Inhalational mold toxicity: fact or fiction? Emil Bardana

[Guest guest]

Everyone should enjoy reading this. I don't recall seeing it before.

May

May Indoor Air Investigations LLC

Tyngsborough, MA

www.mayindoorair.com

978-649-1055

-------------------------------------------------------------------------------

Inhalational mold toxicity: fact or fiction? a clinical review of 50 cases

Barzin Khalili, MD , Emil J. Bardana Jr, MD

Received 27 January 2005; accepted 28 March 2005.

Background

Three well-accepted mechanisms of mold-induced disease exist: allergy,

infection, and oral toxicosis. Epidemiologic studies suggest a fourth

category described as a transient aeroirritation effect. Toxic mold

syndrome or inhalational toxicity continues to cause public concern

despite a lack of scientific evidence that supports its existence.

Objectives

To conduct a retrospective review of 50 cases of purported

mold-induced toxic effects and identify unrecognized conditions that

could explain presenting symptoms; to characterize a subgroup with a

symptom complex suggestive of an aeroirritation-mediated mechanism and

compare this group to other diagnostic categories, such as sick

building syndrome and idiopathic chemical intolerance; and to discuss

the evolution of toxic mold syndrome from a clinical perspective.

Methods

Eighty-two consecutive medical evaluations were analyzed of which 50

met inclusion criteria. These cases were critically reviewed and

underwent data extraction of 23 variables, including demographic data,

patient symptoms, laboratory, imaging, and pulmonary function test

results, and an evaluation of medical diagnoses supported by medical

record review, examination, and/or test results.

Results

Upper respiratory tract, lower respiratory tract, systemic, and

neurocognitive symptoms were reported in 80%, 94%, 74%, and 84% of

patients, respectively. Thirty patients had evidence of

non?mold-related conditions that explained their presenting

complaints. Two patients had evidence of allergy to mold allergens,

whereas 1 patient exhibited mold-induced psychosis best described as

toxic agoraphobia. Seventeen patients displayed a symptom complex that

could be postulated to be caused by a transient mold-induced

aeroirritation.

Conclusion

The clinical presentation of patients with perceived mold-induced

toxic effects is characterized by a disparate constellation of

symptoms. Close scrutiny revealed a number of preexisting diagnoses

that could plausibly explain presenting symptoms. The pathogenesis of

aeroirritation implies completely transient symptoms linked to

exposures at the incriminated site. Toxic mold syndrome represents the

furtive evolution of aeroirritation from a transient to permanent

symptom complex in patients with a psychogenic predisposition. In this

respect, the core symptoms of toxic mold syndrome and their gradual

transition to chronic symptoms related to nonspecific environmental

fragrances and irritants appear to mimic what has been observed with

other pseudodiagnostic categories, such as sick building syndrome and

idiopathic chemical intolerance.