The word “mold” is an umbrella term that refers to numerous species of fungi that are found indoors and outdoors.
Both “mold” and “fungus” have negative implications such as moldy carpets, damp basements, soggy drywall, athlete’s foot, and poisonous mushrooms. However, molds have also given us penicillin and tasty blue cheese. Yeast is a fungus, and it is used to make bread, beer, and wine. Some mushrooms are edible and valued worldwide like truffles. Fungi help break down garbage and garden waste.
Mold spores are ubiquitous. However, mold needs moisture and dampness to thrive. You will also find bacteria, dust mites, and break-down products of bacteria and molds, such as proteins, cell-wall particles, volatile organic compounds, airborne chemicals, gasses, and particulate matter caused by the destruction of materials by growing molds.
Indoor mold has the potential to create serious health problems such as allergies and infections. “Toxic mold disease” is a syndrome that affects many although strong evidence does not exist to support the designation. This is true with “sick building syndrome” as well. That does not mean that doctors and health care providers should ignore the issues.
Fungus and mold
Approximately 300,000 species comprise the world of fungi. The U.S. The Environmental Protection Agency defines fungi as “types of plants that have no leaves, flowers or roots.” Fungi reproduce by spreading spores through the air, which then land and survive on various surfaces. Many spores can survive dormant for very long periods in dry environments. In the presence of moisture, they grow into fungi.
Common indoor mold species include Aspergillus, Alternaria, Acremonium, Cladosporium, Dreschslera, Epicoccum, Penicillium, Stachybotrys, and Trichoderma. However, the presence of mold does not always cause illness in humans. Tests can pinpoint the presence of mold at a given moment in time. However, tests do not determine the time frame in which an individual may be exposed and develop an illness. In addition, the presence of mold does not mean that an individual has inhaled dangerous spores.
Health problems linked to exposure to indoor mold and fungi
People who spend time in environments with mold and fungi growth report problems like respiratory problems, headaches, fatigue, and other physical symptoms. In addition to visible mold, damp spaces are likely to contain mold break-down products, dust mites, bacteria, and chemicals, gasses, and particulate matter released from the materials on which molds are growing. Given the difficulties in testing for all of these elements, hard evidence of precise cause-and-effect can be elusive.
In a 2004 report, the Institute of Medicine did not find strong evidence of negative physical symptoms linked to damp indoor spaces. However, the researchers found that being in damp indoor spaces seemed linked to respiratory illnesses such as asthma, wheezing, cough, and nose, and throat symptoms. This included evidence that damp environments can be associated with shortness of breath and lower respiratory symptoms in healthy children.
The IOM reviewed available research, and the organization was not able to substantiate claims of mold causing respiratory infections, lung disease, cancer, fatigue, or skin irritation. The IOM did find enough evidence of overall health effects to call for addressing mold as a public health problem.
Publications in 2007, 2010, and 2011 did not substantially change those findings. They reiterate that evidence exists to support a relationship between damp spaces, indoor mold, and respiratory illnesses. Thus, spending time in damp environments that can support the growth of mold is a potential cause of illness. Researchers note that, if dampness and mold could be confirmed as a cause of ill health, controlling these conditions would make a substantial contribution to public health.
However, some researchers state that mold exposure can cause illness in humans:
- Fisk et al reviewed thirty-three studies to assess the risk of health effects in individuals who spent time in damp, moldy environments. Subjects were adults and children. They found that upper respiratory tract symptoms, cough, wheeze, and asthma were more frequent in people who spent time in damp spaces.
- Bush et al summarized three mechanisms: harmful immune responses, e.g. allergies or the uncommon occurrence of hypersensitivity pneumonitis; infections; and irritation from mold by-products.
- Terr describes four known types of allergy caused by inhaling mold spores, including asthma and a type of sinusitis.
- Yet others include all four mechanisms as possible causes of adverse health effects.
- In a review of studies of children from ten countries, aged six to twelve, Antova and colleagues found that mold in the household correlated with a variety of respiratory disorders, including wheezing, coughing at night, and allergic symptoms, and hay fever.
- Karvonen et al studied a group of 396 children for the first eighteen months of life and found that wheezing was more common in children whose homes had moisture damage in the kitchen and visible mold in the primary living areas.
- Park et al reported an increase in new-onset asthma among employees working in a water-damaged office building. There was a correlation between the onset of asthma and mold levels in the building’s dust.
Many of the researchers called for standardized assessments of environmental mold along with clinical evaluations of the study participants. They called for diagnoses of illness based on objective findings.
Allergies and asthma
Hundreds of studies have produced mixed conclusions. Evaluating every type of mold, spore, fungal fragment, chemicals from mold-colonized materials, even secondhand smoke, can be difficult. Many studies link the presence of indoor dampness to illness. However, the challenge is linking the illness to mold exposure.
Still, it is possible to evaluate and treat people with symptoms of asthma and respiratory allergies. This involves the process of elimination. Before mold is considered as the cause of illness, other potential causes must be ruled out. Once the other possible causes are ruled out, patients can be evaluated for the possibility of a mold-induced illness.
In these situations, 3 groups of patients should be assessed for mold exposure: those who present with symptoms often associated with wet spaces and mold; those whose symptoms occurred at the time of a presumed exposure to mold or damp spaces; and patients concerned about exposures to mold even though they have no symptoms.
As always, these cases should pursue a medical diagnosis. Is it an allergy, asthma, or infection? Diagnosis is about pinpointing the disease, not the specific trigger. For instance, doctors can test a patient for allergies to mold, but a positive result does not automatically mean the symptoms are caused by mold exposure. A significant percentage of patients will test positive for mold allergies but have no symptoms. Treatment will not differ whether the cause is mold or some other condition.
One issue is whether to undertake environmental assessments for the presence of mold or other airborne substances found in damp homes, schools, and workplaces. If someone develops respiratory conditions in a given location only, an environmental assessment may be indicated if there are no other known triggers. These conditions include asthma, the lung conditions called interstitial lung disease and hypersensitivity pneumonitis, sarcoidosis, and recurring cold-like symptoms, sinus infections, and hoarseness.
Hypersensitivity pneumonitis is a lung disease sometimes called “farmer’s lung” as it is associated with overwhelming exposure to fungi found in feed and grain. If you are experiencing symptoms, but you are not a farmer, also take a look at bird droppings and your hot tub if you have one.
If mold and related substances seem to be causing negative health effects, removing yourself from that environment is crucial. Several case studies show that some participants developed allergies, asthma, and bronchitis after spending time in damp spaces. Avoid these places to minimize the symptoms and prevent re-exposure.
Infection
Spending time in damp, moldy buildings seems to increase the risk of bronchitis and respiratory infections. However, it is not definitively proven. If it is a cause of these infections, bacteria or chemical emissions are likely to be responsible.
Fungal infections do occur, although they are not typically the result of an exposure to indoor molds. These include:
- Allergic bronchopulmonary aspergillosis. Although Aspergillus is a fungus found indoors and outdoors, people who develop this condition usually suffer from asthma, cystic fibrosis, or immune deficiency. The illness is related to the anatomy of the lung, not exposure to indoor molds.
- Athlete’s foot and thrush are among many fungal infections that are not related to the presence of indoor mold.
Pulmonary hemorrhage
Toxic mold syndrome
In the 1990s, several children in Cleveland developed pulmonary hemorrhage. One of the children died. A preliminary study identified exposure to mold – specifically to mycotoxins from Stachybotrys chartarum – as the likely cause of the illnesses. The CDC reviewed the report and concluded the analysis was erroneous. The CDC stated the cause remained unknown, and similar cases in Chicago were not linked to mold exposure. The government agency added that pulmonary hemorrhage was not consistent with exposure to this fungus.
The original publication about pulmonary hemorrhage fueled concerns and speculation about the health effects of Stachybotrys chartarum, or “black mold”. “Black mold” is indeed unsightly, but has not been identified as a cause of human illness.
“Toxic mold syndrome” is a legal construct, rather than a medical diagnosis. It involves unidentified disease processes, a constellation of disparate symptoms, and reports of illness uncorroborated by a physical examination of the patients or a professional examination of their surroundings.
While “toxic mold” has been identified in litigation as a cause of human illness, there is no established cluster of symptoms or physical findings associated with this alleged disease. There are neither diagnostic criteria nor any valid scientific publications establishing Stachybotrys or other molds as a cause of these diverse symptoms.
You will find many practitioners advertising on the internet as experts in treating victims of “toxic mold disease.” This diagnosis does not exist. They offer to treat you with restrictive diets and supplements to eliminate mold from your system. However, the human body does not retain mold. Therefore, the money is not wisely spent.
“Sick building syndrome”
The Environmental Protection Agency defines “sick building syndrome” as “situations in which building occupants 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”. Those effects might include headache, fatigue, and irritation of skin, eyes, or throat, among others. Most often, these symptoms are linked to indoor air quality problems when a building is insufficiently ventilated or maintained.
It is possible for mold to be an indoor air contaminant in HVAC ducts or other areas where moisture can accumulate and stagnate. Any number of other contaminants may be responsible for symptoms, though; a lengthy list ranges from bacteria to body odors, plumbing exhaust, copy machine fumes, cleaning agents, pesticides, bird droppings, carpeting, and furniture.
Preventing and eliminating indoor mold
Mold spores are ubiquitous. The key is to limit moisture to prevent their growth. Check your home and business for leaks in the roofs, walls, and basements. Look for standing water in drains, on floors, and HVAC equipment. Check your HVAC ducts, and look for condensation on windows and in bathrooms. Remove standing water and vent areas prone to condensation like kitchens and bathrooms. You can use mold-inhibiting paint indoors, and dehumidifiers help in humid weather.
If mold is present or suspected, it is possible to assess the building for mold and mold spores. However, there are no nationwide standards for mold inspectors, testing methods, normal amounts of mold, or reporting formats. This makes it difficult to interpret test results and their potential implications. A process developed by the EPA identifies the DNA of some molds in indoor spaces, even if the mold is hidden; this testing method is being used experimentally.
If mold is clearly present, as determined by visual inspection or a reputable inspector, it should be removed because it can destroy the materials it grows on and is associated with human health problems. Small amounts of mold on hard surfaces can be removed with commercial mold and mildew removers, or with a solution of bleach and water (one cup bleach to one-gallon water). Follow product instructions carefully to avoid breathing fumes, irritating skin, or splashing chemicals in the eyes.
Large amounts of mold require specialized removal techniques and personal protective equipment. The U.S. Environmental Protection Agency described the necessary steps in a document entitled “Mold Remediation in Schools and Commercial Buildings”. However, this document is applicable to mold removal in homes as well.
Final thoughts
Indoor mold requires moisture to thrive. It damages or destroys the substances it grows on. It creates foul odors and impacts the quality of life of anyone living indoors with it. The scientific community disagrees about whether indoor mold can cause adverse health effects, although most agree that spending time in damp indoor environments can lead to respiratory illnesses such as allergy, asthma, cough, runny nose, and sinus conditions.
While the lack of hard scientific evidence that mold causes illness may be frustrating to anyone suffering from symptoms, there are plenty of reasons to keep your indoor environment clean and dry. This process begins with determining the source of excess moisture, taking necessary steps to eliminate those sources, getting rid of mold that may already be in place, and keeping the area dry to minimize the potential for further growth of mold.
If you are experiencing symptoms, seek medical care to establish a diagnosis and course of treatment. Don’t rely on self-appointed experts who will be happy to sell you an unfounded cure at a high price.