically unexplained symptoms and sick building syndrome or idiopathic environmental intolerance. Long environment-attributed non-specific symptom history and disability may require more intensive interventions. There is a need for improved recognition and early measures to prevent indoor-associated disability. TRIAL REGISTRATION NUMBER: Single-center randomized controlled trial (ISRCTN33165676).

Building-related illness and sick building syndrome: from the specific to the vague.

When a primary-care physician encounters a patient with a possible building-related illness, common sense applies. Does the patient have a potentially serious condition? Does he or she need a referral to a specialist? This paper explores the topics of building-related illness and sick building syndrome.

Sick-building syndrome.

Sick-building syndrome (SBS) is an increasingly common problem. Although objective physiological abnormalities are not generally found and permanent sequelae are rare, the symptoms of SBS can be uncomfortable, even disabling, and whole workplaces can be rendered non-functional. In assessment of patients with SBS complaints, specific building-related illnesses suggested by history or physical examination should be ruled out. On-site assessment of buildings is extremely useful. Treatment involves both the patient and the building. Whenever possible, changes such as ventilation improvements and reduction of sources of environmental contamination should be initiated even if specific aetiological agents have not been identified.

[The non-specific environmental syndromes MCS (Multiple Chemical Sensitivity), IEI (Idiopathic Environmental Intolerance) and SBS (Sick Building Syndrome)]. / Die unspezifischen Umweltsyndrome MCS, IEI und SBS. Klinische Bilder und Therapieansätze.

This review starts with a clinical description of the most common unspecific environmental diseases, such as Multiple Chemical Sensitivities (MCS), Idiopathic Environmental Intolerances (IEI) and Sick Building Syndrome (SBS). These syndromes are very controversial discussed between scientific medicine and "clinical ecology". In addition, they have fundamental similarities to Chronic Fatigue Syndrome (CFS) and Fibromyalgia. Finally the spectrum of therapeutic approaches is discussed.