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Panel: Mold Blamed for Breathing Problems

Tue May 25, 11:08 AM

By RANDOLPH E. SCHMID, Associated Press Writer

WASHINGTON - Increased effort is needed to reduce mold-producing moisture in buildings that has been blamed for respiratory problems, including some asthma, a scientific panel said Tuesday.

While the study by the Institute of Medicine did not blame mold for other, often major illnesses that some have sought to associate with it, the report couldn't rule out those dangers either.

"In short, excessive building dampness is not your friend. It's associated with a lot of things that could give rise to problems," said Noreen Clark, dean of the School of Public Health at the University of Michigan.

"Even though the available evidence does not link mold or other factors associated with building moisture to all the serious health problems that some attribute to them, excessive indoor dampness is a widespread problem that warrants action at the local, state and national levels," she said.

Clark headed the panel that studied the health effects of mold, which has drawn increased attention in recent years with the shutdown of a major hotel, delayed openings of schools in several states and a raft of lawsuits.

The Institute, an arm of the National Academy of Sciences, urged the mold problem be corrected through a range of steps, including changes in how buildings are designed, constructed and maintained.

"An exhaustive review of the scientific literature made it clear to us that it can be very hard to tease apart the health effects of exposure to mold from all the other factors that may be influencing health in the typical indoor environment," said Clark.

"That said, we were able to find sufficient evidence that certain respiratory problems, including symptoms in asthmatics who are sensitive to mold, are associated with exposure to mold and damp conditions," she concluded.

Excessive dampness influences whether mold, as well as bacteria, dust mites and other such agents, are present and thrive indoors, the committee noted. In addition, the wetness may cause chemicals and particles to be released from building materials.

A rare ailment known as hypersensitivity pneumonitis also was associated with indoor mold exposure in susceptible people.

But the committee said it was unable to find evidence that mold is associated with fatigue, neuropsychiatric disorders or other health problems that some people have attributed to fungal infestations of buildings.

The little evidence that is available does not support an association, the committee said, but it added that because there are so few studies it cannot rule out a connection.

Molds that are capable of producing toxins do grow indoors, and toxic and inflammatory effects also can be caused by bacteria that flourish in damp conditions, the report noted.

The committee said information exists on how to control dampness but architects, engineers, building contractors, facility managers and maintenance staff do not always apply this knowledge.

The members called for development of guidelines for preventing indoor dampness and said they should be promoted nationally. In addition, building codes and regulations should be reviewed and modified as necessary to reduce moisture problems, the committee said.

Lawsuits claiming illnesses from mold in buildings that were not properly built or cleaned up have multiplied in recent years.

Changes in building codes in the 1970s to make homes more energy efficient and airtight had the effect of allowing less ventilation through a house that would dry out a wet wall or floor, which in turn may have led to more mold damage claims, according to attorneys involved in some cases.

The National Academy of Sciences is a private institution chartered by Congress to advise the government on scientific matters. The study was funded by the federal Centers for Disease Control and Prevention.

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Well then, I guess that rules out spelunking for asthmatics. And birds. And farming. And working in plastics plants. And household dust. And pets.

Since grain farmers and poultry raisers have the highest incidence of the disease, these industries should be eliminated or highly regulated.

I think it's best to eliminate conditions that encourage mold, and with rare exception (bleu cheese)I'm not a proponent of mold. That said, I think the whole mold scare is dramatically overexposed and I'd be willing to bet that no more than one percent of lawsuits are justified.

Background: Hypersensitivity pneumonitis (HP), also called extrinsic allergic alveolitis, is a complex syndrome of varying intensity, clinical presentation, and natural history, rather than a single uniform disease.

First described in Iceland in 1874 and termed heykatarr, HP is caused by sensitization to repeated inhalation of dusts containing organic antigens. These dusts can be derived from a variety of sources, such as dairy and grain products, animal dander and protein, wood bark, and water reservoir vaporizers. The most common antigens are thermophilic actinomycetes and avian proteins; the most common diseases are farmer's lung and bird fancier's lung.

HP is characterized by diffuse inflammation of lung parenchyma and airways in previously sensitized patients. Based on the length and intensity of exposure and subsequent duration of illness, clinical presentations of HP are categorized as acute, subacute (intermittent), and chronic progressive.

Pathophysiology: Pathologically, acute HP is characterized by poorly formed noncaseating interstitial granulomas and mononuclear cell infiltration in a peribronchial distribution with prominent giant cells.

The subacute, or intermittent, form produces more well-formed noncaseating granulomas, bronchiolitis with or without organizing pneumonia, and interstitial fibrosis.

Chronic forms reveal additional findings of chronic interstitial inflammation and alveolar destruction (honeycombing) associated with dense fibrosis. Cholesterol clefts or asteroid bodies are present within or outside granulomas.

Pathogenesis

Most patients have circulating immunoglobulin G antibodies that are specific for the offending antigen. The antibody (called precipitating antibody) reacts with a specific antigen to form a precipitation. However, approximately 50% of asymptomatic persons exposed to the sensitizing antigen also have these antibodies.

Although initially thought to be an immunocomplex-mediated process, later studies showed that cell-mediated immunity is more important.

Early response to the antigen is characterized by an increase in neutrophils in the alveoli and small airways followed by an influx of mononuclear cells. These cells release proteolytic enzymes, prostaglandins, and leukotrienes. The production and release of interleukins, cytokines, growth factors, and various other mediators from T lymphocytes and macrophages play important roles in HP pathogenesis.

Frequency:

In the US: Resistance or susceptibility to infection following exposure varies. Incidence also varies considerably. Studies document 8-540 cases per 100,000 persons per year for farmers and 6000-21,000 cases per 100,000 persons per year for pigeon breeders. High attack rates are documented in sporadic outbreaks. Approximately 52% of office workers exposed to an infected humidifier were infected, and 27% of workers at a molding plant for polyurethane foam parts were infected.

Prevalence varies by region, climate, and farming practices. HP affects 0.4-7% of the farming population. Reported prevalence among bird fanciers is estimated to be 20-20,000 cases per 100,000 persons at risk.

Internationally: The prevalence of farmer's lung in the United Kingdom is reported to be 420-3000 cases per 100,000 persons at risk, in France is 4370 cases per 100,000 persons at risk, and in Finland is 1400-1700 cases per 100,000 persons at risk.

Mortality/Morbidity:

Most patients recover completely after the inciting exposure ceases.

Bird fancier's disease has a worse prognosis than farmer's lung.

The outcomes of other varieties of HP are more variable.

CLINICAL Section 3 of 11

Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Pictures Bibliography

History: The clinical presentation of HP is categorized as acute, subacute, or chronic, according to duration of illness.

Acute HP

The acute form may develop 4-6 hours following heavy exposure to an inciting agent. Symptoms often resolve spontaneously within 12 hours to several days upon cessation of exposure.

Patients abruptly develop fever, chills, malaise, cough, chest tightness, dyspnea, headache, and malaise.

Subacute (intermittent) HP

Patients may gradually develop a productive cough, dyspnea, fatigue, anorexia, and weight loss.

Findings may be present in patients who experience repeated acute attacks.

Chronic HP

Patients often lack a history of acute episodes.

They have an insidious onset of cough, progressive dyspnea, fatigue, and weight loss.

Removing exposure results in only partial improvement.

Physical: Physical examination findings vary according to clinical presentation.

Patients with acute HP present with fever, tachypnea, and diffuse fine bibasilar crackles upon auscultation.

Patients with subacute HP present similarly to patients with acute disease, but symptoms are less severe and last longer.

Patients with chronic HP present with muscle wasting and weight loss. Clubbing is observed in 50% of patients. Tachypnea, respiratory distress, and inspiratory crackles over lower lung fields often are present.

Causes: More than 300 etiologies of HP have been reported from a wide range of exposures involving airborne antigens.

Selected Etiological Agents for HPDisease Source of Exposure Major Antigen

Farmer's lung

Moldy hay Saccharopolyspora rectivirgula

(Micropolyspora faeni)

Bagassosis Moldy sugar cane fiber Thermoactinomyces sacchari

Grain handler's lung Moldy grain S rectivirgula, Thermoactinomyces vulgaris

Humidifier/air-conditioner lung Contaminated forced-air systems, heated water reservoirs S rectivirgula, T vulgaris

Bird breeder's lung Pigeons, parakeets, fowl, rodents Avian or animal proteins

Cheese worker's lung

Cheese mold Penicillium casei

Malt worker's lung

Moldy malt Aspergillus clavatus

Paprika splitter's lung Paprika dust Mucor stolonifer

Wheat weevil Infested wheat Sitophilus granarius

Mollusk shell hypersensitivity Shell dust Sea snail shells

Chemical worker's lung Manufacture of plastics, polyurethane foam, rubber Trimellitic anhydride, diisocyanate, methylene diisocyanate

Reported occupations and major causative antigens are as follows:

Farmers and cattle workers develop the most common form of HP.

The major causative antigen is thermophilic actinomycetes.

Farmer's lung must be distinguished from febrile toxic reactions to inhaled mold dusts (organic dust toxic syndrome). This nonimmunologic reaction occurs 30-50 times more commonly than HP.

Ventilation workers and those exposed to water-related contamination may be exposed to microorganism-colonized forced-air systems, humidifiers, whirlpools, hot tubs, and spas. Antigens are various species of Thermoactinomyces or Cladosporium.

Poultry and other bird handlers are commonly exposed to droppings, feathers, and serum proteins of pigeons, other birds, and fowl

Veterinarians and animal handlers have significant contact with animals and organic antigens.

Grain and flour processors and loaders are exposed to grain that may become colonized with a variety of microorganisms that are easily aerosolized. Exposure may lead to HP.

Lumber mill workers and paper and wallboard manufacturers are exposed to wood products colonized with molds.

Plastic manufacturers, painters, and electronics industry workers may be exposed to inciting agents that are synthetic in origin, possibly including diphenylmethane diisocyanate or toluene diisocyanate.

Textile workers may have exposures that lead to lung injury characterized by diffuse alveolar damage or airway dysfunction (eg, byssinosis, nylon worker's lung). This is not a true form of HP.

Conditions that mimic HP that occur from inhalation of organic agents but are not true forms of HP are as follows:

Patients with inhalation fever present with fever, chills, headaches, and myalgias without pulmonary findings (although mild dyspnea may occur). Onset is 4-8 hours following exposure, but no long-term sequelae occur.

Organic dust toxic syndrome results from exposure to bioaerosols contaminated with toxin-producing fungi (mycotoxins). Fever, chills, and myalgias occur 4-6 hours after exposure, and chest radiographs may show diffuse opacities. Bronchiolitis or diffuse alveolar damage may be present on lung biopsy specimens. These are not true forms of HP because no prior sensitization is required.

Chronic bronchitis can result from chronic obstructive pulmonary disease, which is the most common respiratory syndrome among agricultural workers. The prevalence of chronic bronchitis is 10%, compared with 1.4% for HP. Smoking and atopy have additive effects. An association may exist between chronic bronchitis and HP.

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Originally posted by hausdok

When you think about it,

It's our exposure to stuff that makes our immune system work and do what it's supposed to. If we keep limiting our kids' exposure to stuff that humans have been exposed to for hundreds of thousands of years and successfully fought off, eventually the immune systems of our decendents will be the wimps, everything will be toxic to us and the human race will die off.

In nature it has always been survival of the fittest. Will our decendents be as fit as we are or less so?

ONE TEAM - ONE FIGHT!!!

Mike

That's exactly right. For years, I've continued in my boneheaded contention that a little dirt was good for me; I operate on the idea that whatever doesn't kill me makes me stronger.

Well, the other day I read an article in the paper about researchers that are recommending that we forget the antibiotic soaps, cleaners, & let kids get dirty. Their (the researchers) study concluded that kids need some dirt to allow their immune systems to develop properly. They essentially stated what Mike O' just said.

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Originally posted by kurt

Originally posted by hausdok

When you think about it,

It's our exposure to stuff that makes our immune system work and do what it's supposed to. If we keep limiting our kids' exposure to stuff that humans have been exposed to for hundreds of thousands of years and successfully fought off, eventually the immune systems of our decendents will be the wimps, everything will be toxic to us and the human race will die off.

In nature it has always been survival of the fittest. Will our decendents be as fit as we are or less so?

ONE TEAM - ONE FIGHT!!!

Mike

That's exactly right. For years, I've continued in my boneheaded contention that a little dirt was good for me; I operate on the idea that whatever doesn't kill me makes me stronger.

Well, the other day I read an article in the paper about researchers that are recommending that we forget the antibiotic soaps, cleaners, & let kids get dirty. Their (the researchers) study concluded that kids need some dirt to allow their immune systems to develop properly. They essentially stated what Mike O' just said.

Years ago when there wasn't any "refigeration" methods, people used to bury their beef and game animals in the ground with salts, etc. to preserve them. Their were natural enzymes from the ground (dirt) that helped the natural digestion process and balance the stomach acids.

Naturally, over time, with the invent of refigeration and people being overcautious to wash their fruits and vegetables before eating (mainly from the insecticides used now days), there is no longer an intake of these natural enzymes found in the dirt. A lot of people have digestive problems such as Irritable Bowell Syndrome (IBS). Most of these people have had these problems rectified or at the very least, well maintained, by the addition of these enzymes (medically called "probiotics") in their diets.

There is a product you can get at most health food stores called "Primal Defense" which has all the enzymes that occur naturally in soil. Thing is, a 30 day supply is about $40!!!

Nope, a little dirt never hurts anybody really.

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I've weighed in on this line before, but I'll say again that I believe antibacterial soap is a FAR greater threat to the general population than mold ever thought about being. We live in the most neurotic country in the world.

I also agree with the statements about the need to expose / exercise the immune system to maintain it. Science fact as far as I know.

When we were kids my brother and I used to cut poison oak vines loose at the bottom and swing on them. It was a vine, we didn't know. To this day I can handle poison oak or lay down in poison ivy with zero effects.

Brian G.

HEPA Filtered Mask? I Don't Need No Stinking HEPA Filtered Mask! [:-masked]

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Kurt stated:

***That's exactly right. For years, I've continued in my boneheaded contention that a little dirt was good for me; I operate on the idea that whatever doesn't kill me makes me stronger.

Well, the other day I read an article in the paper about researchers that are recommending that we forget the antibiotic soaps, cleaners, & let kids get dirty. Their (the researchers) study concluded that kids need some dirt to allow their immune systems to develop properly. They essentially stated what Mike O' just said. ***

How many are old enough to remember dropping a piece of food on the floor and if the dog didn't get it your mother would pick it up, dust it off, and put it back on your plate.

My God, she would even cut veggies after cutting chicken without washing the knife first!! [:-bigeyes]

Don't they lock up parents for doing that now?

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