Mold is a form of fungi that is very small. It is present as spores that will grow in the form of a net of mold filaments when the surrounding environment is damp.
Molds affect the health of the individual in three different ways: allergies, infection and toxic effects. In other words, the person can develop symptoms when exposed to the mold (allergies), the mold can grow inside the person’s body (infection) or the person can develop symptoms when the mold, growing inside the body or present in the surrounding environment, produces toxins (mycotoxins).
Mold allergy is extremely common, yet very difficult to diagnose. Patients with mold allergy characteristically develop symptoms when exposed to a damp environment. A damp environment can be as simple as a rainy day, or a place that is damp. A typical place that is commonly damp is a basement, but any house or building that has been affected by water intrusion constitutes a damp environment. Water intrusion can occur because of a faulty roof or a bad seal around a window so each time it rains the dwelling becomes wet, but water intrusion can also develop when a pipe or a toilet leak.
It is not uncommon to live in an apartment that develops a stain on the ceiling. Often this is due to a slow leak from an upstairs bathroom. Because this occurs slowly and insidiously, the person can be exposed for a rather long time before becoming aware that there is a problem.
Symptoms of mold allergy
Besides the usual symptoms of allergy like sneezing, runny nose, itchy nose or itchy and watery eyes, etc., mold allergy can trigger other symptom that may not be associated with an allergic condition. These include persistent nasal obstruction, recurrent headaches (usually sinus headaches but also migraines), recurrent cough, asthma or worsening of preexistent asthma or a skin rash without a clear diagnosis from a skin biopsy. To compound the problem, often the patient presents only with these “atypical symptoms”. A patient that complains of headaches and cough for example, will not be suspect of having allergies, when actually this patient could be an allergy sufferer.
Symptoms can worsen at night or upon entering some area of the house, usually the one initially affected by the water intrusion.
Diagnosis of Mold Allergy
When the medical history is suggestive of allergic conditions, a test is obtained to confirm such diagnosis. While pollen is a highly reactive allergen, mold allergens are not as reactive. While pollen allergy is often mediated by IgE, mold allergy is usually mediated by IgG or cell mediated immunity.
Following the above information, this is what usually happens when a patient has symptoms triggered by exposure to mold (Mold Allergy):
1) Blood tests are usually negative. Usual blood tests measure for the presence of IgE which is usually not involved in mold allergy.
Allergy medications often do not work well (very small effect or no effect at all). The lack of response to medical treatment and a negative blood test will lead into the false assessment that the patient does not have allergies. Often this patient is subjected to antibiotic treatments that in the long run will also fail.
2) Skin tests give erratic results. In this case the results will be dependent on the test being used. The most common test being used by the large majority of the allergy doctors is the prick test that deposits the allergen in the surface of the skin without penetrating it. As stated above the mold allergens are less reactive than pollens. Even for pollens, the prick test often gives a negative result, so it is only logical to expect that the prick test will more often than not give a negative result when testing for molds (again: false negative result as above explained).
The only test that has a good chance of diagnosing mold allergy is the intradermal test which injects the allergen directly under the skin, where the Mast Cells live. These are the cells responsible for the allergic reaction and if the allergen is not close to them the response could be falsely negative.
Even with intradermal tests, it is important to understand that mold allergens are not very reactive, so often times a relatively large amount of allergen needs to be injected in order to prove reactivity to the mold allergen. There is only one intradermal test able to do this: The Intradermal Dilutional Test, which is the skin test mostly used at Associates in ENT & Allergy. This is why at our office, mold allergy is regularly diagnosed and therefore a rational and effective treatment can be planned, consisting of an allergy vaccine against the mold(s) that affect the person.
Mold disease as an infection or toxic disease
Another way the mold can affect a person’s health is when it grows inside the body. Usually it is thought that this can happen only to severely debilitated patients, like the diabetic who is decompensated, in coma, often admitted to the ICU, or the patient on Chemotherapy. The fact is that mold can grow in healthy individuals too. The growth is dependent on two factors: intensity of exposure, and genetic predisposition of the patient.
There is a subgroup of people that are predisposed to be invaded by pathogens (including mold). It is estimated that around 25% of the population fit this characteristic. When a person with this genetic predisposition is exposed to a damp environment, if the exposure is sustained, mold can grow inside the body. Usual places for mold to grow are the sinus, the lungs, the gut but essentially mold can grow everywhere.
Molds produce toxins called mycotoxins. A very small amount of these chemicals is enough to trigger chronic symptoms. Because these poisons disturb all glands, many functions of the normal body function are disrupted. It is typical for the patient affected by mold to develop a multitude of symptoms pertaining to completely different body systems to the degree that most health care providers will suspect this patient has psychological problems. This wrong perception is sometimes reinforced when this person is usually a “lone complainer” in a household with other members of the family not being affected or not being affected in the same degree as this mold sufferer.
Water Damaged Buildings (WDB)
Mold is always present in the environment, both indoors and outdoors. When appropriate levels of humidity are met, the mold spore will start to grow and reproduce. Unless a case of water intrusion is not remediated immediately, the building will become moldy. It takes 48-72 hours of persistent humidity for mold to grow. A building that is affected by water intrusion will quickly become a “damp building” and therefore a WDB.
1) Building with roof leaks. This can happen to any house but it is commonly found in schools as school buildings are usually old and often, they have a flat roof which is more prone to water intrusion. When these roofs leak, the situation is often neglected. The fact that “only a few drops of water come down when it rains” is meaningless. For the first drop to fall down requires that all the building materials around the leak become soaked therefore mold can grow in it very easily. A “remediation” consisting of scraping the stained area and re-paining it is less than a band-aid and will never fix the problem.
2) Basements: When the water table around the house is high either because of too much rain or an overflow of a nearby body of water, the water can permeate into the basement. Unless a basement has a good quality water draining system, it is not unusual that on rainy days a musty smell accumulates. The most dangerous basements are the finished ones with no water drainage systems. When water accumulates, the building materials will get wet and essentially never dry so mold can be growing behind the “intact” wall.
3) Faulty windows: When the waterproofing materials around the window crack and break down, rain water can slowly intrude and produce further deterioration of the building materials around the window. If the window sill feels wet or soft, it is highly likely that the materials inside the wall are moldy.
4) Bathrooms: Common sources of humidity are: The “J-Tube” of the sink drain and the wax ring of the toilet. Sometimes the tiles are loose and humidity develops in the undersurface. When the toilet, has a leak the ceiling of the room below the toilet is usually discolored and/or the paint bubbles.
5) Pipes that burst or valves that leak, even if the leak is minimal, can trigger a raised level of humidity and mold can start to grow. A carpet that remains wet for more than 48-72 hours is likely to become moldy. Even wood floors can develop mold in the undersurface after being soaked in water.
Management of the patient affected by mold growth and mycotoxins
This is a very complex problem. Management is difficult and controversial. Main stream medicine does not yet fully accept that a healthy individual can be invaded by mold or affected by mycotoxins.
There are no good tests to demonstrate mold invasion. Available tests at this time include:
- Blood tests for inflammation. These tests can become abnormal whenever the patient is exposed to toxic substances. So, a good medical history is important to give interpretation to the test: a patient that has been exposed to a toxic heavy metal at work can have these tests abnormal, too.
- Blood tests measuring antibodies against mold. These antibodies are in the family of IgG. From the infectious point of view a positive level means that the patient has been exposed to the mold being tested but does not imply presence of mold at the present time. Again, the history is important to give validity to the test.
- Measurement of mycotoxins in urine. The kidneys and the liver are the main organs for detoxification of toxins in the body. A urine test is easy to obtain. If the urine contains mycotoxins the conclusion is that the person being tests HAS mycotoxins that ARE being eliminated in the urine. Certainly, one can get contaminated by mycotoxins through the air but when the point has a history consistent with exposure to a moldy building the presence of mycotoxins gives essentially a certainty that the patient is affected by mold. This is a very useful test and repetition of this test over time can give a clear idea of success or lack of success of medical intervention. The main problem with this test is that it is not covered by most insurance carriers and it is rather pricy.
Treatment is complex. The first and most important thing is to stop the exposure. This can mean, in extreme cases, the need to abandon one’s house and belongings or change jobs.
After exposure finishes, different interventions need to be implemented, including:
- Diet that will not provide “fuel” for the mold
- Supplements that will fortify the mechanism of detoxification
- Binding agents that will capture the mycotoxins as they are excreted in the bile
- Eventually antifungals which is a controversial treatment as it will require long term treatment. This treatment can be toxic to the liver so most doctors will not provide it very easily.
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