Expert Commentary

Indoor Air Quality: No Easy Answers

Molds, bacteria, and viruses in homes and businesses can create a wide variety of health problems. This article discusses the “A Microbiological Menace? Indoor Air Quality and Molds, Bacteria & Viruses” seminar at the RIMS Annual Conference.

Personal Lines Insurance
May 2001
  • "A civilized country is one whose inhabitants must go to a backward area in order to breathe pure, clean air."


Molds, bacteria, and viruses in homes and businesses can create a wide variety of health problems in humans. Symptoms include the following:

  • Dry, itchy, and watery eyes
  • Stuffy, bloody, or runny nose
  • Dry throat
  • Lethargy
  • Headache
  • Flu-like illness
  • Breathing difficulty
  • Skin rash

Scientists and doctors can now sometimes make the link between these symptoms and indoor air quality.

This subject was covered in one of the many insightful seminars at the RIMS Annual Conference held April 29-May 4 in Atlanta. The seminar, "A Microbiological Menace? Indoor Air Quality and Molds, Bacteria & Viruses" was led by Howard Sandler, M.D., of OccuLink, and Sandler Occupational Medicine Associates, Inc., and Martin Reape, Ph.D., Director of Health Sciences with FMC Corporation. This article discusses their speech.

Sick Buildings Defined

Dr. Sandler began the seminar with two important definitions. First, he defined a "building-related illness" as "a specific, well-defined illness for which a direct building related condition can be shown as the cause of the illness." Second, he defined "sick building syndrome" as "a situation where some building occupants experience health and comfort issues associated with being in the building. No specific illness or cause is identified."

He listed a host of complaint triggers. These include the following:

  • Poor housekeeping
  • Seasonal change
  • Water damage
  • New building
  • Recently painted, carpeted, or refurbished environment
  • Pest control activity

Biological Contaminants and Their Consequences

Various biological contaminants include:

  • Viruses
  • Bacteria
  • Molds, including Stachybotrys
  • Fungi
  • Biotoxins
  • Dust mites
  • Allergens, e.g., cockroaches

These contaminants can lead to devastating consequences. Dr. Sandler mentioned a case in which an entire home was allegedly ruined by the mold, Stachybotrys. Not only was the house allegedly destroyed, but all the contents ruined as well. In addition, all four of the residents claimed that they suffered various permanent disabilities.

Another case, reported by the Sacramento Bee in February 2001 concerned a California couple whose home and contents were saturated by toxic molds. In this case, the local fire department purposefully burned down their home. The couple claimed that the molds left everyone in the home with respiratory problems, nosebleeds, rashes, vision problems, and other illnesses. They estimated spending nearly $200,000 in building, testing, and medical costs during their 2-year struggle with these molds.

It is noteworthy, however, that there is no clear consensus on this issue. For example the mold Stachybotrys has been implicated in several cases of pulmonary hemorrhage in infants. However, this implication, initially proposed by researchers at the Centers for Disease Control in Atlanta, is now being questioned. This same organization is now suggesting that this conclusion was premature, citing problems with the methodology used in the original study.

A complicating factor, according to Dr. Reape, is that not all symptoms may be caused by mold or other indoor air pollution within a building. In some tests, the level of mold was higher outside the affected building then inside it. In other tests, the levels of contaminants were the same in houses with and without complaints. There are a host of factors that could cause the symptoms, including indoor air pollution at the individual's workplace, stress levels of the individual, and the individual's allergies.

Managing the Risk

How should a homeowner or landlord handle the indoor air pollution exposure? According to these authorities, if this is suspected as causing an illness, the following steps should be taken.

  • Check inside and outside the dwelling or building for leaks and any visual evidence of contaminants. This includes going to the attic and basement to check closely for dampness and discoloration. Also attempt to detect odors of mold. Plumbing leaks are a chief culprit in causing molds in homes. In addition, an evaluation of the heating, ventilation, and air conditioning (HVAC) system is warranted.
  • If mold or other contaminants are found, immediate steps should be taken to rid the dwelling or building of the contaminants. In many cases, the use of an environmental consultant may be necessary. It is imperative to check out the credentials of this consultant and contact the references provided. In addition, it is wise to select someone that does not perform the actual remediation work or have an interest in a company that does.
  • If symptoms persist, it is recommended to see a physician who specializes in occupational and environmental medicine instead of a family practitioner. The specialist will often be able to more easily isolate the cause.

Dr. Sandler stated, however, that remediation of the mold problem does not always work. "There is limited success in this process, particularly if the symptoms are not related to indoor air pollution, but to stress and allergies. In some cases, the allergies could be related to dust mites and not to mold."

Dr Sandler also stressed that, in most cases, there is not a direct causal relationship between indoor air pollution and the symptoms or it is impossible to prove the contamination is the sole and direct cause of the illness. "But this is not always the case and it should be investigated. What is not recommended is to ignore the problem or tell residents or tenants that the problem is in their head."


There are no easy, solid answers to the problem of indoor air pollution, whether it occurs in the workplace or at home. According to Dr. Sandler, assumptions of a direct cause of the symptoms may be premature and should be tested using sound scientific methodology.

Special thanks to Howard Sandler, M.D. for his assistance in this article. Dr. Sandler is the President of OccuLink and Sandler Occupational Medicine Associates, Inc., in Melville, New York. His website can be found at OccuLink is an Internet-based provider of management systems and clinical services.

Opinions expressed in Expert Commentary articles are those of the author and are not necessarily held by the author's employer or IRMI. Expert Commentary articles and other IRMI Online content do not purport to provide legal, accounting, or other professional advice or opinion. If such advice is needed, consult with your attorney, accountant, or other qualified adviser.

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