Adverse Health Effects of Indoor Molds

[Guest guest]

Journal of Nutritional & Environmental Medicine (September 2004) 14

(3), 1–14

Adverse Health Effects of Indoor Molds

LUKE CURTIS MS, CIH,1 ALLAN LIEBERMAN MD,2 MARTHA STARK

MD,3 WILLIAM REA MD4

AND MARSHA VETTER MD, PHD5

1School of Public Health, University of Illinois at Chicago,

Illinois, 2Center for

Occupational and Environmental Health, North ton, South

Carolina, 3Harvard

University, Newton Center, Massachusetts, 4Environmental Health

Center, Dallas,

Texas, 5Environmental Health Center, Hoffman Estates, Illinois, USA

Abstract

Purpose: It has long been known that eating moldy food is hazardous,

and airborne

Aspergillus and other fungi can cause life-threatening illnesses in

immunocompromised

patients. However, the possible health risks of indoor mold exposure

in immunocompetent

humans are controversial. This literature review examines the health

effects of indoor airborne

exposure to mold.

Design: Literature review.

Materials and Methods: This review was conducted by searching PubMed

and other medical

databases, as well as reading recent conference reports.

Results: Many studies link exposure to damp or moldy indoor

conditions to increased

incidence and/or severity of respiratory problems such as asthma,

wheezing and rhinosinusitis.

Stachybotrys produces trichothecenes and other mycotoxins, which can

inhibit protein

synthesis and induce hemorrhaging disorders. Indoor mold exposure

can alter immunological

factors and produce allergic reactions. Several studies have

indicated that indoor mold

exposure can alter brain blood flow, autonomic nerve function, brain

waves and worsen

concentration, attention, balance and memory. Failure to perform the

appropriate objective

evaluations on patients may account for the commonly held belief

that indoor mold exposure

poses no significant health risks to immunocompetent humans.

Conclusions: Exposure to high levels of indoor mold can cause injury

to and dysfunction of

multiple organs and systems, including respiratory, hematological,

immunological, and

neurological systems, in immunocompetent humans.

Keywords: mold, fungi, mycotoxin, allergy, indoor air quality,

asthma, neurotoxicity, lung hemorrhage,

Aspergillus, Penicillium, Cladosporium, Alternaria, Stachybotrys.

INTRODUCTION

In recent years, public attention has become increasingly focused on

human health

concerns linked with mold (fungi) inside homes and workplaces.

Indoor airborne mold

exposure has been associated with adverse human health effects in

multiple organs and

body systems, including respiratory, nervous, immune, hematological

and dermatological

systems. Indoor mold exposure can also lead to life-threatening

systemic infections in

immunocompromised patients.

A qualitative systematic literature review was undertaken in order

to examine and

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Journal of Nutritional & Environmental Medicine (September 2004) 14

(3), 1–14

ISSN 1359-0847 print/ISSN 1364-6907 online/02/010071-02 # 2004

& Francis Ltd

DOI: 10.1080/13590840400010318

appraise the current state of knowledge about indoor mold-linked

health effects, and to

summarize the available evidence for the use by health

professionals. Physicians, in

particular, may encounter patients with common symptoms occurring in

particular

environments, and understanding the potential for mold-related

health effects is key to the

complete investigation of those environments. Physicians and

industrial hygienists may be

asked to contribute reports to assist the courts in settling suits.

In 2002, an estimated

10,000 mold-related cases were pending in US courts [1]. Also in

2002, the insurance

industry paid out $2 billion in mold-related claims in Texas alone

[2].

Literature was reviewed using the peer-reviewed database, and from

recent conferences

on indoor molds. The levels of evidence available for each topic

varied from level I (from at

least one properly randomized controlled trial) through level II

(from trials without

randomization, exceptionally convincing uncontrolled experiments,

cohort or case–control

studies), to level III (opinion of respected authorities based on

clinical experience,

descriptive studies, or reports of expert committees) [3].

MOLDS IN THE INDOOR ENVIRONMENT

Fungi (or molds) are ubiquitous in both indoor and outdoor

environments and are

frequently dispersed by airborne spores. Mold and mold spores

require moisture and a

food source, such as cellulose or decaying food, to grow [4]. As

mold spores swell with

water and grow, they elongate, forming balloon-like protuberances

(hyphae), which secrete

digestive enzymes and mycotoxins. The fungi then digest the food

source to support their

growth.

About 100,000 fungal species have already been identified; in fact,

fungi are estimated to

comprise an astounding 25% of the world's biomass [5]. Various

surveys of homes in North

America and Europe have reported that visible mold and/or water

damage are common,

found in 23–98% of all homes examined [6–9]. There are no official

standards at this time

for indoor airborne fungi concentrations. However, indoor fungal

levels above a range of

150–1000 colony-forming units per cubic meter of air (cfum23) are

considered to be

sufficient to cause human health problems [7, 10–12]. Numerous

reports have documented

that indoor air can be contaminated with fungal spore levels well in

excess of 1000 cfum23

[13–20]. The most common indoor fungal genera collected are

Cladosporium, Aspergillus

and Penicillium [13–20]. Alternaria, Stachybotrys, Rhizopus, Mucor,

Wallemia, Trichoderma,

Chaetonium, yeasts, Botrytis, Epicoccum and Fusarium species are

often found indoors as

well [13–20].

MOLD-RELATED HEALTH SYMPTOMS

Patients have been reporting multiple ill health effects linked to

exposures to mold. Studies

of more than 1600 patients suffering ill effects associated with

fungal exposure were

presented at one meeting in Dallas in 2003 (21st Annual Symposium of

Man and His

Environment, Dallas, Texas, 19–22 June 2003) [21–25].

To cite a few studies: Lieberman [21] examined 48 heavily mold-

exposed patients who

had the following health problems: muscle and/or joint pain (71%),

fatigue/weakness (70%),

neurocognitive dysfunction (67%), sinusitis (65%), headache (65%),

gastrointestinal

problems (58%), shortness of breath (54%),

anxiety/depression/irritability (54%), vision

problems (42%), chest tightness (42%), insomnia (40%), dizziness

(38%), numbness/tingling

(35%), laryngitis (35%), nausea (33%), skin rashes (27%), tremors

(25%) and heart

palpitations (21%). Rea et al.'s study [23] of 150 heavily indoor

mold-exposed patients

found the following health problems: fatigue (100%), rhinitis (65%),

memory loss and other

neuropsychiatric problems (46%), respiratory problems (40%),

fibromyalgia (29%), irritable

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2 L. CURTIS ET AL.

bowel syndrome (25%), vasculitis (4.7%) and angioedema (4.0%). These

clinical reports

suggest that there can be multisystem adverse effects of airborne

mold. All reported cases

had environmental mold exposure consistent with toxic mold exposure.

MECHANISMS OF MOLD-RELATED HEALTH EFFECTS

Fungi can exert ill health effects by three major mechanisms:

allergy, toxicity, and

infection.

Allergy and Irritation

At least 70 allergens have been well characterized from spores,

vegetative parts and small

particles from fungi (0.3 mm and smaller) [26, 27]. A review of 17

studies revealed that

6–10% of the general population and 15–50% of atopics had immediate

skin sensitivity to

fungi [28]. Fungi produce beta glucans, which have irritant

properties [29].

Toxicity

Fungi produce a wide variety of toxic chemicals called mycotoxins

[4, 30, 31]. Some

common mycotoxins include: aflatoxins—very potent carcinogens and

hepatotoxins,

produced by some Aspergillus species; ochratoxins—nephrotoxic and

carcinogenic,

produced by some Aspergillus and Penicillium; sterigmatocystin—

immunosuppressive

and a liver carcinogen, produced by Aspergillus species, especially

A. versicolor;

trichothecenes—produced primarily by Stachybotrys and Fusarium

species and have

been reported to inhibit protein synthesis and cause hemorrhage and

vomiting. Fungi also

produce beta glucans, which have immunological effects [32]. The

smell of molds comes

primarily from volatile organic compounds [33].

Adverse human and animal effects from mycotoxin-contaminated

foodstuffs have been

well recognized since the early twentieth century [30, 34], but the

pathway of mycotoxin

injury through inhalation is questioned [35]. Because it is

unethical to conduct controlled

studies on humans with inhaled mycotoxin exposure, only controlled

animal exposures and

human cohort and case–control studies can be carried out. The

literature reveals that

significant amounts of mycotoxins (including ochratoxin,

sterigmatocystin and trichothecenes)

are present in indoor dust [36–39] and dust or fungal particles less

than 10 mm

in diameter are respirable, thus allowing absorption of mycotoxins

through the lungs

[31, 34, 40, 41].

Patients exposed to indoor Stachybotrys have been found to have

measurable blood

levels of the Stachybotrys hemorrhagic toxin stachylysin [42].

Levels of trichothecene

mycotoxins in urine have also been found in significantly higher

levels in patients exposed

to high indoor fungal levels as opposed to an unexposed control

group [43].

Blood ochratoxin levels have been found to be significantly higher

in food industry

workers exposed to airborne ochratoxin vs. unexposed controls [39].

These findings support

an inhalation pathway for entry of mycotoxins into the body.

Infection

Fungi such as Candida, Histoplasmosis, Cryptococcus, Blastomyces and

Coccidioides can

infect immunocompetent people [44]. Fungi such as Trichophyton,

Candida and Malasezia

commonly cause minor skin infections in immunocompetent humans [45].

Serious infections by such fungi as Candida, Aspergillus and

Pneumocystis mostly involve

severely immunocompromised patients [45–47]. In recent years, the

incidence of lifethreatening

infections in immunocompromised patients from Aspergillus and other

common

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ADVERSE HEALTH EFFECTS OF INDOOR MOLDS 3

fungi has been growing rapidly [48, 49]. Invasive aspergillosis is

very common among

immunocompromised patients, with the following reported incidence

rates: lung

transplants: 17–26%; allogenic bone marrow transplants: 5–15%; acute

leukemia: 5–24%;

heart transplants: 2–13% [50–51]. Even with strong anti-fungal drugs

and intense hospital

treatment, mortality rates from invasive aspergillosis range from 50

to 99% in the

immunocompromised [52, 53].

SAMPLING FOR MOLD EXPOSURE

Indoor fungal sampling is most commonly performed by measuring

airborne levels of

viable (culturable) or total (viable and non-viable) spores [54,

55]. Some of the airborne

viable sampling methods, such as Andersen samplers, collect air for

only a few minutes.

Settle plates are an inexpensive method to obtain a semi-

quantitative measure of indoor

airborne fungi levels. Viable and non-viable airborne spore counts

can vary considerably

over a period of minutes, so air sampling over several periods of

time may be necessary to

accurately characterize airborne fungal spore levels [54, 55].

However, airborne fungi

measurements fail to take into consideration mold contamination in

dust or surfaces (often

visible to the naked eye) and mycotoxins in air, dust and on

surfaces [54, 56]. Therefore,

testing settled dust for fungi and mycotoxins has been recommended

[54, 55]. Other

techniques, such as polymerase chain reaction (PCR), enzyme-linked

immunosorbent assay

(ELISA), and measurement of fungal volatile organic compounds,

polysaccharides,

ergosterol and beta glucans, have also been found to be useful in

assaying indoor

environments for molds, their allergens and mycotoxins [54].

INDOOR MOLD EXPOSURE AND HEALTH EFFECTS IN BODY SYSTEMS

Respiratory System

Many epidemiological studies have noted that residential exposure to

molds and/or chronic

dampness can increase asthma/wheezing incidence or morbidity in both

children and adults

[7–9, 57–70]. Asthma and related conditions are very common in the

USA, with an overall

prevalence of about 5.4% among all age groups and incidences as high

as 27% in inner city

children [71]. Studies with infants have reported that higher fungal

exposures are associated

with more wheezing, coughing and respiratory illness [72, 73].

Higher indoor beta glucan

levels have been associated with significantly higher levels of

chest tightness and joint pain

[74]. Non-industrial occupational mold exposure has been reported to

be associated with

significantly higher levels of asthma, sinusitis, irritated skin and

eyes, and chronic fatigue

[75–79]. One study found that patients exposed to high indoor fungal

levels had

significantly lower lung function than unexposed controls [24].

Higher outdoor fungal

concentrations have been linked to higher asthma death rates [80]

and higher asthma

incidence [81–83] in children or young adults. Challenge exposures

with Penicillium and

Alternaria extracts equivalent to high outdoor levels of fungi were

noted to severely lower

lung function in asthmatics [84]. Skin sensitivity to Alternaria has

been linked to much

higher risk (odds ratio 190, 95% confidence interval 6.5–6.536,

pv0.0001) of respiratory

arrest [85]. Various epidemiological studies have associated skin

sensitivity to common

indoor fungi and higher asthma incidence or severity [86–90] and

higher rates of sinusitis

[91].

Airborne fungal exposure is known to cause bronchopulmonary

aspergillosis and

hypersensitivity pneumonitis, and can cause sinusitis [92, 93]. An

estimated 14% of the US

population suffers from rhinosinusitis and related conditions [94].

Allergic fungal sinusitis

was diagnosed on the basis of fungal growth in nasal secretions and

the presence of allergic

mucin in 93% of 101 consecutive patients undergoing sinus surgery

[94]. Another study was

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4 L. CURTIS ET AL.

able to recover and culture fungi from the sinuses of 56% of 45

patients undergoing

endoscopic sinus surgery for chronic rhinosinusitis [95]. A long-

term cohort study of 639

patients with allergic fungal sinusitis demonstrated that remedial

steps taken to reduce

fungal exposure (by utilizing, for example, air filters, ionizers,

moisture control and antimicrobial

nasal sprays) significantly reduced rhinosinusitis and improved

nasal mucosa

morphology [22]. This study concluded that failure to reduce

airborne fungi levels to less

than four per hour on a settle plate failed to resolve the sinusitis

[22]. Although,

historically, anti-fungal drugs have generally not been recommended

for the treatment of

fungal sinusitis [92, 93], recent observational studies have found

beneficial effects of oral

and nasal medication for sinusitis patients [22, 96]. Several

studies have linked residential

exposure to various fungi with hypersensitivity pneumonitis [97–99].

Hematological Effects

Exposure to high indoor levels of Stachybotrys, Aspergillus and

other fungi has been

epidemiologically associated with infant lung hemorrhage [100–104].

Although questions

were raised after this association was discovered [105], it meets

many epidemiological

criteria for causality [106]. Acute infant pulmonary hemorrhage can

be rapidly fatal; when

the infant survives, lung blood vessel damage is present and

deposits of hemosiderin will

remain in the lung macrophages and can be seen in tissue obtained

during bronchoscopy

[101]. Stachybotrys fungi produce a wide range of trichothecene

mycotoxins (including

satratoxins and T2), several roridin epimers, verrucarin J and B and

hemolysin [31, 103]. A

hemorrhagic protein called stachylysin has been isolated from

Stachybotrys collected from

homes of infants with lung hemorrhage [107, 108] and from serum of

patients with

residential Stachybotrys exposure [42]. It is hypothesized that

infants with their rapidly

growing lungs are more susceptible to the toxic effects of

Stachybotrys mycotoxins [109].

Studies with Stachybotrys-exposed adults have noted a significantly

higher incidence of

health conditions such as wheezing, skin and eye irritation, 'flu-

like symptoms and chronic

fatigue [110]. Stachybotrys has been isolated from the lungs of a

child with pulmonary

hemosiderosis [111].

A case study was presented of 16-month-old twins in a mold-infested

home, one of whom

died of pulmonary hemosiderosis [112]. High levels of trichothecene

mycotoxins were found

in the lungs and liver of the dead infant, while high IgG levels to

Stachybotrys and IgM

levels to satratoxin and trichothecenes were found in the serum of

the surviving infant.

Environmental sampling in the twins' home found high levels of

satratoxin as well as high

levels of spores from Stachybotrys, Aspergillus versicolor and

Penicillium [112].

Immune System

Some studies have reported that indoor fungi-exposed patients have

higher serum levels of

IgG, IgA and IgM antibodies to common fungi, trichothecenes and

satratoxins [113–115].

IgG antibodies to nine common indoor fungi were significantly higher

in subjects with

sinusitis vs. non-sinusitis subjects in a moldy school [116]. Other

studies have noted no

significant increases in fungal IgG [117, 118] or fungal IgE [113]

in fungi-exposed patients.

Indoor fungal exposure has been associated with altered levels of

T4, T8 and natural killer

cells and higher levels of autoantibodies [23, 25, 119, 120].

Occupants of homes with high

Indoor glucan exposure had a lower proportion of cytotoxic t-cells

(CD8zSF61z) and

higher secretion of tumor necrosis factor than occupants of homes

with lower levels of beta

glucans [121]. Studies of animals given such common mycotoxins as

aflatoxins, ochratoxins

and trichothecenes orally showed considerable immune impairment,

including depression

of T cells, B cells and macrophages [122]. Human cell line studies

have also found that

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ADVERSE HEALTH EFFECTS OF INDOOR MOLDS 5

many mycotoxins can suppress T-cell, B-cell and natural killer cell

activity at serum

concentrations similar to those found in indoor mold-exposed

patients [123].

Central Nervous System

Two case series of 48 and 150 mold-exposed patients found

significant fatigue and

weakness in 70–100% of cases, and neurocognitive dysfunction

including memory loss,

irritability, anxiety and depression in over 40% of the patients

[21, 23]. Numbness, tingling

and tremor were also found in a significant number of patients [21,

23]. These signs and

symptoms have been described as classic manifestations of

neurotoxicity [124].

A study of 43 mold-exposed patients found that they performed

significantly worse than

202 controls on many neuropsychiatric tests, including balance sway

speed, blinking reflex,

color perception, reaction times and left grip strength (pv0.0001)

[125]. Quantitative

electroencephalogram (qEEG) studies in 182 patients with documented

mold exposure also

noted significant alterations in brain waves, including

hypoactivation of the frontal cortex

and narrowed frequency bands [126]. Higher levels of mold exposure

(longer time in moldinfested

area, presence of Stachybotrys or higher cfum23 air) were associated

with

significantly more abnormal qEEGs as well as significantly worse

scores of concentration

and motor and verbal skills in these 182 patients [126]. A triple-

headed SPECT brain scan ;

revealed neurotoxic patterns in 26 of 30 (87%) mold-exposed patients

[127]. An iriscorder

study of autonomic nervous function in 60 mold-exposed patients

found that 95% had

abnormal autonomic responses of the pupil compared with the

population reference range

[23]. Visual contrast sensitivity studies were often abnormal in

indoor mold-exposed

patients [23]. Additional studies have reported that mold-exposed

patients do significantly

worse on tests of attention, balance, reaction time, verbal recall,

concentration, memory,

and finger tapping compared with the general population reference

range [24, 128, 129].

Most of these patients also experienced many health problems,

including chronic fatigue,

headaches, insomnia and decreased balance, concentration and

attention. Studies of indoor

mold-exposed children and adults found significantly more

neurophysiological abnormalities

vs. controls, including abnormal EEGs and abnormal brainstem, visual

and

somatosensory evoked potentials [25, 130, 131].

Lieberman [21] presented a case series of 12 patients who developed

tremors following

documented heavy indoor mold exposure. Numerous articles have

reported domestic dogs

developing tremors following ingestion of moldy food [132–134].

Territrem b, a mycotoxin

produced by the common fungus Aspergillus terreus, has been shown to

be an irreversible

binder and inhibitor of acetylcholinesterase [135].

Renal System

It is known that ochratoxin-contaminated food is nephrotoxic [136,

137]. Indoor airborne

exposure to ochratoxin may also be nephrotoxic. In a case report of

a family presenting

with increasing thirst/urination, lethargy, and skin rash, a

considerable amount of

ochratoxin was found in their house dust. The family recovered after

moving to another

home [36].

Reproductive System

The literature suggests a relationship between heavy airborne fungal

exposure and

reproductive dysfunction. sen et al. [138, 139] reported that

airborne mycotoxin

exposures in Norwegian grain farmers was significantly related to

higher rates of preterm

deliveries, late-term miscarriages and higher rates of endometrial

and ovarian

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6 L. CURTIS ET AL.

endocarcinoma. The veterinary literature finds a strong association

between mycotoxtins in

feedstuffs and reproductive problems [140].

Diabetes

There is a great deal of evidence that links environmental factors

to the triggering of type 1

diabetes. Exposure to viruses, bacteria and mycotoxins such as

alloxan, streptozatocin and

L-asparginase has been linked to the development of type 1 diabetes

in animals and

humans [141–143]. Lieberman [21] reported that in a single year,

five of his patients

developed type 1 diabetes following documented heavy indoor mold

exposure.

DIAGNOSIS AND MANAGEMENT OF POTENTIALLY MOLD-RELATED

HEALTH PROBLEMS

A careful medical and environmental history is an essential first

step in evaluating a patient

for mold-related health problems [144–147]. Particular attention

should be paid to any

history of exposure to visible mold and/or water damage at the home

or workplace.

Environmental sampling for viable spores, total spores, and

mycotoxins in the air and dust

can provide important exposure information. For a helpful overview

of sampling methods,

see references [54, 148, 149]. For an informative guide to the

classification, identification

and biology of common indoor fungi, see reference [4]. Several good

guides exist for the

prevention and remediation of indoor fungi problems [144, 148–151].

For patients suspected of having substantial fungal exposure, a

battery of sophisticated

laboratory tests has been developed: a basic metabolic panel to test

for several important

parameters (including electrolytes, blood sugar, liver and kidney

status); measurement of

antibodies to molds and mycotoxins in serum [113, 114]; immune tests

for autoantibodies,

complement, gamma globulins and lymphocyte panels [120]; urine and

blood testing for

mycotoxins [43]; visual contrast sensitivity tests; and pupillometry

and heart rate variation

to assist in the evaluation of autonomic nervous system function.

The use of standard

neuropsychological test batteries [23, 128–130], EEG and brain

imaging techniques such as

SPECT and magnetic resonance imaging (MRI) can be very helpful tools

in documenting

neurological damage [25,125, 127, 131, 145]. Pulmonary function

tests are also useful for

patients with respiratory symptoms [24, 124]. Failure to perform

objective evaluations to

access system or organ dysfunction account for the presently

accepted position that

airborne mold exposures have no significant adverse effects [35]. If

end-stage organ damage

is suspected, consultation with a specialist may be useful.

Other common indoor environmental exposures should also be

considered as a potential

source of health problems. Common non-fungal indoor environmental

factors include poor

ventilation, carbon monoxide from faulty heat sources, leaking

natural gas, pesticides,

wood smoke, second-hand tobacco smoke, petrochemicals, such as

cleaners/building

materials/solvents, formaldehyde from outgassing carpets, building

materials, bacteria, and

allergens from the fur, feathers, saliva and excrement of common

household animals such

as cockroaches, dust mites, cats, dogs, mice, rats, caged birds, and

pigeons. Exposure to

ozone, second-hand tobacco smoke, cockroach allergens, formaldehyde,

and viral

infections have been noted to have a synergistic effect with fungal

exposure to worsen

asthma and rhinitis [152–156].

The most important part of treatment for mold-exposed patients,

symptomatic or not, is

avoidance of fungal exposure and remediation of mold contamination

in the home and

workplace. Any water leaks and damage from flooded or damp areas

should be rectified

immediately. Non-porous surfaces such as floors and walls that have

visible mold growth

should be cleaned. Porous waterlogged materials like carpet and

furniture should be

discarded. Control of humidity is important to control mold growth.

The use of air

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ADVERSE HEALTH EFFECTS OF INDOOR MOLDS 7

conditioners and dehumidifiers can significantly reduce summertime

indoor airborne mold

concentrations [13, 157]. HEPA air filters can also significantly

reduce indoor airborne

fungi concentrations [158]. For cleaning severe indoor water or mold

problems, the use of

protective equipment like face masks and/or the use of a

professional remediation firm may

be essential [148–151].

Environmental control plays a key role in preventing Aspergillus

infections. Several

studies have linked hospital construction work to increased rates of

invasive aspergillosis

[159–162]. Environmental controls such as using HEPA filters,

sealing rooms, regular

cleaning of rooms, and using anti-fungal copper-8-quionolate paint

have been shown to

both significantly reduce airborne levels of Aspergillus and

significantly reduce rates of

invasive aspergillosis in immunocompromised hospital patients [158,

160–165]. Other recent

research has indicated that a large number of Aspergillus spores can

spread through water

supplies [166] and that cleaning shower facilities can significantly

lower airborne levels of

Aspergillus [167].

Use of sublingual or fungal immunotherapy by injection has been

shown to be beneficial

to some patients sensitized to common indoor molds such as

Alternaria and Cladosporium

herbarium [168, 169]. Some studies with laboratory animals suggest

that a high-quality diet

with adequate antioxidant vitamins, selenium, phytochemicals,

methionine and total

protein can reduce the harmful effects of food mycotoxins [170, 171].

SUMMARY

There is an accumulated weight of evidence linking indoor airborne

mold and/or

mycotoxin exposures to multisystem adverse human health effects. A

history of new

neurocognitive symptoms occurring in patients soon after heavy mold

exposure,

accompanied by objective neuropsychological findings in such

patients, adds considerably

to the weight of evidence from animal studies, epidemiological

research, and case series.

Health care professionals, building managers, homeowners and the

general public need

to be much more aware of the potential adverse health effects of

high indoor fungal

exposures and the need for proper building construction,

maintenance, and remediation of

dampness to prevent such effects. Potentially mold-related illnesses

need to be considered in

differential diagnoses, and careful exposure histories taken. Prompt

removal from exposure

to fungal contamination remains the treatment of choice, with some

evidence that

immunotherapy and nutritional support are also useful. Indoor

airborne mold particles can

be irritative to the respiratory tract, and fungal spores, antigens,

volatile organic

compounds, and mycotoxins can be absorbed through the respiratory

route to provoke

injury by the mechanisms of allergy, toxicity, and infection.

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Journal: Journal of Nutritional & Environmental Medicine

Title: Adverse Health Effects of Indoor Molds

Authors: L. CURTIS ET AL.

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