60th Anual meeting of ACAII

[Guest guest]

This article is 3 years old, but Bardana gave the keynote lecture and states

that exposure to mycotoxins is one of 6 possible health effects from mold

exposure. He does not limit it to ingestion. All of the speakers emphasized

there needs to be more research.

http://www.medscape.com/viewarticle/447470?src=search

The Impact of Environmental Molds in the Home

from: Medscape Conference Coverage, based on selected sessions at the:

60th Annual Meeting of the American College of Allergy, Asthma and Immunology

November 15 - 20, 2002, San , Texas

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Montanaro, MD

Introduction

A fascinating review of the potential human health impact of environmental

molds was presented during the recent 60th Annual Meeting of the American

College of Allergy, Asthma and Immunology. In the initial presentation,

undertaken by Elliott Horner, PhD, Microbial Laboratory Director at Air Quality

Sciences, Inc. in Marietta, Georgia, it was pointed out that environmental molds

potentially can result in human illness by the production of allergens,

proteases, beta-glucans, and volatile organic compounds. Dr. Horner further

emphasized that in order for molds to grow, they require moisture. The

temperature tolerance of molds is extremely variable. The ecologic types of

molds are those included in the classes of phylloplane, which are molds that can

grow on leaf surfaces. These molds include Cladosporium and Alternaria.

Soil-based molds are typified by Penicillium and Aspergillus. Typical molds

found in wood decay include the Basidiomycetes. Indoor molds typically include

Alternaria,

Cladosporium, and Epicoccum, but Dr. Horner pointed out that these are

typically from outdoor sources. Dr. Horner pointed out that in interpreting

industrial hygiene reports on mold measurements, colonization vs contamination

must be determined. When mold contaminates, the mycelial elements will actually

penetrate the substrate. The mycelium is connected to the conidiophore, which is

the reproductive structure of the mold. The food source for fungal growth in

buildings may include cellulose, which can be found in ceiling tile, insulation,

sheetrock, as well as wood and dirt.

Biology of Mold in the Home

Dr. Horner reviewed potential detection methodology for molds. These include

the use of direct microscopy or culture-based methods. Dr. Horner stated that

use of " settle plates " are no longer considered a reliable methodology. Dr.

Horner further noted the importance of taxa identification, which is much more

important than the absolute number of colony-forming units. Taxa identification

may allow comparisons of indoor vs outdoor taxa.

Doing an Effective Home Assessment

M. ph Fedoruk, MD, of Exponent and Associate Clinical Professor at the

University of California, Irvine, California, further elaborated on the

importance of home inspections when evaluating potential mold contamination. Dr.

Fedoruk pointed out that the home inspection industry is essentially

unregulated. He noted that many home inspectors for mold contamination, in fact,

are qualified only by attending a meeting without any subsequent testing. Dr.

Fedoruk noted the importance of visual inspection of potential moisture

intrusions, including inspection for the presence of staining or discoloration.

He also pointed out that odor detection can be quite important and noted that

" if you can smell mold, you have a problem. " Dr. Fedoruk also reviewed air

testing methodology surface dust analysis and noted that, in many cases,

" destructive testing " is necessary. He pointed out that this destructive testing

requires actual destruction of walls or floors.

Dr. Fedoruk also highlighted the importance of measuring both indoor and

outdoor levels of molds as has previously been noted. He further pointed out

that both complaint and noncomplaint areas of homes must be evaluated. He

re-emphasized that both direct microscopy as well as culture identification must

be undertaken. Dr. Fedoruk also mentioned that a specific number of

colony-forming units are rarely of any benefit.

Evaluating Patients for Mold Exposure

Emil J. Bardana, Jr., MD, presented the S. Chapman Keynote Lecture on the

potential human health effects of mold contamination. Dr. Bardana presented the

historical background of mold sensitivity by pointing out that indoor air

quality problems had actually begun in approximately 1973, following the oil

embargo and subsequent efforts to conserve energy. Subsequently, in 1994, a

paradigm shift had occurred in which individuals who had previously been

diagnosed with " sick building syndrome " were subsequently informed that they

were potentially suffering from " toxic mold syndrome. "

Dr. Bardana highlighted the fact that in any well constructed home without

evidence of water contamination, significant levels of airborne fungi can be

measured. Dr. Bardana noted that these airborne fungi typically reflect outdoor

levels of fungi. Furthermore, it was noted that fungi are ubiquitous and, in

fact, account for at least 25% of the earth's biomass. Dr. Bardana again

emphasized that while there were guidelines for the assessment of mold

contamination in homes, there had been no uniformity or agreement of any

specific level that could potentially result in human disease. In addition,

there has been no established dose-response relationship between mold levels and

human disease. Dr. Bardana gave examples of sawmills that had been evaluated

that revealed workers without symptoms exposed to 1.5 M cfu/m3. In addition,

there have been studies of farmers without symptoms who were exposed to 120 M

cfu/m3.

Dr. Bardana reviewed the 6 types of human responses associated with mold

exposure. These responses include:

Potential irritant effect, which at best is mild and transient and may be

associated with exposure to beta-1,3 glucans or volatile organic compounds;

Nonspecific respiratory symptoms, which are poorly correlated to airborne

fungal levels;

Allergic sensitization, which is usually not considered to be severe and is

usually not considered to be a major problem and is more problematic with

outdoor exposures;

Fungal infections, which mostly arise from outdoor sources and may occur from

exposure to soil-based saprophytic fungi;

Exposure to mycotoxins, which have recently been described. There are

currently more than 300 mycotoxins that have been described that are low in

molecular weight and nonvolatile in nature. Dr. Bardana highlighted the fact

that all species of fungi are capable of producing mycotoxins; and

Psychogenic effects, which can occur when an individual perceives that he or

she is being harmed by the effects of fungal exposure.

These potential health effects of indoor fungal bioaerosol exposures are

highlighted in a recent publication.

Finally, Dr. Bardana outlined the recent health concerns of individuals

exposed to species of Stachybotyrs. Dr. Bardana reviewed the fact that

Stachybotyrs has been referred to as toxic or " black mold. " Dr. Bardana

highlighted the fact that there were, in fact, no bona fide reports of human

infection in the medical literature. Reports of potential allergic disease have

been characterized as being inconclusive. In fact, Dr. Bardana highlighted a

recent observation that pointed out that half of blood donors have

immunoglobulin (Ig) G antibody to Stachybotyrs, with 9% of these individuals

having evidence of IgE to Stachybotyrs. Given the ubiquitous nature of

Stachybotyrs, it is not considered to be unusual that one would observe these

findings. Dr. Bardana further noted that there have been no reports of allergic

alveolitis or sinusitis due to Stachybotyrs. Although there have been recent

concerns regarding the potential of " toxic encephalopathy and Stachybotyrs, " Dr.

Bardana pointed

out there has been " no scientific link. " Dr. Bardana suggested further reading

on the potential role of Stachybotyrs in a recent publication by the American

Industrial Hygiene Association.

The potential human effects of mold exposure have led to a new legal industry

with devastating impact on the immune insurance industry. A recent example of

mold litigation occurred in Texas, where a jury determined that an insurance

company acted fraudulently and in bad faith when fixing water damage in a

22-room mansion. This particular case resulted in a delay in the repair of what

many considered a relatively small innocuous water leak but awarded the

homeowner with a multimillion dollar verdict. It is pointed out that the number

of mold-related claims in the State of Texas alone rose from 7000 in the year

2000 to 37,000 in the year 2001! These claims were further fueled by the

presence of tropical storm Alison, which occurred in June of 2001 and affected

the Houston metropolitan area for approximately 2 days, resulting in massive

flooding along the Gulf Coast. In Houston alone, there was a 58% increase in

claims, representing 2.96 claims for every 1000 households. There have

been many high profile lawsuits reported in the press, including that of ny

Carson's ex-sidekick, Ed McMahon, who brought suit against his insurance company

for 20 million dollars in April of 2002 for the death of his dog, which was

alleged to have been due to exposures to mycotoxins from Stachybotyrs chartarum.

Sports stars have not been immune from this weight of litigation. Jordan

has required that his home in the Washington, DC area at the Ritz-Carlton Hotel

have extensive renovation due to the perception of mold-related problems. The

celebrity status of some of these claims has resulted in increased hysteria in

the general population. The ultimate effect of this hysterical response to

suspected phoma-related problems has had a tremendous impact on the insurance

industry, with more than 1.3 billion dollars spent in 2002 to settle lawsuits

and mold-related damages.[7] Unfortunately, the response from the insurance

industry has clearly been to settle cases and to

attempt to no longer put themselves at risk of covering potential mold-related

damages. Recently, the State Farm Mutual Automobile Insurance Company has

attempted to eliminate coverage from mold-related damages in 33 states.

There is little doubt that mold can indeed result in human disease. Mold

exposure can result in allergic rhinitis, allergic asthma, allergic sinus

disease, and pulmonary hypersensitivity pneumonitis. Despite the fact that there

is no doubt that mold can result in human disease, aside from these specific

incidences, there was very little data to support human disease caused by

" mycotoxins. " All of the presenters emphasized the need for further research in

this area.

References

Horner E. General sessions. Environmental molds: biology of molds. Program

and abstracts of the 60th Annual Meeting of the American College of Allergy,

Asthma and Immunology; November 15-20, 2002; San , Texas.

Fedoruk J. General sessions. Environmental molds: home assessments: how they

are done. Program and abstracts of the 60th Annual Meeting of the American

College of Allergy, Asthma and Immunology; November 15-20, 2002; San ,

Texas.

Bardana EJ. General sessions. Environmental molds: A. Chapman Lecture.

Health effects of mold exposure and how to evaluate patients who think they have

it. Program and abstracts of the 60th Annual Meeting of the American College of

Allergy, Asthma and Immunology; November 15-20, 2002; San , Texas.

Fung F, Hughson WG. Health effects of indoor and fungal bioaerosol exposure.

Proc Indoor Air. 2002;1:46-51.

Page EH, Trout DB. The role of Stachybotyrs mycotoxins in building-related

illness. Amer Indus Hyg Assoc J. 2001;62:644-648.

Sharp R. Mold getting a costly hold on homes. USA Today. June 19, 2002.

Cahill SF. For some lawyers mold is gold. Amer Bar Assoc J. December

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