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. 2008 Jul 25;105(30):523–531. doi: 10.3238/arztebl.2008.0523

Table 2. Frequently encountered problems in environmental medicine practice (17): constellations of symptoms.

Problem Relevant substance Routes/sources of uptake Environmental medicine anamnesis, physical findings Indication for laboratory tests Laboratory test/evaluation criteria Environmental medicine relevance/evaluation
Indoor mucosal irritation Formaldehyde Ambient air, indoor air (e.g., tobacco smoke), consumer products: furnishings, foam rubber, materials, disinfectants, etc. Irritation of mucosa and airways Symptoms and current exposure Indoor air/BfR safe level 0.124 mg/m3 HBM: not indicated owing to endogenous production paints, cleaning

  • Removal of potential sources recommended in presence of typical symptoms and confirmed exposure

  • Proven carcinogenicity
Indoor mucosal irritation, central nervous disorders Volatile organic compounds Ambient air, solvents (e.g., from paints), new buildings, renovation Irritation of mucosa and airways Symptoms and current exposure Indoor air/UBA reference and threshold values (16)

  • Removal of potential sources recommended in presence of typical symptoms and confirmed relevant exposure
Allergy, infection, and/or intoxication from indoor mold Mold spores and components Airways, skin Irritation of mucosa and airways, immune status: aspergillosis or asthma, dyspnea and/or pulmonary infiltrates Symptoms and current visible exposure in inhabited rooms Possibly indoor air and material samples, UBA (25)

  • Preventive renovation in the presence of dampness and/or visible mold
Sick building syndrome (SBS) No specific substance Indoor air/mucosae Irritation of ocular mucosae and upper and lower airways, non-specific symptoms Symptoms and current exposure, other people also affected Site inspection and standardized interview regarding interior perceptions and health problems Symptoms are as a rule primarily related to factors from the following areas:

  • Working activities and ergonomics

  • Personal disposition

  • Psychosocial context
Electrosensitivity High-frequency electromagnetic fields, e.g., from cell phone masts Field exposure, transdermal No acute symptoms, no warming-up effect expected at exposure below threshold values Interior space/Ordinance on Electromagnetic Fields*1

  • Adherence to threshold values (e17)

  • To date no levels above threshold values measured indoors or outdoors in Germany: BfS

  • Risk communication
Multiple chemical sensitivity – – No typical constellation of symptoms known, neurovegetative symptoms frequent Typical symptoms and history of specific exposure

  • Usually no reason to assume environmental cause for health problems

  • Risk communication

  • Interdisciplinary clinical diagnosis

  • Refer to specialized environmental medicine service

*1 26th Ordinance for Enforcement of the German Federal Immission Protection Law (Ordinance on Electromagnetic Fields – 26.BImSchV) of 16.12.1996 (BGBI. I S. 1966 ff.); BfR, Bundesinstitut für Risikobewertung (German Federal Institute for Risk Assessment); BfS, Bundesamt für Strahlenschutz (German Federal Office for Radiation Protection); UBA, Umweltbundesamt (German Federal Environment Agency)