Infection Control Today Experts Sort Fact From Fiction on Health Effect of Mold

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Experts Sort Fact from Fiction on Health Effects of Mold Posted on:

10/24/2005

(http://www.infectioncontroltoday.com/hotnews/5ah2412351998374.html#)

Distinguishing fact from fiction, leading experts gathered to discuss the

most recent scientific evidence on health effects of mold at the annual meeting

of the American College of Allergy, Asthma and Immunology (ACAAI) in

Anaheim.

“Fungi, including molds, are spore-producing organisms that comprise some 25

percent of the earth’s biomass and function as decomposers of organic

material,†said W. Weber of the National Jewish Medicine & Research

Center

in Denver. “Only about 80 of the 1.5 million species of fungi are known to

be allergenic.

“The most common fungi found in homes include Cladosporium, Aspergillus,

Penicillium, Alternaria, basidiospores, Chaetomium, Periconia and Stachybotrys.

Indoor levels of airborne fungi are generally below outdoor levels of similar

species in a well-constructed home without water damage. We have found 30

percent to 70 percent of recovered indoor spores come from outside sources,â€

Weber said.

An estimated 10 percent of the U.S. population has fungal sensitivity. In a

1991 study published in The New England Journal of Medicine, asthmatics

sensitive to Alternaria fungi faced a 200-fold risk for respiratory arrest.

“Well-known health effects caused by exposure to fungi include infections,

toxins and hypersensitivity diseases including asthma, rhinitis,

hypersensitivity pneumonitis and allergic bronchopulmonary aspergillosis

(fungal infection

of the lungs),†said K. Bush, MD, of the University of Wisconsin in

Madison.

“Sensitivity to fungi is prevalent in asthmatics, and those who are

sensitive are at risk for severe, potentially life-threatening asthma.

Increased

outdoor fungal spore counts have been associated with increased asthma

emergency

department visits and hospitalization,†Bush said.

Immunotherapy, or allergy shots, have been effective in several

double-blind, placebo-controlled trials in mold sensitive patients.

“Although there are hundreds of thousands of species of fungi, allergen

extract availability is limited to a relatively small number of fungi including

the two most prevalent outdoor fungi, Alternaria and Cladosporium,†said

Harold S. , MD, of the National Jewish Medical and Research Center. “

Immunotherapy should be limited to those patients with documented sensitivity

to

fungus, whose symptoms occur during periods of high atmospheric exposure to

that

fungus, and environmental control is not possible.â€

Toxic mold syndrome or inhalational toxicity continues to cause public

concern despite a lack of scientific evidence that supports its existence said

Emil J. Bardana, Jr., MD, Oregon Health & Science University in Portland, Ore.

In a recent study published in ls of Allergy, Asthma & Immunology, the

scientific journal of the ACAAI, investigators at the Oregon Health & Science

University conducted a retrospective review of 50 individuals who claimed

compensation for toxic mold disease, and in every case found alternative

medical

and/or psychiatric explanations for the claimed illness.

Investigators found only two of the 50 subjects had evidence of mold-related

allergic disease attributable to their home or workplace. Seventeen

individuals complained of a nonspecific irritant symptoms complex that could

not be

linked to mold exposure. These symptoms included headache, irritability,

cognitive impairment and fatigue.

“Based on our findings, no case definition is possible for so-called ‘toxic

mold syndrome,’†said Bardana, co-author of the report. “Fungal

contamination of a residence does not necessarily constitute an abnormal

exposure. The

presence of fungal allergen sensitivity proves prior exposure, but not

necessarily a symptomatic state.

“Because molds are encountered both indoors and outdoors, it is almost

impossible to determine where the sensitivity arose. Specific toxicity due to

inhaled molds, including the role of Stachybotrys in building-related illness,

has not been scientifically established by any published study,†he said.

Mycotoxins are low molecular-weight secondary metabolites produced by more

than 350 specifies of fungi. Those of significant detriment to human and

animal health include aflatoxins, trichothecenes, fumonisins and ergot

alkaloids.

“Centuries of documented examples of human mycotoxicosis have occurred after

ingestion of mycotoxin,†said D. Hardin, PhD, of Veritox Inc., in

Redmond, Wash. “An estimated 25 percent of the world’s crop production is

contaminated to some extent with mycotoxins, and its prevalence has led to

regulations regarding acceptable levels of contamination.â€

Other current concerns include:

-- In developing nations, where contamination of dietary staples is high,

the risk of liver cancer from chronic dietary aflatoxin exposure is elevated by

hepatitis infection. Except for mass poisonings, aflatoxicosis in humans has

rarely been reported, and is sometimes difficult to recognize.

-- Mycotoxins such as T-2 toxin and aflatoxin B1, have been purified and

developed for use as biological warfare agents by a number of nations including

the USSR/Russia, the United States and Iraq.

-- Ergot poisoning in Europe and the United States today is almost

exclusively due to excessive ingestion of ergotamine tartrate prescribed for

the

treatment of migraine.

According to Hardin, direct skin contact with purified mycotoxin (e.g. T-2

toxin) or heavily contaminated products produce local skin reactions. Other

routes of exposure to mycotoxins have not been linked to effects on human

health.

“Some people believe that anything with the word ‘toxin’ in it must be

very

dangerous,†said D. Fox, PhD, of Glendale, Calif. “Some individuals

tend to focus on their symptoms and attribute all of their problems to mold

exposure, downplaying other causes.â€

Molds typically cited as causing psychological or cognitive problems are

Stachybotrys chartarum, Aspergillus, Fusarium and Penicillium. Symptoms of a

physical nature may include sleep deprivation, loss of appetite, fatigue,

headaches, dizziness, vague aches and pains and respiratory problems.

Psychological

and cognitive symptoms are also attributed to toxic mold, including

irritability, panic, anxiety, poor concentration and confusion.

“It is a normal psychological need to have an explanation for symptoms. Many

people show psychological or cognitive symptoms that are exacerbated when

their health is potentially threatened. Pre-existing psychological disorders

and misinformation from media, friends and even doctors can play a role in

causing symptoms,†said Fox.

Although indoor mold is prevalent in all homes, there are steps that

mold-sensitive individuals can take to control indoor mold contamination.

“The first step toward preventing indoor mold is to stop leaks, minimize

condensation, and keep relative humidity low,†said Jay M. Portnoy, MD, of

Children’s Mercy Hospital in Kansas City, Mo. “Dehumidifiers, proper

ventilation,

and control of air flow and air pressure can help reduce indoor mold growth.

Bleach solutions are recommended for removing mold on nonporous surfaces.

Porous surfaces may require removal and replacement of materials if mold

contamination is extensive.â€

In a study conducted by Portnoy and his colleagues, which was published in

2001 in Aerobiologia, mold spore counts were found to be highest in the

laundry room (11,424), bathroom (8,540) and unfinished basement (6,694) in a

sampling of 241 rooms.

“If a patient who is sensitive to mold is exposed to substantial mold in

their environment, it may be determined that there is evidence of a

relationship

between mold exposure and symptoms. An environmental assessment may be

important if health effects are associated with the home or building and there

is

structural damage and aesthetic problems, including odor,†said Portnoy.

“We would want to look at the family history of allergic disease and find

out if the symptoms are associated with specific activities or events. The

history of the home or building, its occupancy and its environmental

characteristics would be evaluated. Fungal exposure can be measured by

collection and

analysis of house dust if validated methods are used,†he said.

Source: ACAAI