Mold inhalation not as toxic as patients may think

IDC NY 2011

NEW YORK — Despite what many parents think, inhaling mold spores generally does not cause severe disease. Severe disease occurs only after mold spores are ingested, according to a presenter at the recent 24th Annual Infectious Diseases in Children Symposium.

Cyrus Rangan, MD, director of the Bureau of Toxicology at the Los Angeles County Department of Public Health, spoke about the myths that typically surround molds and fungus. He said reasonable evidence exists that links exacerbation of allergies and asthma to mold inhalation, but true systemic disease tends to occur after a patient ingests mold species such as Fusarium and Aspergillus.

According to Rangan, historical reports of cases of systemic poisoning in humans were found to be linked to ingestion and absorption of mold or the reports have since been proven false, including the original 10 cases of idiopathic pulmonary hemosiderosis among infants in Cleveland that were supposedly caused by Stachybotrys atra. Contact with inhaled or aerosolized mold causes only minor respiratory or dermal complaints in most.

Mold may be a red herring

Rangan, who also serves as an assistant medical director at the California Poison Control System and is a medical toxicology consultant for Children’s Hospital Los Angeles, said mold grows almost everywhere if the temperature is ideal (which it is in most of the United States) and a nutrition and water source is present.

The key point, he said, is that the conditions that are ideal for the growth of mold are also ideal conditions for growth of mites, roaches and microbes.

“All of these have much more proven background in causing human disease. Ultimately, mold may be more of a red herring when you look at indoor environments because all these other things are growing at the same time,” Rangan said.

He said allergy testing may be useful in some patients who have persistent respiratory symptoms, but mold antibody screening tests are not approved by the FDA and are commonly misinterpreted.

“CLA testing is only for allergic conditions and not for ‘toxic exposure’ evaluation,” he said. “There is little evidence to support other evaluations.”

What to tell the parents

If parents of a child present to the office with concerns about mold exposure in the residence, Rangan said he advises the parents that they should clean the mold, which can be done through normal household cleaning methods and generally does not require the help of a third party unless structural damage or water intrusion has occurred.

Air sampling is also not typically required because it is “highly variable and does not impact plans for remediation,” Rangan said.

Disclosure: Dr. Rangan reports no relevant financial disclosures.

Matthew Greenhawt

Mold is a ubiquitous indoor and outdoor environmental allergen that most individuals are exposed to on a daily basis. We are exposed to these indoors on a daily basis (most without any awareness of the exposure, given how common this is in the environment), as well as outdoors except when the ground is frozen and covered with snow.

The term “black mold” is often a source of confusion and unnecessary worry for patients. The case report from Cleveland with Stachybotrys atra represents the exception, not the rule, and no other such similar cases have been reported. In fact, most people who are exposed to so-called “black mold” suffer no symptoms at all, because most mold appears black and few of these colonies are Stachybotrys. Unfortunately there is a hysteria associated with this term and a connotation that this is somehow highly toxic. Instead, it is easier to focus on mold’s most notorious health problem — allergic disease. The highest risk groups for mold exposure are those who are allergic or have allergic asthma. Mold exposure has been proven to exacerbate both allergic rhinitis and asthma, and sensitive patients are generally placed on prophylactic medication therapy (eg, antihistamines, nasal or inhaled steroids) and/or allergen immunotherapy.

While there have been numerous reports of the so-called phenomenon of “sick building syndrome,” this is rare and exceptionally difficult to prove. Other mold-related immunologic conditions, such as allergic bronchopulmonary aspergillosis, occupation asthma or allergic fungal sinusitis, can arise. However, these tend to be rare, and related to specific medical conditions (eg, nasal polyps, chronic lung disease, asthma or cystic fibrosis) or to specific occupations (eg, farm/silo workers, home remodeling/construction).

As was mentioned by the presenter, mold abatement is relatively simple, and can be accomplished with bleach and water. For patients where there is a concern for mold-triggered or mold-attributed respiratory symptoms, consultation with a board-certified allergist/immunologist is recommended for testing and assistance with appropriate treatment.

Matthew J. Greenhawt, MD
Infectious Diseases in Children Editorial Board

Disclosure: Dr. Greenhawt reports no relevant financial disclosures.

For more information:

• Rangan C. Mold myths and fungal fallacies: sorting out “toxic mold.” Presented at: 24th Annual Infectious Diseases in Children Symposium; Nov. 19-20, 2011; New York.

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