Dr. Claudia Miller: Why Smoke Forced Me to Abandon My Condo

Two years ago, Dr. Claudia Miller, allergist/immunologist, professor emeritus, and leader of the Hoffman TILT Program at UT Health San Antonio, abandoned her condo in a 23-story building.

The reason?

A smoker moved into the unit directly above hers, connected by a large vertical chase to her unit.

“It was horrid,” Dr. Miller said.

Why Is Smoke a Health Danger in Apartments, Condos

Many people know secondhand smoke is a danger to health.

However, most people, including many health professionals, don’t realize just how dangerous it is, especially inside multifamily housing like apartment buildings and condominiums.

People spend more time at home than anywhere else.

This means any family member can potentially develop health problems related to secondhand smoke, according to the American Cancer Society.

“Multi-unit housing where smoking is allowed is a special concern and a subject of research. Tobacco smoke can move through air ducts, wall and floor cracks, elevator shafts, and along crawl spaces to contaminate units on other floors, even those that are far from the smoke,” according to the agency. “[Secondhand smoke] cannot be controlled with ventilation, air cleaning, or by separating smokers from non-smokers.”

This is why HUD adopted a smoke-free policy for public housing in 2018.

But Dr. Miller’s condo was privately owned.

How Dr. Miller Tried to Deal with the Smoke

When the smoker first moved into the unit above, Dr. Miller tried multiple air filters.

“We monitored 24/7 for 2.5u and ultrafine smoke particles. There were thousands of ultrafine particles/cc present for every 2.5 µm particle,” Dr. Miller said. “You simply cannot adequately filter out ultrafine particles for an individual who has developed chemically intolerance (CI).”

claudia miller CI TILT smoking apartment condoFor someone with CI, their mast cells have been sensitized by prior acute or repeated exposure events, a process known as Toxicant Induced Loss of Tolerance, or TILT (the state of being “TILTed”).

But air filters are a “probability game,” Miller said.

“You are hoping that any particle or gas will go through the filter media before it reaches the occupant’s nose. We know this does not work, for example, with cat dander or other allergens,” Dr. Miller said.

“The source must be stopped. TILT involves sensitization too, not unlike an allergy but involving much smaller molecules/particles such as formaldehyde, VOCs or smoke. Smoke particles may be smaller than a red blood cell (6-8u) and readily enter the bloodstream.”

Why Dr. Miller Decided to Move Out

Dr. Miller decided to take more systemic action.

She worked with other condo unit owners and got the majority of owners to agree to designate their building a “no smoking” property.

But, legally, the smoker was “grandfathered” in.

“We tried everything,” Dr. Miller said. “Ultimately, I had to move out.”

How Dr. Miller Is Helping Others Who Are TILTed

Dr. Miller’s personal experience continues to motivate her work on behalf of those suffering with CI and TILT.

Her research, published in Environmental Sciences Europe, was the first to identify mast cell activation syndrome and mediator release (MCAS) as an underlying mechanism for TILT.

She previously connected TILT to several unexplained illnesses.

“Our ancient first-responder mast cells drive both of our immune pathways. Faced with large proteins or glycoproteins, they will drive humoral immunity (antibody production). For much smaller molecules they drive cell-mediated immunity (delayed type hypersensitivity). Both humoral immunity and cell-mediated immunity are sensitization phenomena. Few doctors recognize the latter except for contact dermatologists who do 48-72 hour patch testing and can directly observe responses to chemicals (such as fragrances) which are initiated by dermal mast cells,” Dr. Miller said.

Dr. Miller is also part of the “Mil Gracias for Not Smoking Indoors!” campaign from UT Health San Antonio.

The campaign encourages people to: email a “thank you” message to smokers who protect others by not smoking indoors; sign a letter to acknowledge the health consequences of secondhand smoke exposure; and download an action pack to promote smoke-free multifamily housing in your city.

The campaign also features English and Spanish fact sheets and news about the impacts of secondhand smoke, and resources to help smokers quit if they are ready.

“There should be absolutely no smoking allowed in any multifamily dwelling, public or private,” Miller said. “Period.”

Are You TILTed? Suffering from CI?

Answer these three questions from Hoffman TILT’s Brief Environmental Exposure and Sensitivity Inventory (BREESI):

  1. 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.
  2. 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?
  3. 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) and share the results with your doctor!