In 1976, at an American Legion convention in Philadelphia, a particularly deadly strain of bacteria caused the tragic deaths of 29 participating veterans. It was later discovered that the bacteria, now named Legionella Pneumophila, had spread via the ducts in the hotel’s air-conditioning system.

Fortunately, this was a rare and isolated case of sick building syndrome (SBS). However, SBS in its many milder forms is more common than most people realize and can result in reduced productivity and increased health care costs, estimated to be has high as $200 billion per year. To establish and enforce truly adequate safety standards would place an enormous economic strain on developers, building owners and government at every level. It is troubling to think that the prospect of eliminating health problems from indoor air might be too expensive to bear.

Older buildings are often the source of the problem. Patients frequently come to the clinic seeking relief from allergy symptoms including sneezing, itchy, burning eyes and runny nose; a cough that comes from postnasal drip; rashes; and even asthma. Much of the time, symptoms are not related to vog or exposure to plant life. In fact, a frequent complaint is, "I am fine when I am outside. It is when I go indoors that the sneezing starts." When testing my patients for allergies, I find that the most common reactions are to mold and dust mite feces, routinely found in older buildings.

New buildings can have their own problems. Building materials such as carpet, wallboard and adhesives tend to emit toxic chemicals, especially when they are newly installed, through a process called outgassing. If the building you are in doesn’t have sufficient ventilation, these toxins remain in the air until they reach levels that can lead to illness. Again, symptoms vary, ranging from burning, watering eyes and nose to dizziness, depressed mood, inability to concentrate or worse.

So what’s the answer? Well, in Sweden they strongly encourage new buildings to remain vacant for up to six months to allow the toxin levels to taper off. For economic reasons that solution is unlikely to fly in this country. Fortunately, however, the advance of "green" building technology has led to the creation of hundreds of new building products that don’t emit volatile organic compounds and other noxious substances associated with SBS.

A "best-practices" certification program called LEED (Leadership in Energy and Environmental Design) recommends the use of these products wherever possible, as well as retrofitting older buildings during regular maintenance. Other best practices include new building designs that minimize the accumulation of moisture to prevent mold and enough ventilation so the incoming fresh air can reduce the ambient concentration of toxins in the air. Recommendations also include minimizing the use of carpets and, if possible, removal of old carpets that might harbor mold and mite feces.

In a perfect world, regulations would be in place to ensure that all new buildings and building maintenance schedules will serve the health of human occupants over the long run. For now, if you start sniffling and sneezing when you go indoors, or experience other troublesome symptoms, you might need to treat not just yourself, but also the building you are in. Remember, buildings can be sick, too.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.