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Use and misuse of biomarker tests in "environmental conditions".

In the diagnostic evaluation of suspected building-related illness, one generally must thoroughly evaluate the following: (1) workplace or office industrial hygiene measures; (2) material safety data sheets on products or agents used in that particular building; (3) medical records of all persons who claim to have building-related illness; (4) the type and incidence of symptoms, which is usually evaluated by conducting epidemiologic surveys; and (5) current health status of allegedly affected persons, which is evaluated by obtaining a history and performing a physical examination and routine laboratory tests. Depending on the findings gained in these diagnostic evaluations, one may also want to perform psychiatric or neuropsychologic evaluations, a personality test evaluation, and certain laboratory tests, such as complete allergy testing by in vitro or in vivo (skin) tests, selected skin testing with a suspected environmental or occupational allergen, or, where indicated, challenge testing with the suspected offending allergen. These measures would appear to be reasonable when performed by teams of investigators who are selected depending on the situation. Among these investigators would be internists, allergists, pulmonologists, toxicologists, environmental engineers, industrial hygienists, psychologists, and others. Nonetheless, there has been a recent tendency to suspect, without objective evidence and on the basis of belief only, that chemicals or related agents existing in trace amounts in special environmental settings such as buildings, offices, or factories may damage the immune system in humans. Suppression of the immune system would theoretically result in an increased incidence of infections or a decrease in immune tumor surveilance mechanisms. Activation of the immune system by a putative offending environmental agent could theoretically result in autoantibody formation and autoimmune disease or some other form of hyper-