Is It Really Mold Allergy or Is It Something Else?

Is It Really Mold Allergy or Is It Something Else?

Use Objective Tests to Uncover the Actual Culprit

By David Wild

Many patients who complain of mold-related allergies or other health problems are not truly allergic to mold. Instead, often other indoor irritants or allergens are responsible for their symptoms, including cough, wheeze, or other upper and lower respiratory tract symptoms. These findings come from a new study published in the Annals of Allergy, Asthma & Immunology (2005;94:39-44).

Physicians often assume the diagnosis of mold allergy based on the history and the patient’s symptom profile without using available testing modalities to uncover the true etiology. In contrast, considering the entire differential diagnosis is necessary even when mold seems to be the culprit, the study researchers suggest.

Available data from many epidemiologic studies have suggested that people living in damp homes are up to 2.2 times more likely than those living in dry homes to have cough, wheeze, asthma, airway infections, fatigue, or headache. However, investigator Jonathan Bernstein, MD, of the Department of Internal Medicine, Division of Immunology/Allergy Section, University of Cincinnati College of Medicine, observed that those studies did not use objective assessment tools, such as skin-prick testing or lung-function testing, nor did they examine the possibility that other irritants or allergens may have been responsible for physical symptoms among patients with suspected mold-related health problems.

In this study, medical records from 135 patients with suspected mold-related symptoms were retrospectively reviewed and reexamined 2 years after their initial presentation. As part of that assessment, 90% of patients underwent skin testing and 7% had serum-specific immunoglobulin E tests. Indoor environmental reports were also examined, which had been prepared by an industrial hygienist for 75% of patients.

Of all patients, 29.6% (40/135) were atopic, based on skin testing, and the rest had nonallergic or irritant-induced rhinitis, which could have been caused by mold byproducts, such as volatile organic compounds or other unidentified indoor air pollutants. Surprisingly, those patients who were sensitized to mold had fewer lower respiratory tract symptoms and better lung function than those not sensitized to mold (P <.04).

Furthermore, in all but 1 of the cases, symptoms significantly improved or were eliminated by patients either changing their living or working environments or improving the air quality of these spaces.

Dr Bernstein told IMWR that these results highlight the need for physicians to conduct rigorous and objective examinations of patients presenting with respiratory tract symptoms and for environmental assessments to include testing for possible irritants and other allergens in their work and living spaces.

“It’s much like defining and treating occupational asthma,” Dr Bernstein said. “You have to obtain a careful history, use objective measures, conduct workplace and home environment tests, and monitor the patient’s clinical symptoms both in and out of that environment. In most cases, you can treat the symptoms by modifying the environment or removing the irritant or allergen.”

In an accompanying editorial (pages 12-13) Michael Zacharisen, MD, and Jordan Fink, MD, both of the Department of Allergy and Immunology, Medical College of Wisconsin, Milwaukee, noted that these findings have direct relevance for physicians who are part of a medical litigation process.

The study results showed “no association among the patients’ presenting symptoms, atopic status, and magnitude of mold exposure. Also, no patient had skin reactivity to Stachybotrys, which has been implicated in ‘toxic mold syndrome,’” they wrote. “It is vital that all physicians, including allergists-immunologists, carefully evaluate these patients and their environments in hopes of finding the truth, not the win.”