Molds and Indoor Toxins
We evaluate and treat sickness caused by mold and indoor allergens[caption id="attachment_755" align="alignnone" width="1280"] Mold growth on the walls after water damage[/caption] Dr Kushnir is a specialist and medical expert on immune problems related to environmental toxins. She evaluates and treats patients with a history of exposure to unhealthy living conditions (dampness, standing waters, water leak and subsequent growth of toxic mold). While mold is common and lives everywhere, it can become first a sign of increased moisture and then become a significant health hazard when growth goes out of control. Sick building syndrome (SBS) is a phenomenon affecting building occupants who claim to experience acute health and comfort effects that appear to be linked to time spent in a building, but no specific illness or cause can be identified. SBS is also used interchangeably with “building-related symptoms”, which orients the name of the condition around patients rather than a “sick” building. A 1984 World Health Organization (WHO) report suggested up to 30% of new and remodeled buildings worldwide may be subject of complaints related to poor indoor air quality.
What can cause sickness in the house?Sick building causes are frequently pinned down to flaws in the heating, ventilation, and air conditioning (HVAC) systems. Other causes have been attributed to contaminants produced by outgassing of some types of building materials, volatile organic compounds (VOC), molds (see mold health issues), improper exhaust ventilation of ozone (byproduct of some office machinery), light industrial chemicals used within, or lack of adequate fresh-air intake/air filtration (see Minimum Efficiency Reporting Value). Many physicians are not aware of the recent scientific evidence documenting the facts (questionable in the past) that a susceptible person can develop multiple chronic health problems due to high indoor exposure to multiple molds, bacterial overgrowth, indoor allergens (dust mites, rodents, and organic matter (VOC released from disintegrating building materials). Chronic mold exposures are even more problematic than short-term, and can induce changes in inflammatory and immune system responses to specific mold and mycotoxin challenges. Recent scientific publications have shown consistent associations between evident indoor dampness or mold and respiratory or allergic health damages. Mixed molds and their associated mycotoxins exposure leads to multiple health problems, in addition to pulmonary effects and allergies.
What are the symptoms that may be caused by mold?[caption id="attachment_718" align="alignright" width="300"] Hives and respiratory problems frequently are the first problems in people living in contaminated households[/caption] Here are some of the most frequent complaints from patients exposed to damp and moldy conditions in their living spaces:
- New onset allergy to multiple molds and indoor allergens
- New onset or severe exacerbation of asthma
- Lung interstitial diseases
- Body rashes, hives and itching
- Headaches and migraines
- Inability to concentrate and chronic fatigue, balance problems
- Pregnancy complications and miscarriages
- Seizures in babies carried during pregnancy and born into unhealthy living conditions
- Digestive issues and food allergy
Are there tests for mold-induced health problems?
- First and most conclusive test is a skin allergy test that is confirming allergic sensitization of a person to indoor allergens – molds, dust mites, mice, rats, cockroaches. If sensitization is not confirmed, it is hard to conclude that symptoms felt by a patient are indeed related to exposures. There are other factors such as viral diseases or food allergy that can possibly cause similar symptoms.
- Laboratory analysis of the blood can indicate activation of the inflammatory and autoimmune mechanisms that have no other diagnostic explanation other than indoor toxic mold exposure.
- We do not offer urine mycotoxin tests, but Dr Kushnir can review mycotoxin studies done by Naturopathic Doctors.
- Pulmonary Function test can identify new onset or exacerbation of asthma, or any other obstructive and restrictive diseases of the lungs.
- Clinical evaluation and exam can document rashes, allergic rhinitis, ear fluid and eye allergy.
Are molds toxic?[caption id="attachment_867" align="alignright" width="300"] Little boy using nebulizer while sitting on floor near window in mold-contaminated apartment[/caption] More recently, there is an increasing awareness of the adverse effects of various mycotoxins on vulnerable structures in the intestines and the impairment of intestinal integrity. Ochratoxin A (OTA) is a mycotoxin produced by various species of Aspergillus and Penicillium (Marin et al. 2013). Exposure to OTA is a worldwide phenomenon, as evidenced by the presence of OTA in the majority of the tested human blood samples in many countries (Peraica et al. 2001; Pfohl-Leszkowicz and Manderville 2007; Studer-Rohr et al. 2000). The kidney is the major target organ for OTA and its derivatives, and some epidemiological studies in humans have associated the exposure to OTA with a chronic tubulo-interstitial nephritis (also denoted Balkan endemic nephropathy (BEN)) and urothelial tract tumors (Fink-Gremmels 2005; Grollman and Jelakovic 2007; Marin et al. 2013). At higher concentrations, OTA has been shown to be nephrotoxic, teratogenic and immunotoxic. Of clinical relevance is the finding that the OTA-induced intestinal barrier impairment in concentrations equal or higher than 1 µM OTA triggers a concentration- and time-dependent increase in the translocation of Escherichia coli across Caco-2 cell monolayers (Maresca et al. 2008). Multiple experimental pulmonary exposures to S. chartarum induced significant metabolic changes in the lungs but not in the plasma. These changes suggest a shift from type 1 inflammation after an acute exposure to type 2 inflammation after multiple exposures to S. chartarum. Eotaxin, vascular endothelial growth factor (VEGF), MIP-1α, MIP-1β, TNF-α, and the IL-8 analogs macrophage inflammatory protein-2 (MIP-2) and keratinocyte chemoattractant (KC), had more dramatic changes in multiple- than in single-dosed mice, and parallel the cytokines that characterize humans with histories of mold exposures versus unexposed control subjects.( Am J Respir Cell Mol Biol. 2016 Oct;55(4):521-531.Repeated Mouse Lung Exposures to Stachybotrys chartarum Shift Immune Response from Type 1 to Type 2.Rosenblum Lichtenstein JH, Molina RM, Donaghey TC, Hsu YH, Mathews JA, Kasahara D, Park JA, Bordini A, Godleski JJ, Gillis BS, Brain JD). Aspergillus, the mold that causes aspergillosis, makes me significantly concerned. For people with healthy immune systems, breathing in Aspergillus isn’t harmful. However, Aspergillus spores are capable of triggering immune response, and produce mycotoxins that over a prolonged period of time can cause health problems. Recently study that was part of a larger multicenter investigation of patients with multiple health complaints attributable to confirmed exposure to mixed-molds infestation in water-damaged buildings reported new findings confirming immune damage. Abnormally high levels of ANA, ASM, and CNS myelin (immunoglobulins [Ig]G, IgM, IgA) and PNS myelin (IgG, IgM, IgA) were found; odds ratios for each were significant at 95% confidence intervals, showing an increased risk for autoimmunity. The authors conclude that exposure to mixed molds and their associated mycotoxins in water-damaged buildings leads to multiple health problems involving the CNS and the immune system, in addition to pulmonary effects and allergies. Mold exposure also initiates inflammatory processes. The authors propose the term "mixed mold mycotoxicosis" for the multisystem illness observed in these patients (Arch Environ Health. 2003 Jul;58(7):410-20.Mixed mold mycotoxicosis: immunological changes in humans following exposure in water-damaged buildings. Gray MR1, Thrasher JD, Crago R, Madison RA, Arnold L, Campbell AW, Vojdani A.)
Is there bacteria growth in the wet building materials?Non-infectious inhaled microbial particles can cause illness by triggering an inappropriate immunological response. From the pathogenic point of view these illnesses can be seen to be related to on one hand autoimmune diseases and on the other infectious diseases. Hypersensitivity pneumonitis (HP) is the best known of these illnesses and it has also been widely studied in animal models and clinically. In contrast to HP Pulmonary mycotoxicosis (PM) is not considered to involve immunological memory, it is an acute self-limiting condition is caused by an immediate "toxic" effect. Damp building related illness (DBRI) is controversial and from a diagnostic point poorly defined entity that is however causing, or attributed to cause, much more morbidity than the two other diseases. In the recent decade, there has been a shift in the focus of immunology from the lymphocyte centered, adaptive immunity towards innate immunity. The archetypal cell in innate immunity is the macrophage although many other cell types participate. Innate immunity relies on a limited number of germline coded receptors for the recognition of pathogens and signs of cellular damage. The focus on innate immunity has opened new paths for the understanding of many chronic inflammatory diseases.( Int J Biol Sci. 2011 Mar 15;7(3):261-8.Innate immunity and the pathogenicity of inhaled microbial particles. Wolff CH). The main microbials' produced metabolites found on pinewood were ketones (e.g. 2-heptanone) and alcohols (e.g. 2-methyl-1-propanol). Some of these compounds were also found on particle board, gypsum board and the synthetic medium, but there were more differences than similarities between the materials. For example, dimethoxymethane and 1,3,5-trioxepane and some nitrogen containing compounds were found only on particle board. The metabolite production on gypsum board was very low, although some terpenes (e.g. 3-carene) could be identified as fungal metabolites (J Environ Monit. 2002 Oct;4(5):667-72).
When should I worry about unhealthy indoor exposure?You should always take immediate care of the leaks and water intrusion. If you see discoloration of the walls, wet carpets or warped ceiling and wall paint – these are the sure signs of moisture accumulation. Mold and mildew growth should not happen in a well-ventilated and properly constructed housing. Some weather conditions such as floods cannot be avoided, but remediation done on time can prevent further damage and mold growth. It is a known fact that health damage of any unhealthy exposure is proportionate to the time of exposure and amount of toxin. The United States Centers for Disease Control and Prevention reported in its June 2006 report, 'Mold Prevention Strategies and Possible Health Effects in the Aftermath of Hurricanes and Major Floods, that "excessive exposure to mold-contaminated materials can cause adverse health effects in susceptible persons regardless of the type of mold or the extent of contamination." When mold spores are present in abnormally high quantities, they can present especially hazardous health risks to humans, including allergic reactions or poisoning by mycotoxins, or causing fungal infection (mycosis).( Weinhold B (June 2007). "A spreading concern: inhalational health effects of mold". Environ. Health Perspect. 115 (6): A300–5. doi:10.1289/ehp.115-a300. PMC 189213. PMID 17589582. Indoor Environmental Quality: Dampness and Mold in Buildings. National Institute for Occupational Safety and Health. August 1, 2008.
Are there groups of people who are more affected?Most significant concern is younger child with exposure during intrauterine and early life with immature immune and nervous system. (Pediatrics.2001Aug;108(2):E33. Sensitization to common allergens and its association with allergic disorders at age 4 years: a whole population birth cohort study. Clin Exp Allergy. Arshad SH1, Tariq SM, Matthews S, Hakim E). Starting from the Developmental Origins of Health and Disease (DOHaD) hypotheses proposed by David Barker, namely fetal programming, in the past years, there is a growing evidence of the major role played by epigenetic factors during the intrauterine life and the perinatal period. Furthermore, it has been assessed that these factors (including but not limited to exposure to environmental toxicants) can affect the health status in infancy and even in adulthood (Birth Defects Res C Embryo Today. 2016 Sep;108(3):207-223. doi: 10.1002/bdrc.21139. Epub 2016 Oct 24.Fetal programming of neuropsychiatric disorders. Faa G, Manchia M, Pintus R, Gerosa C, Marcialis MA, Fanos V). Elderly people and immunocompromised patients who have weakened immune systems are at higher risk. For these groups breathing in Aspergillus spores can cause an infection in the lungs or sinuses which can spread to other parts of the body. There are approximately 180 species of Aspergillus, but fewer than 40 of them are known to cause infections in humans. Aspergillus fumigatus and A. niger are the most common cause of human Aspergillus infections. Other common species include A. flavus, A. terreus,. (https://www.cdc.gov/fungal/diseases/aspergillosis/causes.html). Allergic bronchopulmonary aspergillosis (ABPA) and Allergic fungal rhinosinusitis (AFRS) are allergic reactions that happen to some people after exposure to Aspergillus fungus. The fungus causes inflammation in the lungs and air passages. ABPA is more common in people with cystic fibrosis or asthma because they tend to have more mucus in their airways. Although it is unclear exactly why the allergic reactions occur, the mucus in their airways may provide a good environment for the mold to grow. Unfortunately, the allergic reaction may produce symptoms similar to those associated with asthma or cystic fibrosis, including wheezing, coughing and difficulty with breathing (http://my.clevelandclinic.org /health/articles/aspergillosis)