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problems 42%; 10) chest tightness, 42%; 11) insomnia, 40%; 12) dizziness, 38%; 13) numbness/tingling, 35%; 14) laryngitis, 35%; 15) nausea, 33%; 16) skin rashes, 27%; 17) tremors, 25%; and 18) heart palpitations, 21%. Rea's* study of 150 indoor-mould-exposed patients found the following health problems: 1) fatigue, 100%; 2) rhinitis, 65%; 3) memory loss and other neuropsychiatric problems, 46%; 4) respiratory problems, 40%; 5) fibromyalgia, 29%; 6) irritable bowel syndrome, 25%; 7) vasculitis, 4.7%; and 8) angio-oedema, 4.0%. These clinical reports demonstrate the multi-system adverse effects of airborne mould. There is now considerable evidence in the medical literature that indoor airborne fungus exposure can cause numerous adverse health effects in multi-organ systems. epidemiology studies can be used. The literature demonstrates that significant amounts of mycotoxins (including ochratoxin, sterigmatocystin and trichothecenes) are present in indoor dust*“* and in fungal spores which can be absorbed through the respiratory route.**”“** Patients exposed to indoor Stachybotrys have been found to have measurable blood levels of the Stachybotrys haemorrhagic toxin stachylysin.** Levels of trichothecene mycotoxins in the urine have also been found in significantly higher levels in patients exposed to high indoor fungus levels, as opposed to a control group not exposed to high indoor fungus levels.” Blood ochratoxin levels have been found to be significantly higher in food industry workers exposed to airborne ochratoxin versus in unexposed controls. ** These findings clearly demonstrate an inhaled pathway for entry into the body. cd Mechanisms of Mould-Related Health Effects Fungi can exert ill health effects by three mechanisms: 1) Sampling for Mould Exposure infection; 2) allergy; and 3) toxicity. Indoor fungus sampling is most Serious infections by such fungi as commonly performed by measuring airborne Candida, Aspergillus and Pneumocystis are levels of viable (culturable) or total (viable common and mostly involve severely and non-viable) spores.“ Some of the immuno-compromised patients.**** Fungi airborne viable sampling methods, such as such as Candida, Histoplasmosis, Andersen samplers, collect air for only a few Cryptococcus, Blastomyces and Coccidioides minutes. can infect internally immuno-competent Settle plates are an inexpensive method to people.*? Fungi such as Trichophyton, TANITL get a semi-quantitative measure of indoor Candida and Malasezia commonly cause Significant amounts airborne fungus levels. Viable and non- minor skin infections in immuno-competent of mycotoxins are viable airborne spore counts can vary humans.* A 4 considerably over a period of minutes, so air At least 70 allergens have been well present In indoor dust sampling over several periods of time may characterised from spores, vegetative parts and in fungal spores be necessary to characterise airborne fungal and small particles from fungi (0.3 48.49 microns and smaller).***' Allergies to fungal allergens are very common, with a review of 17 studies finding that 6%-10% of the general population and 15%-50% of atopics had immediate skin sensitivity to fungi.” Fungi produce a wide variety of toxic chemicals called mycotoxins. '*** Some common mycotoxins include: 1) Aflatoxins: very potent carcinogens and hepatotoxins produced by some Aspergillus species; 2) Ochratoxins: nephrotoxic and carcinogenic; produced by some spore levels accurately . However, airborne fungus measurements fail to take into consideration non-airborne mould contamination such as mould contamination in dust or surfaces (often visible to the naked eye) and mycotoxins in air, dust and on surfaces.***° Therefore, testing the settled dust for fungi and mycotoxins is often recommended.** In order to secure a more complete assessment, therefore, it is often recommended that airborne measurements e supplemented by testing for moulds which can be absorbed through the respiratory route. Aspergillus and Penicillium species; and mycotoxins in already-settled dust or air.” 3) Sterigmatocystin: immuno-suppressive and a liver Other techniques such as PCR (polymerase chain reaction), carcinogen produced by Aspergillus species, especially A. ELISA (enzyme-linked immunosorbent assay) and measurement versicolour; and of fungal volatile organic chemicals, polysaccharides, ergosterol 4) Trichothecenes: produced primarily by Stachybotrys and and beta glucans can also be useful in assaying indoor Fusarium species, and reported to inhibit protein synthesis and environments for moulds and their allergens and mycotoxins. cause haemorrhaging and vomiting. For a helpful overview of sampling methods, please see Fungi also produce beta glucans which have immunological Pasanen** and Macher.*! For an informative guide to the effects.* classification, identification and biology of common indoor fungi, The smell of moulds comes primarily from volatile organic see Samson.' Several good guides exist for prevention and compounds.” remediation of indoor fungi problems.*'** Adverse human and animal effects from mycotoxin- contaminated foodstuffs have been well recognised since the early Indoor Mould Exposure and Respiratory Problems 20th century.’ But the pathway of mycotoxin injury through Many epidemiological studies have noted that residential inhalation is questioned.* exposure to moulds and/or chronic dampness can increase In the absence of ethical, controlled studies on human-inhaled asthma/wheezing incidence or morbidity in both children and mycotoxin exposure, only animal-controlled exposure and human adults.“*** Asthma and related conditions are very common in as . Significant amounts of mycotoxins are present in indoor dust “and in fungal spores which can be | absorbed through the respiratory route. as Indoor Mould Exposure and Respiratory Problems Many epidemiological studies have noted that residential exposure to moulds and/or chronic dampness can increase asthma/wheezing incidence or morbidity in both children and adults.“*** Asthma and related conditions are very common in 20 + NEXUS JUNE — JULY 2006 www.nexusmagazine.com