Mechanisms underlying nontoxic indoor air health problems: A review
Open accessAbstract
Indoor air health problems of the type non-specific building-related symptoms (NBRS; formally called "sick-building syndrome") and chemical intolerance (CI; e.g. multiple chemical sensitivity) can in severe cases lead to significant disability and poor quality of life. Apart from suffering of the afflicted individuals, the productivity loss ascribed to environmental intolerances of this kind is very costly for society. Preventive measures and appropriate treatment call for understanding of the mechanism underlying NBRS and CI. Considerable similarities between NBRS and CI suggest that the two conditions at large share mechanisms. Since typical cases of these conditions cannot be explained by toxic exposure, the present objective is to describe underlying mechanisms of psychobiological nature for which there is well-developed theoretical ground and empirical support. Focus lies on the mechanisms neurogenic inflammation and neural sensitization. Apart from describing its basic mechanisms, neurogenic inflammation is reviewed in relation to NBRS and CI regarding neurogenic switching, activation of the autonomic nervous system and axon reflex as well as interaction effects between chemical irritants, allergens, and psychosocial stressors. In addition to describing various types of sensitization, empirical support for their role in NBRS and CI is reviewed. The mechanism classical conditioning, symptom misattribution and somatosensory amplification, and nocebo are also addressed. The review rounds off with a discussion on why only a subset of individuals exposed to these indoor environments develop NBRS and CI, and a discussion on integration of the presented mechanisms, accompanied by proposed hypotheses for future research.
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Disabling PPS, manifesting as building-related environmental intolerance, has a biopsychosocial nature, emphasizing symptom perception, awareness, and interpretation rather than organic or toxicological causes.
“Research has revealed that disabling PPS, manifesting as building-related environmental intolerance, has a biopsychosocial nature, emphasizing symptom perception, awareness, and interpretation rather than organic or toxicological causes [12, 13, 15].”
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Self-citationIdiopathic environmental intolerances
den Bergh, O. V., Pitron, V., Nordin, S., & Witthöft, M. (2023) · Elsevier eBooks · doi:10.1016/b978-0-12-824315-2.00595-9 · Cited by 3 · see citing works
Self-citationSaijo, Y., Yoshioka, E., Sato, Y., Shiotsuki, H., Nakanishi, K., Kato, Y., Nagaya, K., Takahashi, S., Ito, Y., Ikeda, A., et al. (2025) · PLoS ONE · doi:10.1371/journal.pone.0324562 · Cited by 2 · see citing works
Kang, T., Qiu, Z., Aodeng, S., Liu, Y., Zhu, Z., & Lv, W. (2026) · Biomedicines · doi:10.3390/biomedicines14051015 · Cited by 2 · see citing works
Changes in Reported Symptoms Attributed to Office Environments in Sweden between 1995 and 2020
Egfors, D., Gunnarsson, A. G., & Ricklund, N. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191811434 · Cited by 2 · see citing works
Reichherzer, A., Wargocki, P. L., Mayer, F., Norrefeldt, V., & Herbig, B. (2022) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2022.114045 · Cited by 2 · see citing works
Biomonitoring of Indoor Air Fungal or Chemical Toxins with Caenorhabditis elegans nematodes
Paavanen‐Huhtala, S., Kalichamy, K. S., Pessi, A.-M., Häkkilä, S., Saarto, A., Tuomela, M., Andersson, M. A., & Koskinen, P. J. (2023) · Pathogens · doi:10.3390/pathogens12020161 · Cited by 2 · see citing works
Iwayama, R., Shimatani, K., Nakayama, Y., Takaguchi, K., Nakaoka, H., Suzuki, N., & Sakurai, K. (2025) · Buildings · doi:10.3390/buildings15173013 · Cited by 1 · see citing works
Köteles, F. G., Witthöft, M., Bräscher, A., Bailer, J., & Nordin, S. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112495 · Cited by 1 · see citing works
Self-citationde Vocht, F. (2022) · Reviews on Environmental Health · doi:10.1515/reveh-2022-0058 · Cited by 1 · see citing works
Nordin, S., Finell, E., & Nordin, M. (2024) · Cogent Psychology · doi:10.1080/23311908.2024.2424613 · Cited by 1 · see citing works
Self-citationVuokko, A., Immonen, M., Lappalainen, P., Keinonen, K., Sainio, M., Lappalainen, R., Paunio, T., & Selinheimo, S. (2026) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-026-10400-z
Nordin, S. (2020) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2020.113544
Self-citationChemical intolerance : disability and health aspects from a biopsychosocial perspective
Söderholm, A. (2020) · DiVA at Umeå University (Umeå University)
Nynäs, P., Vilpas, S., Kankare, E., Karjalainen, J., Lehtimäki, L. A., Numminen, J., Tikkakoski, A., Kleemola, L., & Uitti, J. (2023) · Healthcare · doi:10.3390/healthcare11070971
Köteles, F. G., Nordin, S., & Claeson, A. (2023) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2023.111476
Self-citationIndoor Environment: Background Information
Fromme, H. (2023) · Springer eBooks · doi:10.1007/978-3-031-40078-0_1
Hurraß, J., Teubel, R., Fischer, G., Heinzow, B., & Wiesmüller, G. A. (2024) · Allergo Journal · doi:10.1007/s15007-024-6287-0
INDOOR AIR QUALITY MONITORING IN DWELLINGS: CASE STUDIES IN MADRID, SPAIN
Gonzalo, F. D. A., Contreras, G. S., Fernandez, E. J. L., & González‐Lezcano, R. A. (2024) · Journal of Green Building · doi:10.3992/jgb.19.3.117
The frequency and features of allergic diseases in environmental pathology
Валентиновна, Б. Е., Валерьевна, Д. А., Владимирович, О. В., & Викторовна, Б. Л. (2024) · Meditsinskiy sovet = Medical Council · doi:10.21518/ms2024-271
Selinheimo, S., Eidstø, E., Lampi, J., Salmela, A., & Pekkanen, J. (2024) · Indoor Environments · doi:10.1016/j.indenv.2024.100061
Keränen, H., Vuokko, A., Korenius, P., Selinheimo, S., & Juvonen-Posti, P. (2026) · Work · doi:10.1177/10519815251414377
Zhang, Y., Chen, Z., Xiao, G., & Saha, S. (2026) · Indoor Air · doi:10.1155/ina/3652817
Kaikkonen, S., Savijärvi, M., & Finell, E. (2026) · Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine · doi:10.1177/13634593261473147
- Authors
- Nordin, S.
- Affiliations
- Umeå University (SE)
- Corresponding author
- Nordin, Steven
- ORCID
- Nordin, Steven
- Venue
- International Journal of Hygiene and Environmental Health
- Publisher
- Elsevier BV
- Published
- 2020-05
- Volume
- 226
- Pages
- 113489
- ISSN
- 1438-4639 (ISSN-L)
- OpenAlex
- W3009129425
- Cited by
- 58
- References
- 175
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 18 · 2023: 11 · 2022: 6 · 2021: 7 · 2020: 7
- FWCI
- 0.67
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Hygiene and Environmental Health (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DiVA at Umeå University (Umeå University) (submittedVersion, other-oa)
- Funders
- AFA Försäkring
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Physical Sciences › Engineering › Building and Construction › Building Energy and Comfort Optimization
- Keywords
- sick building syndrome, multiple chemical sensitivity, chemical intolerance, neurogenic inflammation, neural sensitization, autonomic nervous system, axon reflex, chemical irritants, allergens, psychosocial stressors, classical conditioning, symptom misattribution, somatosensory amplification, nocebo, psychobiological mechanisms, indoor air quality
- MeSH terms
- Animals, Humans, Air Pollution, Indoor, Multiple Chemical Sensitivity, Sick Building Syndrome
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