A new article in The Atlantic asks, “Why Aren’t We Talking More About Ventilation?”
People with chemical intolerance have been asking this question for decades. As the COVID19 pandemic drags on, we’d expect more interest in making sure the air we share in buildings is as clean and fresh as possible.
Instead, what we’ve seen is a nightmare situation for chemically susceptible individuals. Another Atlantic article termed this situation, Hygiene Theater, the unscientific and excessive hyper-anxious cleaning of every nook and cranny with whatever strong chemical disinfectant is available.
The result: Our air indoors may be worse than ever, not only because we have this airborne virus, but strong disinfectants fill the air with fragrances and other chemicals. These can irritate the airways of people who aren’t even particularly susceptible to indoor air contaminants — not a great idea in the middle of a respiratory pandemic.
“I’m deeply concerned,” Claudia Miller, MD, MS, Professor Emeritus at UT Health San Antonio said. “People may be making themselves very sick by heavy and repeated use of these chemicals indoors without adequate fresh air.”
She explained that some might have only mild or transient symptoms, but others could acquire Toxicant-Induced Loss of Tolerance (TILT). 
“For decades we have known that people who work in a sick building or become ill during the remodeling of a home or office, for example, can lose their ability to tolerate everyday exposures to the chemicals, foods, or medications that never bothered them before and do not bother most people,” Miller said. “This can also happen with intense or repeated exposures to strong cleaning chemicals like what we see now with COVID cleaning.”
She notes people who already show signs of TILT need to be extra careful about cleaning products and practices.
Some products are safer than others, but unfortunately, even “green” products can pose a problem for susceptible or sensitive individuals. Product labels often advise to use with adequate ventilation and avoid exposing vulnerable individuals.
“If you suspect you might be susceptible, take our brief screening questionnaire, the BREESI,” Miller said. “These questions ask whether you’ve ever had a reaction to chemicals, foods, or medications. If you answer yes to one of these three questions, then I recommend that you take the full questionnaire, the QEESI.”
Long-term, Miller tries to be optimistic.
“People are becoming more interested in indoor air,” she said. “That’s a good thing because there is so much we can do to protect ourselves and vulnerable populations. I hope people read Zeynep Tufekci’s article in The Atlantic. She does a great job explaining why scientists are haggling over particles and droplets. We need to understand the mechanism of airborne transmission to prevent the spread of COVID19.”
Miller stresses that while individuals can do a great deal to protect themselves, institutions also need to understand and act to improve indoor air quality.
“Schools and businesses should seek professional advice about how they can optimize fresh air intake,” she said. “Cities can find ways to make indoor air cleaner, too, by banning all smoking in multifamily housing or shared office buildings. Businesses should examine their cleaning practices and choose the safest, fragrance-free products, and use only what is necessary, properly diluted.” 
How sensitive are you? Take the Brief Environmental Exposure and Sensitivity Inventory (BREESI):
- Do you feel sick when you are exposed to tobacco smoke, certain fragrances, nail polish/remover, engine exhaust, gasoline, air fresheners, pesticides, paint/thinner, fresh tar/asphalt, cleaning supplies, new carpet or furnishings? By sick, we mean: headache, difficulty thinking, difficulty breathing, weakness, dizziness, upset stomach, etc.
- Are you unable to tolerate or do you have adverse or allergic reactions to any drugs or medications (such as antibiotics, anesthetics, pain relievers, X-ray contrast dye, vaccines or birth control pills), or to an implant, prosthesis, contraceptive chemical or device, or other medical/surgical/dental material or procedure?
- Are you unable to tolerate or do you have adverse reactions to any foods such as dairy products, wheat, corn, eggs, caffeine, alcoholic beverages, or food additives (e.g., MSG, food dye)?
If you answer YES to any of these three questions, take the Quick Environmental Exposure and Sensitivity Inventory (QEESI).
Written by:
Tatjana Walker, RN, RDN, MPH, CDE, CPH
Clinical Research Nurse – Associate
Hoffman TILT Program
Department of Family and Community Medicine
UT Health San Antonio