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Diagnosis and Treatment of Mould-Related Health Problems reduce summertime indoor airborne mould concentrations. '*'* HEPA air filters can also significantly reduce indoor airborne fungus concentrations." For clean-up of severe indoor water or mould problems, use of protective equipment like face masks and/or use of a professional remediation firm may be essential.** Use of sublingual or injective fungal immunotherapy has been shown to be beneficial to some patients sensitised to common indoor moulds such as Alternaria and Cladosporium herbarium.'*'* Other therapies found helpful include: 1) detoxification (sauna, massage, exercise); 2) correction of identified immune deficiencies; 3) use of topical, nasal or oral antifungal drugs when indicated. Some studies with laboratory animals suggest that a high- quality diet with adequate anti-oxidant vitamins, selenium, phytochemicals, methionine and total protein can reduce the harmful effects of food mycotoxins.'*'*° A careful environmental and medical history is an essential first fungus concentrations.'' For clean-up of severe indoor water or step in evaluating a patient for mould-related health problems.” mould problems, use of protective equipment like face masks “146 Particular attention should be paid to any history of and/or use of a professional remediation firm may be essential.** exposure to visible mould and/or water damage at the home or Use of sublingual or injective fungal immunotherapy has been workplace. Environmental sampling for viable spores, total shown to be beneficial to some patients sensitised to common spores and mycotoxins in the air and dust can provide important indoor moulds such as Alternaria and Cladosporium exposure information. For patients suspected of having herbarium.'*'* Other therapies found helpful include: substantial fungal exposure, a battery of sophisticated laboratory 1) detoxification (sauna, massage, exercise); tests has been developed to test for: 2) correction of identified immune deficiencies; 1) antibodies to moulds and mycotoxins in the sera of these 3) use of topical, nasal or oral antifungal drugs when indicated. patients;'*'” Some studies with laboratory animals suggest that a high- 2) immunological factors;'"° quality diet with adequate anti-oxidant vitamins, selenium, 3) mycotoxins in urine and blood;” and phytochemicals, methionine and total protein can reduce the 4) several important parameters (including electrolytes, blood harmful effects of food mycotoxins.'*'*° sugar and kidney status) using a basic metabolic panel. Visual contrast sensitivity tests should be Summary done on all mould-exposed patients. The use of Indoor airborne mould and/or mycotoxin standard neuropsychological test batteries* exposures cause many multi-system adverse vod al as auonomie neve tena, EG | Additional studies mon rth tet act by the mor MRI can be very helpful tools in documenting have reported that professionals, building managers, home re ange att | MOULd-exposed | ovnesansie ener pune bs uch for patients with respiratory symptoms.** '” patients do effects of moulds and mycotoxins, the need for shpat symptoms andor view of | significantly more | pone iin renin and he need throat, gastrointestinal system, the eyes or poorly on tests of There is sufficient data from the medical ie ame then consuston 8 [J attention, balance, — if ser rds es umber cn environmental exposures (be they a reaction time, verbal adverse health effects of indoor airborne doctor, an ENT specialist, a gastro- recall concentration mould. Indoor mould and mycotoxin 3 3 memory and finger tapping. enterologist, an ophthalmologist or a exposure absorbed through the respiratory cardiologist) may be very useful. Failure route can be a major pathway of injury by to perform objective evaluations for all three mechanisms: infection, allergy assessing system or organ dysfunction and toxicity. oo accounts for the presently accepted position that airborne mould exposures have no significant adverse health Editor's Note: The above article first appeared in the effects.* Journal of the Australasian College of Other common indoor environmental Nutritional & Environmental Medicine, exposures should also be considered as a potential source of vol. 23, no. 1, April 2004, pp. 3-8. Unfortunately, due to space health problems. Common non-fungal indoor environmental Constraints, we are unable to publish the extensive endnotes. To factors include poor ventilation, carbon monoxide from faulty View these, go to web page http://www.acnem.org/journal/23- heat sources, pesticides, second- hand tobacco smoke, 1_april_2004/indoor_moulds.htm. The article is reproduced petrochemicals such as those found in cleaners, building materials Hanan ar aie etre aunts. ana copyright is vested with and solvents, formaldehyde from outgassing carpets and building Medicine: PO Box 324 Black Rock, Vic. 3193, Australia, tel materials, bacteria, and allergens from the fur, feathers and saliva 461 (0)3 9589 6088 , fax +61 (0)3 9589 51 58 email of common household animals like cockroaches, dust mites, cats, mail@acnem.org website http:/www.acnem.org. , dogs, caged birds and pigeons. Exposure to ozone, second-hand , tobacco smoke, formaldehyde, cockroach allergen and viral About the Authors: infections can also have a synergistic effect with fungal exposure ‘At the time of their collaboration for this article, the authors’ to worsen asthma and rhinitis. details were as follows: The most important part of treatment for mould-exposed = Luke Curtis, MS, CIH, School of Public Health, University of patients is avoidance of fungal exposure and remediation of Illinois at Chicago, Illinois, USA mould contamination in the home and workplace. Any water - Allan Lieberman, MD, Center for Occupational and leaks and flooded or damp areas should be rectified immediately. Environmental Health, North Charleston, South Carolina, USA Non-porous surfaces like floors and walls which have visible ° Martha Stark , MD, Harvard University, Newton Center, mould growth should be cleaned. Porous waterlogged materials Massachusetts, USA like carpet and furniture should be thrown out. Control of - William Rea, Environmental Health Center, Dallas, Texas, USA humidity is important to control mould growth. + Marsha Vetter, MD, PhD, Environmental Health Center, The use of air conditioners and dehumidifiers can significantly Hoffman Estates, Illinois, USA. have reported that mould-exposed patients do significantly more poorly on tests of attention, balance, reaction time, verbal recall, concentration, memory and finger , tapping. About the Authors: At the time of their collaboration for this article, the authors" details were as follows: + Luke Curtis, MS, CIH, School of Public Health, University of Illinois at Chicago, Illinois, USA - Allan Lieberman, MD, Center for Occupational and Environmental Health, North Charleston, South Carolina, USA + Martha Stark, MD, Harvard University, Newton Center, Massachusetts, USA - William Rea, Environmental Health Center, Dallas, Texas, USA + Marsha Vetter, MD, PhD, Environmental Health Center, Hoffman Estates, Illinois, USA. JUNE — JULY 2006 NEXUS = 23 Additional studies www.nexusmagazine.com