| Mold Allergy | | Counselor, There has been a recent increase in litigation regarding residential exposure to molds. Molds are fungi and they are ubiquitous, existing in virtually all environments including home and work. They are airborne allergans and are important causes of disease, particularly of the upper and lower respiratory tracts. Molds are saprophytic meaning they obtain their nutrition from the breakdown and decay of organic matter. They can thrive in many places such as soil, plant litter, wood, live plants, indoor and outdoor, and play a vital role in the environment as a decomposer of dead plant matter. We value all your comments, so, if you have a suggestion for a newsletter subject but haven't submitted it yet, or if you have already submitted one but think of another, please take a minute to let us know by clicking on your "Reply" button and dropping us a note. To learn more about AMFS, Inc., the organization run by Physicians and Attorneys that provides medical experts and case review services nationwide, and has produced the following informational newsletter to aid you in understanding complex medical issues, please click here - www.medicalexperts.com. |
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| Biology of Molds: Five major classes of fungi are known to be potent allergens: Oomycetes, Zygomycetes, Ascomycetes, Basidiomycetes, and Deuteromycetes. Most molds require oxygen, carbohydrate and an ambient moisture level and temperature that is conducive for growth. Mold spores typically increase with increased moisture. Some molds are asexual, others are sexual and produce spores. Either the mold itself or the spores can be allergans. Common species of molds that have appeared recently in the mold allergy literature are Aspergillus, Stachybotrys (so-called "Black Mold"), Cladosporium, Fusarium, Penicillium, and Mycotoxins. |
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| Collecting Samples: A common method for sampling molds is to use the Anderson Air Sample Volumetric Collector. Sampling allows trapping of air particles in the filter that can then be plated in a petri dish with the appropriate media to allow the mold to grow. If spore counts are higher than 200 spores per cubic meter of air, allergies in those who are susceptible will occur with greater frequency. |
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| | Basic Pathophysiology of the Allergic Response to Molds: Mold antigens cause an increased level of immunoglobulin E (IgE) which is produced by B lymphocytes. B lymphocytes are stimulated to produce IgE by other substances (interleukins) produced by T lymphocytes. IgE binds to mast cells in tissue which causes a release of a variety of substances which cause the clinical manifestations of allergy, including histamine, leukotrienes, and prostaglandins. The net effect is inflammation. Inflammation causes disease. |
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| | Clinical Presentation of Mold Allergy: The two most common diseases caused by mold allergy are allergic rhinitis and allergic asthma. Allergic rhinitis is year round with seasonal fluctuations based on humidity and temperature. Severe perennial rhinitis often leads to chronic sinusitis and turbinate hypertrophy which results in difficulty moving air through the nasal passages. Some recent studies have also linked mold allergy to upper respiratory infections that persist through the rainy and cold seasons. The most characteristic symptoms are red eyes, headache, fatigue, moodiness, and mild memory loss, as well as the usual runny and itchy nose, sneezing, nasal congestion, raspy voice, chronic cough from post-nasal drip, and a chronic mild sore throat. Asthma can become chronic and resistant to bronchodilators, but responsive to anti-inflammatory agents, like steroids. Allergic pneumonia can also result from mold- induced asthma. |
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| |  Epidemiology: It is estimated that 40% of children with allergic rhinitis test positive in allergy testing for molds. A history of prolonged cold symptoms that last for more than 2 weeks in cold seasons may indicate the presence of mold allergy. In fact, a recent study in Kansas City indicated that fungal allergens were highest in the homes of children with asthma! Nearly 20 allergenically important molds are related to the household environment. Among them, Alternaria and Hormodendrum species are the most common. Usual habitats include damp, dark places (e.g., cellars, bathrooms, garages, attics); rotting leaves or vegetation, indoor plants, and organic plant containers (eg, wicker, straw, hemp); old foam rubber pillows and peeling wallpaper; furniture stuffed with decaying kapok or cotton; rubber gaskets on old refrigerator doors; dishwashers, drainage sinks, and washing machines; and garbage cans. Water-damaged areas, such as leaky roofs, walls with dry rot, and wet carpets, or areas with poor drainage are also prime habitats for indoor mold. Mold can also grow in room air humidifiers, cold-mist vaporizers and air- conditioning systems. |
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| | Testing People for Mold Allergy: Mold allergy can be confirmed by skin testing, radioallergosorbent assays (RAST testing), nasal cytology for eosinophils, serum IgE, precipitin test to measure IgG levels that will be produced in response to fungal antigens, and direct fungal culture. |
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| |  Prevention and Treatment: Symptoms can be alleviated by simply decreasing exposure to the mold allergen. The way to do this is to keep the local environment dry, and plants inside the house should be eliminated. Humidifiers and vaporizers should be properly maintained since they are a common source of indoor mold. Roof leaks and wet walls are also a common source for indoor mold growth. Fungicidal agents should be used frequently for cleaning. Also, an air cleaner like a HEPA (high efficiency particulate air) filter can be used to sequester mold spores. Effort should made to reduce mold growth by decreasing excessive moisture build up. Additionally, other pollution factors like cigarette smoking can aggravate mold allergy and is particularly harmful to susceptible people. Avoiding mold allergans 100% of the time is virtually impossible. Therefore, drug therapy assumes a central role in helping to ameliorate symptoms in those who are sensitive to molds. The medications include antihistamines, decongestants, eye drops, steroid nose sprays, bronchodilators, and oral and inhaled steroids, mast cell stabilizers like Cromolyn sodium, Singulair, and in severe cases, immunotherapy. |
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