Conference Agenda

This plenary is about non-specific building-related symptoms (NBRS), which refer to symptoms from the indoor air that are not likely to be caused by toxins, nor show organ pathology. The presentation will provide (i) an overview of common reactions in NBRS, including symptomatology, impact on quality of life, and adopted coping strategies, (ii) explanations as for why the afflicted individual manifests these reactions, and (iii) an overview of possible psychobiological mechanisms that may underlie the symptoms. The mechanisms include neural sensitization, neurogenic inflammation, classical conditioning, symptom misattribution and somatosensory amplification, and the nocebo effect. The important roles of the olfactory and chemosomatosensory systems and associative learning in NBRS will be addressed.

A first important message of this plenary is that NBRS manifest a very broad picture of symptoms, can in some cases have a severe impact on quality of life, and that persons with NBRS commonly adopt coping strategies that in long-term, in fact, may aggravate the NBRS. A second message is that, with our “stone-age” biology, the NBRS are likely intended to protect us from potentially harmful exposures by reducing its intake (e.g. by nasal congestion), expelling (e.g. by coughing) and avoiding it (e.g. by evoking pungency and pain), and recovering from it (e.g. by fatigue to encourage rest). Hence, these protective measures often do more harm than good. A third message is that there indeed are mechanisms that can explain how the “protective” symptoms are evoked, and that anyone of us, under certain circumstances, may develop NBRS. Finally, the question is addressed whether the practitioner can obtain information that would indicate possible underlying mechanism without having to test the individual that otherwise would require a well-controlled laboratory setting with specialized instrumentation and considerable time.

The goal of healthy indoor air for all is an ambitious one, but we have already made some progress and can leverage the renewed attention on indoor air related to the pandemic to continue to make progress. An incredibly diverse array of contaminants is found in indoor air and each has different physicochemical and biologic properties. The scientific literature implicating each type of contaminant to health effects is highly variable and building this evidence base is a challenging task. For example, some biologic contaminants may be beneficial in some circumstances and harmful in others. Understanding how best to reduce exposure to any given contaminant can also be complicated and in some circumstances very difficult to achieve. For other contaminants where the evidence of harm is virtually universal and there are clear strategies for reducing airborne concentrations the dissemination and implementation of these strategies has hit obstacles limiting their potential to improve health. Importantly, environmental justice and health equity, concepts that are strongly tied to outdoor air pollution, are also salient for indoor air since marginalized communities are less likely to have health-promoting indoor air in their homes, schools, and places of work. Identifying the challenges to achieving healthy indoor air for all and assembling inter-disciplinary teams and coalitions to tackle these challenges will be the key to making meaningful progress towards this goal.