Do you all follow the ACOEM chatboard? Wow!!! Mold

[Guest guest]

Wow! I don't know if any of you follow the Occ-Env-Med

Chatboard, which is funded in part by NIOSH and ASTAR, and

is the chatboard for the physicians of the ACOEM, but It's

Hot over the mold issue!!!

Dr. Coifman, who is an allergist, wrote:

1/7/07: Re: Inhaled mycotoxins as causes of human disease:

fact or fancy?

To separate science from pseudoscience concerning questions

of causality and issues of liability for symptoms claimed

by persons with histories of mold exposures at levels

encountered in damp indoor spaces, the Academy of Medicine

of the National Academy of Sciences commissioned a

comprehensive review of relevant scientific knowledge,

published as Damp indoor spaces and health, Institute of

Medicine of the National Academies, National Academies

Press, Washington DC 2004. The preparation of this report

and its publication in this book were commissioned

to, “conduct a comprehensive review of the scientific

literature regarding the relationship between damp or moldy

indoor environments and the manifestation of adverse health

effects, particularly respiratory and allergic symptoms.

The review will focus on the non-infectious health effects

of fungi, including allergens, mycotoxins and other

biologically active products. In addition, it will make

recommendations or suggest guidelines for public health

interventions and for future basic science, clinical, and

public health research in these areas.â€

The Institute of Medicine report finds that molds that can

produce mycotoxins under the appropriate environmental and

competitive conditions can and do grow indoors. It finds

that the doses of such toxins required to cause adverse

health effects in humans have not been determined, and that

there is no evidence supporting any association between

mold exposure at levels likely to be encountered in damp

indoor spaces and dyspnea (shortness of breath), skin

symptoms, airflow obstruction (in otherwise-healthy

persons), asthma development, mucous membrane irritation

syndrome, gastrointestinal tract problems, chronic

obstructive pulmonary disease, fatigue, inhalation fevers

(nonoccupational exposures), neuropsychiatric symptoms,

lower respiratory illness in otherwise-healthy adults,

cancer, rheumatologic and other immune diseases,

reproductive effects or acute idiopathic pulmonary

hemorrhage in infants.

The report concludes that there is an association between

exposure to damp indoor spaces and asthma and upper

respiratory symptoms in individuals who are already

affected by these conditions, but it finds no evidence that

such exposures cause any permanent increase in those

symptoms or the activity of the underlying diseases that

persists after exposure is reduced to pre-increase levels.

In other words, exposure to moldy indoor spaces can

aggravate respiratory symptoms during the period of

increased mold exposure, without persisting adverse

effects, and there is no evidence of any mechanism by which

such exposures can cause any of the other conditions

attributed to such exposures by Dr. Nagy.

How should readers decide between the conflicting claims of

the Institute of Medicine and those of Dr. Nagy and the

authors she cites? Dr. Nagy and her co-believers have

anchored the economic base of their careers on a model of

disease causality and liability that has so-decimated the

legitimate insurance industry that it is no longer possible

to insure against even unequivocal and objective damage

from mold. If one takes the time to critically read their

literature one will find a mix of extrapolations from

animal toxicity studies at doses hundreds of times those

inhaled by humans in damp indoor spaces, studies confounded

by various forms of selection bias, and reports of

associations between various symptoms and exposures by

individuals who stand to receive significant economic

benefits if they can convince or persuade others that those

symptoms were caused by those exposures. The purpose of

the Institute of Medicine study was to subject those claims

to critical review by experts with no vested economic

interest in the outcome, and the outcome was that there is

simply no evidence to support that model of disease

causality.

Sincerely,

E. Coifman, M. D.

If anyone wishes to correspond with me regarding this

matter, we have had some incoming email loss at our

aasj.com domain so please use the substitute email address,

..

E. Coifman, M. D.

e-mail rcoifman@..., http://www.aasj.com

Allergy & Asthma of South Jersey, P. A. &

Clinical Research South Jersey Network

1122 N. High Street, Millville NJ 08332-2529

tel 856.825.4100, fax 856.825.1700

personal fax 206.202.2105

Dr. Nagy, who is affiliated with the American Academy of

Environmental Medicine wrote:

I had assistance in locating this information that pertains

to the IOM report.

1. I believe Dr. Coifman is incorrect with his evaluation

of the findings of the Institute of Medicine, Damp Indoor

Spaces and Health Report. Dr. Harriet Amman was the

Toxicologist (Washington State Dept of Health) who the

Institute chose to author Chapter 4 of the Report which

pertains to illness from mycotoxins. She is also the

author of the following paper that finds there are serious

threats to human health from mold/mycotoxin exposure. The

paper is entitled, " Is Indoor Mold Contamination a Threat

to Health " . It may be found at

www.moldsurvivor.com/harrietammann.htm.

2. It is unfortunate, but much misinformation is relayed

regarding the findings of this study. At the Surgeon

General's Workshop on Indoor Air, Jan 2005, Dr. Noreen

, Chair of the IOM Damp Indoor Spaces and Health

Committee commented on this fact:

" A journalist commented on press coverage of the Damp

Indoor Spaces and Health report and how it may have misled

many people by over- or under-emphasizing (depending on the

publication)committee conclusions regarding the seriousness

of the health concern. Dr. indicated that they made

every effort to help the media cover the report

effectively, but acknowledged that accurate media messages

may not have reached the public. A health activist

suggested that some responses to the report may have

resulted partly from things that were not evaluated,

contending that the report was primarily a respiratory

study and that non-infectious health effects such as

headaches and fatigue were not really examined. Mold

hypersensitivity and autoimmune-like symptoms have been

reported by some people, but have not been adequately

recognized by scientists or by physicians. One participant

suggested a need for an anecdotal reporting center

for such cases, indicating that there is too much emphasis

on determining causation and not enough on finding

effective treatment or training physicians to be sensitive

to the needs of these patients. In reply, Dr.

indicated that the report did not consider only respiratory

symptoms,but that these were the symptoms for which

associations were strongest. She noted that “absence of

evidence is not evidence of absence,†and said that the

report did not intend to dismiss the possibility of effects

for which the existing evidence of association was not

strong or for which evidence was not available. "

This information may be found at the following link,

page 33.

http://www.hhs.gov/surgeongeneral/topics/indoorenv/pdf/HIEWo

rkshopBinder.pdf

3. Within the IOM Damp Indoor Spaces and Health Report

there are no less than 135 places where it is specifically

called out as " more research is needed " . What this

indicates is that it is in no way conclusive these

illnesses are not occurring. When a document as respected

as the IOM Report indicates such dire need for more

research in so many area, it should set off alarms within

the medical community that our children's health is being

gravely impacted and this is an area in much need of our

attention.

4. Dr. Coifman also only addresses mycotoxins entering the

body via one route of exposure, inhalation. The molds

and mycotoxins that are more than abundantly present within

the sick environment enter the body via all routes of

exposure; ingestion, inhalation and dermal contact. They

are exposed to multiple fungi simultaneously. Within a

water damaged building, there is never only one mold/toxin

present. As such, the dose response theories promoted by

some and based on single exposure studies are of limited

value in understanding human illness from the matter.

Dr. Johanning, who is often times recognized as the father

of Bioaerosol illness, chimed in:

Dear colleague(s) – I would not put so much weight on the

IOM Damp in Indoor Spaces paper or the “scientific

position†announcements to the press and media – I think it

reflects more a political public policy position of the

CDC & P and involved IOM editors. It is a rather secretive

and undemocratic process how these publication and

positions of “scientific conclusions†are made – at least

from my perspective and experience – I was invited to

present our clinical experience and research results from

the FUNGAL RESEARCH GROUP FOUDATION at the meeting, but was

not allowed to stay for a full discussion or listen to the

committee deliberations – as well as the other specially

invited speakers at the meeting – the discussions and

written papers by the committee members were kept secret

and exclusive to any other input or interested party – even

the writer of the toxicology chapter – a well respected

public health official - was reportedly not allowed to

respond to editorial changes by the final editors at the

Institute or outside reviewer comments regarding her

manuscript, as I was told. This committee member apparently

did not fully agree with the content and summary of the

press release and other information from the Institute re

the toxicology data and conclusions. Please also keep in

mind, that none of the members of the Institute or the

reviewers that are publicly listed had any specific

research experience or publication record regarding this

topic of fungal toxicity and human health – indeed many of

the known experts in the field – except for one committee

member – a non-physician – were not even aware of this IOM

paper or were not invited to actively participate in the

development and review of the final IOM document –

Furthermore, one should keep in mind that this committee

was initially chaired by a previous Harvard Adjunct Senior

Lecturer on Environmental Microbiology – who resigned

surprisingly and suddenly after the first meeting – after

she already announced in the Boston Globe the her

conclusions before the committee even had met for the 2nd

time and debated their conclusions. In any case shortly

after the IOM meetings and publication – there was a

meeting by environmental health specialists in Finland –

practicing physicians, researchers and public health

specialists, who formulated the following consensus

conclusions and position paper regarding mold toxicity and

health – I think that still can stand. "

ICT X SATELLITE MEETING:

Indoor Mold –A New Challenge for Toxicologists

10th July, 2004 Kuopio

Symposium of “Indoor Mold -A New Challenge for

Toxicologists†was held in Kuopio, Finland, 10th July,

2004. The event was a satellite symposium of the 10th

International Congress of Toxicology, Tampere, 11-15 July.

The exposure to biological contaminants in indoor air of

damp and moldy indoor environments is a challenge for

toxicological research and risk assessment. The intent of

this Satellite meeting was to present recent scientific

results on exposure and health effects of microbes and

their toxins in indoor air, and to discuss the

implementation of current knowledge.

The specific aims were:

• To bring forth the clinical aspects of exposure to indoor

mold both in home and in workplace

• To share the recent scientific advances in experimental

toxicology

The symposium had over 30 participants from different

countries and different areas of research. The symposium

ended up with a conclusion that dampness control of

buildings is essential for the prevention of health

effects. However, due to the many existing problems, the

need for the toxicological documentation of the harmful

agents and their effects was recognized. As the summary of

the Symposium, the following conclusions, challenges and

research needs for toxicology were presented.

Conclusions

• Dampness and mold in indoor environments are associated

with many diverse health effects, some of which are well

documented in epidemiological studies, and some of which

have been reported as clinical observations

• Based on current evidence, it can be concluded that there

is a biologically plausible connection between the growth

and occurrence of toxigenic molds in indoor environments

and health effects of the occupants. However, many aspects

of exposure and pathophysiological mechanisms are still to

be revealed

• No single exposing agent appears to be the causative

factor for the health effects

• Moist building materials may be favourable habitats for

many potentially toxin-producing fungi and bacteria

• Toxins occur both in the mycelium and in spores. The

release of spores and mycelial fragments can be a source of

inhalation and dermal exposure to toxins

• Other microbial products and components such as peptides,

enzymes, b-D-glucans and LPS may have significant

biological effects

• Health endpoints are probably results from exposure to

many exposing agents, which also have interactions

• More toxicological research is needed to reveal the

causal connections between exposure and health effects of

moldy indoor environments

Challenges and research needs for toxicology

• Challenges for toxicological risk assessment

-Wide variety of health end points and wide variety of

mechanisms

-Importance of building materials on microbe’s

toxicological behaviour

-Interactions of different species in microbial growth

and/or in exposure situations

-Solving the key question of â€causative agentâ€

• Open questions

-What model system would give the best measure for

neurotoxicity or for pulmonary toxicity?

-Which organs are typically affected?

-What explains gender, genetic, age and other host factor

differences?

• Research needs on microbes and their toxins

-Development of biomarkers

-Toxicity assessment of airborne material

-Assessment of neurocognitive outcome

-Case-control studies, intervention studies

-Establishment of NOAEL in acute animal models

-Long term, low-dose exposures in animal models

-In vivo studies on effects of fungal particles and toxins

especially in proximal respiratory tract

I remember that I was told in the beginning by people like

the ‘Havard Adjunct Senior Lecturer on Environmental

Microbiology’ that airborne Stachybotrys toxins cannot be

detected in indoor environments in any quantifiable

concentrations and pose no real inhalation risk, since it

does not easily become airborne (because these are “slimy

sporesâ€) – but we have been able to show that is not the

case and reported about finding significant Stachybotrys

toxins concentrations (trichothecenes) on high-volume air

filter samples in tested homes of patients with non-

allergic symptomatology, see Indoor Air 2002, Monterey Ca,

paper – similar findings of airborne mycotoxins in water

damaged homes using a different sampling and analytical

methodology was later reported by the T.L. Brasel & D.

Strauss group from Texas Tech:

AIRBORNE MYCOTOXIN SAMPLING AND SCREENING ANALYSIS

E Johanning1*, M Gareis2, K Nielsen3, R Dietrich4 and E

Märtlbauer4

1Fungal Research Group (FRG, Inc.), Occupational and

Environmental Life Science, Albany, N.Y. USA.

2Institute for Microbiology und Toxicology, BAFF, Kulmbach,

FRG

3Technical University of Denmark, Lyngby, Denmark

4Institute of Hygiene und Technology of Milk, L.M.

University of München, FRG

ABSTRACT

The indoor mycotoxins inhalation exposure of patients

(n=25) was studied using a high-volume air sampler (60 cfm

x 24 h) with a micropore-paper filter (8x11 inches). The

filters were evaluated for cytotoxicity caused by

mycotoxins using the MTT-cell culture bioassay and by

culture identification. A subset of samples was analyzed

with an enzyme-immuno assay for occurrence of macrocyclic

trichothecenes produced by Stachybotrys chartarum and HPLC-

DAD and GC-MS analyses for different mycotoxins. Highly

toxic air samples (IC50 ≤ 31 mg/ml) were found in seven

cases; moderate toxicities (IC50 > 31 to ≤ 125 mg/ml) in 14

cases, and four cases were not toxic compared to controls.

The subset testing demonstrated that macrocyclic

trichothecenes and other mycotoxins could become airborne.

In conclusion, an inhalation risk could be confirmed (84%

of cases) with the 24-hour high volume air sampling test

method due to the detection of airborne cytotoxic fungal

particles and specific mycotoxins, including trichothecenes

produced by Stachybotrys fungi.

So – it reminds me of the bumper sticker: “Question

authority†– I support working on getting ‘un-biased’

research funded (see above) and for now I believe there is

enough knowledge and science on this topic published to

support the precautionary principle – avoid unnecessary

indoor moisture and mold (including toxic mold) exposure.

I think that January 9, 2007, is going to be a very good

day for mold victims. The issue has been a pot ready to

boil over for quite some time now.

Sharon