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The following peer reviewed research on this page provides readers with key findings that are highly relevant to understanding the potential impact of mold on human health. Victims of mold exposures will recognize the symptoms that can be so debilitating. In the school setting teachers are often ongoing victims of this exposure returning year after year while the student may go on to other rooms and schools.

Some of the most compelling, recent studies on mold are featured here - revealing these biotoxins to be far more harmful than the minor allergen doctors previously understood them to be. (see FUNGALBIONICS for more) Please see our Internet Links page on this site for more studies like these. We are honored to have the support of a number of these researchers, who truly care about school children and the staff who suffer in mold-ridden schools.

Guidance for Clinicians on the Recognition and Management of Health Effects Related to Mold Exposure and Moisture Indoors
Healthy Schools and Achievement

From: Healthy Building News
Date: Friday, October 15, 2004 1:22 AM
Subject: HBN News - The Healthy and High Performing School

Healthy Building News

The Healthy and High Performing School
by Stephen Boese and Claire Barnett [1]

October 15, 2004

The Healthy Schools Network, Inc. is a national not-for-profit organization centered on children's environmental health, and dedicated to assuring every child and school employee an environmentally safe and healthy school.

The Healthy Building News asked its leaders to discuss the impact of an important new report on how school buildings affect student health and achievement.

In the Spring of 2004, Healthy Schools Network, Inc. (HSN) [2] released The Healthy and High Performance School report that for the first time tied together the peer-reviewed international sciences documenting the connection between school indoor environmental quality (IEQ) and student health and achievement. [3] The resulting work and its policy translation for legislators strengthens the call for healthy buildings and moves the call into the school facility sector-- the largest volume of all public construction.

While on the road doing Healthy High Performance School workshops last spring, it was surprising how little awareness the local architectural and engineering professionals had of children's environmental health issues, and how eager they were to hear more. School buildings should be built for their primary occupants--kids, who breathe more air per pound of body weight than adults and spend hours on the floor, not built to meet an abstract notion of what adults like to see.

The paper finds that schools are, on average, in very poor physical condition, even though schools that are poorly designed and/or poorly maintained increase children's and all building occupant exposure to environmental health threats. Threats include poor indoor air pollution, growing mold, diesel fumes, lead, mercury, pesticides, and a variety of toxic substances, not to mention the safety hazards associated with poor engineering or shoddy construction controls. Environmental or occupational health standards do not consider this unique vulnerability of children. Children are required by law to attend school even if the school makes them sick and/or detracts for learning.

HSN has successfully advocated for New York State and major federal advances towards improving indoor environmental quality at school, and now chairs a Schools Work Group at US EPA. Like other states, New York State is engaged in a legal battle concerning state government's responsibility to equitably fund a "sound basic education" for all students. The HSN science paper shows the Court and the Legislature that school environments have a substantial impact on student health and learning. Therefore it is essential that schools the state and schools be held accountable to provide a well designed and well maintained Healthy and High Performance learning environment as part of any resolution to this educational funding and equity debate.

HHPS standards effectively and efficiently provide a well-designed learning environment for children that promote student health, attendance and achievement and save money for localities. Careful materials selection can have an important long-term and short-term impact on IEQ, not only be reducing direct off-gassing emissions but also by reducing the need for toxic cleaning and maintenance products. Over the long term, careful material selection will also help us avoid the systemic problems that plague our schools today. This trend is also helping to build markets for healthier building materials and fixtures, free of PCB's, mercury, lead, formaldehyde and other pollutants. The Healthy Building Network has reported for example, that High Performance Schools are an important factor behind skyrocketing sales of linoleum as an alternative to vinyl flooring. [4]


[1] Claire Barnett is the Executive Director of the Healthy Schools Network, Inc.; Stephen Boese is HSN's State Director for New York


[3] Science-Based Recommendations to Prevent of Reduce Potential Exposures to Biological, Chemical and Physical Agents in Schools, Derek G. Shendell, D.Env, MPH; Claire Barnett, MBA and Stephen Boese, MSW, available from Healthy Schools Network and at

A manuscript concisely summarizing the completed science report and its 300+ references has been accepted for publication in the peer-reviewed Journal of School Health and is in press for December 2004. This paper will also be presented at the APHA 2004 Annual Meeting, on November 9, 2004 in Washington, DC.

[4] Forbo Flooring, which controls more than 80 percent of the US linoleum market, reports that driven by orders from schools and health care facilities, linoleum sales growth has outpaced growth in the overall floor covering market by substantially more than double during the last five years. (

This document contains hotlinks: if you can't see them, check out our web version at

from NewsSlice, an online news service operated by Healthy Schools Network, Inc. to promote healthier students, personnel, school facilities, and communities-- topics at the intersection of health, environment, building sciences, and education.

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Institute of Medicine, National Academy of Sciences: Damp Indoor Spaces and Health (2004)


Damp Indoor Spaces and Health (2004)
Board on Health Promotion and Disease Prevention (HPDP), Institute of Medicine (IOM)
This study was supported by a contract between the National Academy of Sciences and Centers for Disease Control and Prevention

The findings of the IOM, commissioned by the Center for Disease Control (CDC), a two year (2001-2003), conservative but compelling review of selected mold studies through 2003, are available online in draft form, with the final copy in hardcover and as a pdf file, for sale through the National Academy of Sciences (see above). The IOM findings conclusively support that damp buildings are unhealthy for humans - and that dampness produces molds and bacteria that can cause allergenic and non-allergenic responses, some of them initiating new (respiratory) disease and exacerbating other (respiratory) disease, without ruling out more extensive organ and neurological damage. The IOM findings include the strong recommendation for further, extensive mold research, especially in these areas.

Peer Reviewed Published Scientific Information on Mold (2003): 18 Original Studies

For a scientific view, this 2003 compilation of 18 original research reports on mold is available, adding much to the Institute of Medicine (IOM) report (see below).

Archives of Environmental Health: Monograph on Molds and Mycotoxins
Kaye H. Kilburn, M.D., Editor

Are illnesses associated with exposures to indoor mold growth real, or the results of a conspiracy fueled by media hype and greedy lawyers? This book is a compilation of 18 current, scientific, peer reviewed papers presented in 2003 — a veritable mountain of evidence that many mold-exposed people are indeed sick, with significant brain function impairment. The published investigations collected here are based on measurements of single patients and groups, studied systematically. Physiological functions and brain scans (single photon emission computed tomography (SPECT) and quantitative electroencephalograms) were abnormal. Mechanisms of mold damage to brain cells resemble those for Gulf War Syndrome, chemical intolerance, and exposure to chlorine, ammonia, or hydrogen sulfide (“rotten egg”) gases. Clear evidence of brain impairment in several hundred people controverts questions and charges of malingering and secondary gain.

Exposures are invariably to mixtures of molds. Attempts to define exposure in terms of specific molds and toxins, or by searching for biomarkers in body fluids, are inconclusive. Often homes and other buildings are poorly designed, so that rather than “breathing” they collect moisture. Cold temperatures and air conditioning condense this moisture on indoor surfaces, between walls, and in ductwork. Molds grow opportunistically on wet paper, such as the cellulose present in drywall, on wooden studs and floors, carpets and pads, wallpaper, and other organic materials. Because much of the physiological damage suffered by victims of mold-related illnesses is irreversible, avoidance of mold is the key. Buildings must be designed to prevent mold growth.

These papers summarize the preliminary conclusions from studies of several hundred patients. Evidence is presented for severe neurobehavioral impairment, nasal sinus and lung dysfunctions, and immunological disturbance. Integrating these findings and developing treatments are works in progress as are identifying the molds toxic chemicals.


Introduction: Mold Conference Objectives and Summary
Kaye H. Kilburn, William J. Rea

Indoor Mold Exposure Associated with Neurobehavioral and
Pulmonary Impairment: A Preliminary Report
Kaye H. Kilburn

Effects of Toxic Exposure to Molds and Mycotoxins in
Building-Related Illnesses
William J. Rea, Nancy Didriksen, Theodore R. Simon, Yaqin
Pan, Ervin J. Fenyves, Bertie Griffiths

Use of Functional Brain Imaging in the Evaluation of
Exposure to Mycotoxins and Toxins Encountered in Desert
Storm/Desert Shield
Theodore R. Simon, William J. Rea

Mixed Mold Mycotoxicosis: Immunological Changes in Humans
Following Exposure in Water-Damaged Buildings
Michael R. Gray, Jack D. Thrasher, B. Robert Crago, Roberta A. Madison, Linda Arnold,
Andrew W. Campbell, Aristo Vojdani

Psychological, Neuropsychological, and Electrocortical
Effects of Mixed Mold Exposure
B. Robert Crago, Michael R. Gray, Lonnie A. Nelson, Marilyn Davis, Linda Arnold, Jack D. Thrasher

Neural Autoantibodies and Neurophysiologic Abnormalities in
Patients Exposed to Molds in Water-Damaged Buildings
Andrew W. Campbell, Jack D. Thrasher, Roberta A. Madison,
Aristo Vojdani, Michael R. Gray, Al Johnson

Antibodies to Molds and Satratoxin in Individuals Exposed
in Water-Damaged Buildings
Aristo Vojdani, Jack D. Thrasher, Roberta A. Madison,
Michael R. Gray, Gunnar Heuser, Andrew W. Campbell

Chronic Sinusitis: Defective T-Cells Responding to
Superantigens, Treated by Reduction of Fungi in the Nose
and Air
Donald P. Dennis

Health Symptoms Caused by Molds in a Courthouse
Tang G. Lee

Studies on the Role of Fungi in Sick Building Syndrome
David C. Straus, J. Danny Cooley, Wing C. Wong, Cynthia A. Jumper

Analysis for Mycotoxins: The Chemist¹s Perspective
Bruce B. Jarvis

Organophosphorus Ester-Induced Chronic Neurotoxicity
Mohamed B. Abou-Donia

Atmospheric Transport of Mold Spores in Clouds of Desert Dust
Eugene A. Shinn, Dale W. Griffin, Douglas B. Seba

The Way We Build Now
Geoffrey H. Hutton

Proactive Approaches for Mold-Free Interior Environments
Katherine Warsco, Patricia F. Lindsey

Creating Mold-Free Buildings: A Key to Avoiding Health
Effects of Indoor Molds
Bruce M. Small

Lipoic Acid as a Potential First Agent for Protection from
Mycotoxins and Treatment of Mycotoxicosis
Sherry A. Rogers

Treatment of Cancer with Mushroom Products
Jean A. Monro

Summary of the 5th International Conference on Bioaerosols,
Fungi, Bacteria, Mycotoxins, and Human Health
Kaye H. Kilburn

Hardback is available from Dr. K.H. Kilburn
PO Box 5374, Pasadena, CA 91117
or from Heldref Publications
1319 18th St NW, Washington DC, 20036-1802

Dr. Kaye Kilburn

Kaye H. Kilburn M.D.,is a Ralph Edgington Professor of Medicine, USC (University of Southern California) Keck School of Medicine. For more information, visit Dr. Kilburn's website at:

Dr. Kilburn's new book: Endangered Brains just released!

Archives of Environmental Health: Monograph on Molds and Mycotoxins Kaye H. Kilburn, M.D., Editor

Arch Environ Health. 2003 Jul;58(7):390-8.
Indoor mold exposure associated with neurobehavioral and pulmonary impairment: a preliminary report.

Kilburn KH.

University of Southern California, Keck School of Medicine,
Environmental Sciences Laboratory, Alhambra, California 91803, USA.

Recently, patients who have been exposed indoors to mixed molds, spores, and mycotoxins have reported asthma, airway irritation and bleeding, dizziness, and impaired memory and concentration, all of which suggest the presence of pulmonary and neurobehavioral problems. The author evaluated whether such patients had measurable pulmonary and neurobehavioral impairments by comparing consecutive cases in a series vs. a referent group. Sixty-five consecutive outpatients exposed to mold in their respective homes in Arizona, California, and Texas were compared with 202 community subjects who had no known mold or chemical exposures. Balance, choice reaction time, color discrimination, blink reflex, visual fields, grip, hearing, problem-solving, verbal recall, perceptual motor speed, and memory were measured. Medical histories, mood states, and symptom frequencies were recorded with checklists, and spirometry was used to measure various pulmonary volumes and flows. Neurobehavioral comparisons were made after individual measurements were adjusted for age, educational attainment, and sex. Significant differences between groups were assessed by analysis of variance; a p value of less than 0.05 was used for all statistical tests. The mold-exposed group exhibited decreased function for balance, reaction time, blink-reflex latency, color discrimination, visual fields, and grip, compared with referents. The exposed group's scores were reduced for the following tests: digit-symbol substitution, peg placement, trail making, verbal recall, and picture completion. Twenty-one of 26 functions tested were abnormal. Airway obstructions were found, and vital capacities were reduced. Mood state scores and symptom frequencies were elevated. The author concluded that indoor mold exposures were associated with neurobehavioral and pulmonary impairments that likely resulted from the presence of mycotoxins, such as trichothecenes.


Cent Eur J Public Health. 2004 Mar;12(1):36-42.  

See our FAQ page  for info re: Dr. Kaye Kilburn

Dr. Richard Shoemaker

Ritchie Shoemaker, M.D., graduate of Duke University School of Medicine, is a family practitioner in Pokomoke, MD, whose interests in biology led him to study and treat patients exposed to a variety of toxins - including mold and Lyme Disease. Dr. Shoemaker's website is located at He is an author of a number of books on biotoxin poisoning and related illnesses. Click here to learn about Dr. Shoemaker's book, Desperation Medicine, one that explains his philosophy on toxin-related illnesses - Dr. Shoemaker calls it "the primer on mold". A new book, Mold Warriors, will be available very soon. For further publications by Dr. Shoemaker, see Books and Media.


Changes in VEGF, MMP9 and leptin correlate with acute and chronic illness symptoms and visual contrast sensitivity in patients from water damaged buildings: Indicators of complex physiologic disturbances in Sick Building Syndrome

Authors: Ritchie C. Shoemaker¹, Dennis House¹

¹Center for Research on Biotoxin Associated Illnesses, Pocomoke, Md

BACKGROUND: A 5-step repetitive exposure protocol provides a mechanism to document causation of illness in symptomatic patients exposed to in door environments of water-damaged buildings (WDB). By demonstrating benefits of treatment with cholestyramine (CSM) of affected patients, with stability off medication away from exposure and then documenting changes in symptoms and biomarkers prospectively with re-exposure, followed by correction with re-treatment, we have previously shown that the physiologic disturbances underlying illness in Sick Building Syndrome are identical to those of a chronic biotoxin associated illness. We present data here to support use of leptin, vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP9) as biochemical markers for both acute and chronic illness adjunctive to recording of symptoms and visual contrast sensitivity (VCS). We again present data on unique genotypes of HLA DR, analyzed by PCR, previously reported to be associated with a genetic basis of susceptibility to neurotoxic illness caused by exposure to resident indoor toxigenic fungi. The unique grouping of symptoms found in these patients, including fatigue, neurologic, respiratory and rheumatologic symptoms match changes of biomarkers with treatment and re-exposure.

METHODS: 26 consecutive patients exposed to buildings with growth of identified toxigenic fungi attending a private clinic for diagnosis and treatment of chronic fatiguing illness refractory to all prior modalities of therapy agreed to participate in an IRB approved, multiple intervention, longitudinal clinical treatment trial using CSM to assess the effect of exposure, treatment, re-exposure and re-treatment on multiple simultaneously measured clinical and laboratory parameters. Each patient provided informed consent. Exposure to tobacco smoke, IgE, pulmonary function testing results before and after interventions and HLA DR genotypes were recorded.

RESULTS: Each affected patient showed clinical improvement following treatment with CSM and was stable off drug, away from exposure to the known affected building. Each patient relapsed within 3 days of re-exposure to the contaminated building off CSM, with improvement following re-treatment. Change in clinical course was paralleled by symptoms, VCS, leptin, MMP9 and VEGF. Improvement in PFT testing was noted. HLA DR genotypes previously noted to confer susceptibility were again demonstrated. Tobacco smoke was not a relevant clinical parameter. Symptom rosters showed multiple organ system illness, with fatigue, chronic pain and cognitive problems most commonly identified.

DISCUSSION: Use of symptoms, VCS, leptin, VEGF and MMP9 gives the treating physician biomarkers useful in case identification and assessment of efficacy of therapy. Changes in biomarkers suggest pathophysiologic abnormalities acquired following exposure to water damaged buildings. These biomarkers change hyperacutely in each step, with clinical stability in chronic conditions. The direct physiologic effects of toxic elements from indoor buildings can be assessed clinically and used in prospective studies that can assign causation. A double blinded, placebo controlled clinical trial designed to further define these results is underway.

Abstract released by permission of Dr. R. Shoemaker


Abstract: Identifying markers for chronic illness in pediatric patients exposed to water damaged buildings: Linkage disequilibrium of HLA DR, MSH, MMP9 and autoantibodies

Authors: Ritchie C. Shoemaker¹, Courtney Holt¹, Dennis House¹, HK Hudnell²

¹Center for Research on Biotoxin Associated Illnesses , Pocomoke, Md; ²US EPA NHEERL, Research Triangle Park, NC

Background: No studies have previously identified biomarkers adequate to create a case definition of illness associated with exposure to water damaged buildings (WDB) in pediatric patients. Previous work from this facility has presented a case definition of illness in adults that includes exposure, symptoms and absence of confounders, together with biomarkers HLA DR genotypes of the immune response genes; deficiency of the hypothalamic immunomodulatory hormone, alpha melanocyte stimulating hormone (MSH); excess pro-inflammatory cytokine responses, represented by matrix metalloproteinase-9 (MMP9), deficits in visual contrast and pituitary hormone dysregulation. We have seen an increased incidence of antibodies to gliadin, cardiolipin and myelin basic protein in adults with chronic illness following exposure to WDB. Here we present data supporting a pediatric case definition using multiple biomarkers from 66 patients with illness following exposure to WDB.

Methods: Patients under age 19 coming for treatment of chronic illness at a specialized medical clinic provided informed consent for evaluation and blood testing prior to initiation of definitive therapy for presumptive chronic, biotoxin associated illness. Symptoms were recorded and blood was sent to national high complexity labs for analysis of HLA DR genotype, MSH, MMP9, anticardiolipins (ACLA), antigliadins (AGA) and myelin basic protein (MBP) antibodies. Lab parameters were compared to in-house registries of control patients and published registries. Following treatment and confirmation of diagnosis, cases were then analyzed by biomarker to identify unique diagnostic features.

Results: Control populations have markedly different HLA DR genotype distributions from cases, with relative risks for illness identified for the same genotypes as reported previously in adults. Affected patients had lower levels of MSH and MMP9 than controls. Marked increase in incidence of antibodies to antigliadin IgG, anticardiolipin IgM and myelin basic protein antibodies was found in affected patients compared to controls. Taken together, the combination of potential for exposure, absence of confounding diagnoses, presence of distinctive groupings of symptoms, including fatigue and cognitive problems identified over 85% of cases. Adding HLA DR, MSH deficiency, AGA-IgG and ACLA-IgM increased the case detection rate to 100%. For patients with MMP9 over 400, HLA DR and MSH deficiency alone identified all cases.

Conclusion: Specific genetic, physiologic and neurotoxicologic factors can be identified in pediatric patients that identify cases of chronic illness due to exposure to WDB. Physiologic mechanisms associated with increased production of particular autoantibodies will require further study.

10/04 Mayo Clinic Common Airborne Fungi Cause Chronic Stuffy Nose (Rhinosinusitis)

Source: Mayo Clinic Released: Wed 06-Oct-2004, 15:00 ET

Common Airborne Fungi Cause Chronic Stuffy Nose


A team led by Mayo Clinic researchers has determined that over- reactive immune responses to airborne fungi could cause the stuffy noses and airway inflammation among sufferers of chronic rhinosinusitis. These findings could one day lead to a new, longer-lasting treatment.

"It's time to recognize there is a greater sensitivity to airborne fungi in some patients, and therefore we need to remove or reduce the fungal exposure," says lead investigator Hirohito Kita, M.D.

In today's electronic edition of theJournalofAllergyandClinicalImmunology, the Mayo Clinic researchers and a colleague from the University of Utah conclude that certain species of airborne fungus produce spores and by-products, that when inhaled, prompt irregular and damaging immune responses. The responses, in turn, produce the congestion and inflammation. Chronic rhinosinusitis costs society about $5.6 billion a year. And that doesn't include an estimated $70 million in annual lost work days, as well as a diminished quality of life.

Implications of Research "The fungi we're talking about are very common," Dr. Kita. "They are airborne fungi found anywhere in the United States. Now that we know the role of the fungi, we can work toward reducing the potential role of the fungi through such treatments as nasal irrigations (flushing with water) that clear the fungi, or prescription of antifungal medicines taken by mouth."

Preliminary results show that the irrigation treatment relieves symptoms. Larger, multicenter studies are needed before this treatment can move into general use. But the results are encouraging because they support the idea that reducing fungal exposure in sensitive individuals could offer a new treatment option to sufferers worldwide.

Background Chronic rhinosinusitis is one of the most common chronic illnesses in the United States. Its symptoms include persistent stuffy nose, thick mucus production and loss of smell. Though chronic rhinosinusitis causes significant discomfort and health problems, it is not well understood. Viruses, bacteria and allergic reactions all have been researched and debated as potential mechanisms driving the responses. The immune system mounts different kinds of responses for different invaders -- a bacterium gets attacked by a different cell or system than an allergy-prompting particle, for example. That's why it's critical to identify the key mechanisms in the immune response to chronic rhinosinusitis, allowing researchers to design treatments to relieve the distressing symptoms.

The Mayo Clinic work is the first to provide data for the role of airborne fungi in chronic rhinosinusitis and to show that several immune system branches appear to collaborate in response to the fungi -- resulting in an abnormally enhanced response that causes troublesome inflammation and congestion. The research team's data show that specific cells in 90 percent of chronic rhinosinusitis patients produce an enhanced immune-system response to one fungus in particular, Alternaria. Another kind of common fungus, Cladosporium, also provoked an abnormally enhanced immune response.

Mayo Clinic scientists previously used antifungal therapies to treat patients with chronic sinusitis, which marked a new clinical approach. These new findings serve to further support this perspective and will prompt additional research.

The Investigation Researchers tested blood from 18 patients with chronic rhinosinusitis and 15 healthy persons to evaluate how specific immune system cells responded to common airborne fungi. The immune systems of those with chronic rhinosinusitis reacted more robustly than those of healthy individuals. In fact, when exposed to Alternaria, one branch of the immune system's response was five times greater in the chronic rhinosinusitis patients than in the healthy volunteers.

The research team investigated the body's responses to this fungal exposure by measuring components within the two branches of the adaptive immune system. The adaptive immune system takes several days to mount a response to foreign invaders. The two branches of the adaptive immune system are: 1) a cell-directed branch that involves special cells known as T lymphocytes and 2) the humoral branch, which works primarily through cells known as B lymphocytes. Research Team Members and Support

In addition to Dr. Kita, the Mayo Clinic research team includes Seung-Heon Shin, M.D.; Jens Ponikau, M.D.; David Sherris, M.D.; David Congdon, M.D.; Evangelo Frigas, M.D.; Henry Homburger, M.D.; and Mark Swanson. The University of Utah collaborator was Gerald Gleich, M.D. Their work was supported by a grant from The National Institute for Allergy and Infectious Diseases and by the Mayo Foundation.


Public release date: 8-Oct-2004
Contact: Anne A. Oplinger
NIH/National Institute of Allergy and Infectious Diseases

Chronic sinusitis sufferers have enhanced immune responses to fungi

Scientists supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, have discovered that people with chronic sinus inflammation have an exaggerated immune response to common airborne fungi. The results of their study appear online today in The Journal of Allergy and Clinical Immunology.

Additional Research of Note

The remediation of mold damaged school--a three-year follow-up study on teachers' health.

Patovirta RL, Husman T, Haverinen U, Vahteristo M, Uitti JA, Tukiainen H, Nevalainen A.

National Public Health Institute, Kuopio, Finland.

The health effects in teachers of a mold-damaged school before and during an extensive remediation process were assessed. Health data were collected with self-administered questionnaires from teachers (n=31) working in a moisture and mold damaged school and from the reference group of teachers (n=13) working in a non-damaged school. The questionnaire study was repeated three times. Spirometry was measured in 33 individuals in the spring 1997 and repeated in the spring 1999 and 2000. In the damaged school, a cluster of eight asthma cases was identified, the prevalence of asthma being 26%. Before the remediation, the number of sinusitis episodes was higher (p=0.040) and the mean duration of sick leaves longer (p=0.015) among the study group than in the reference group. A higher prevalence of hoarseness and perceived poor quality of indoor air were reported. During the follow-up, no new asthma cases appeared. After the remediation, bronchitis, conjunctivitis, symptoms of allergic rhinitis and the sum of respiratory infection episodes decreased significantly. Some of the asthmatics had low values in the spirometry but no changes in the lung function were observed at the group level. The remediation of the mold damage had beneficial effects on teachers' health.

PMID: 15068207 [PubMed - indexed for MEDLINE]

Ann Allergy Asthma Immunol. 2003 Feb;90(2):203-8. Related Articles, Links

Fungal contamination of elementary schools: a new environmental hazard.

Santilli J, Rockwell W.

BACKGROUND: Sensitivity to fungi is a significant cause of allergic diseases, and prolonged indoor exposure to fungi is a growing health concern. OBJECTIVE: This study evaluates the health effects of mold-contaminated schools on students and teachers. A discussion of the effectiveness of current methods for evaluating these schools, with a focus on the importance of using total mold spore counts, is also provided. METHODS: Two Connecticut public schools were tested using multiple air quality testing methods, with the standard for a healthy indoor environment being total mold spore counts lower than 1,000 spores/m3. The health impact of the mold exposure at each school was evaluated using the validated Rhinitis Outcomes Questionnaire. RESULTS: The testing of the first school found indoor mold counts ranging from 6,000 to 50,000 spores/m3. Eighty-five of the students and teachers reported significant allergic symptoms to the school nurse. This school is currently being demolished. More than 2 years after the exposure ended, a number of occupants of the school continue to have elevated symptoms compared with before their exposure to the school. The testing of the second school revealed total mold spore counts ranging between 2,000 and 9,000 spores/m3, qualifying it an unhealthy environment in need of immediate remediation. Students reported significant allergic symptoms from exposure to certain rooms that are currently being remediated. CONCLUSIONS: Because of the negative impact on health that indoor mold exposure has, particularly in atopic patients, schools should be routinely tested for fungal contamination. Total mold spore counts should be performed using volumetric air sampling such as the Allergenco MK-3 (Allergenco, San Antonio, TX) because testing air quality via semiquantitative culture sampling alone does not give a true reflection of the extent of fungal contamination. Finally, the standard for a healthy indoor environment should be defined as having <1,000 spores/m3.

PMID: 12602667 [PubMed - indexed for MEDLINE]


1: ScientificWorldJournal. 2003 Nov 13;3:1128-37.

The neurological significance of abnormal natural killer cellactivity in chronic toxigenic mold exposures.

Anyanwu E, Campbell AW, Jones J, Ehiri JE, Akpan AI.

Neurosciences Research, Cahers Inc., Conroe, TX, USA.

Toxigenic mold activities produce metabolites that are either broad-spectrum antibiotics or mycotoxins that are cytotoxic. Indoor environmental exposure to these toxigenic molds leads to adverse health conditions with the main outcome measure of frequent neuroimmunologic and behavioral consequences. One of the immune system disorders found in patients presenting with toxigenic mold exposure is an abnormal natural killer cell activity. This paper presents an overview of the neurological significance of abnormal natural killer cell (NKC) activity in chronic toxigenic mold exposure. A comprehensive review of the literature was carried out to evaluate and assess the conditions under which the immune system could be dysfunctionally interfered with leading to abnormal NKC activity and the involvement of mycotoxins in these processes. The functions, mechanism, the factors that influence NKC activities, and the roles of mycotoxins in NKCs were cited wherever necessary. The major presentations are headache, general debilitating pains, nose bleeding, fevers with body temperatures up to 40 degrees C (104 degrees F), cough, memory loss, depression, mood swings, sleep disturbances, anxiety, chronic fatigue, vertigo/dizziness, and in some cases, seizures. Although sleep is commonly considered a restorative process that is important for the proper functioning of the immune system, it could be disturbed by mycotoxins. Most likely, mycotoxins exert some rigorous effects on the circadian rhythmic processes resulting in sleep deprivation to which an acute and transient increase in NKC activity is observed. Depression, psychological stress, tissue injuries, malignancies, carcinogenesis, chronic fatigue syndrome, and experimental allergic encephalomyelitis could be induced at very low physiological concentrations by mycotoxin-induced NKC activity. In the light of this review, it is concluded that chronic exposures to toxigenic mold could lead to abnormal NKC activity with a wide range of neurological consequences, some of which were headache, general debilitating pains, fever, cough, memory loss, depression, mood swings, sleep disturbances, anxiety, chronic fatigue, and seizures.

1: Arch Environ Health. 2003 Jul;58(7):410-20.

Mixed mold mycotoxicosis: immunological changes in humans followingexposure in water-damaged buildings.

Gray MR, Thrasher JD, Crago R, Madison RA, Arnold L, Campbell AW,
Vojdani A.

Progressive Healthcare Group, Benson, Arizona, USA.

The study described was part of a larger multicenter investigation of patients with multiple health complaints attributable to confirmed exposure to mixed-molds infestation in water-damaged buildings. The authors present data on symptoms; clinical chemistries; abnormalities in pulmonary function; alterations in T, B, and natural killer (NK) cells; the presence of autoantibodies(i.e., antinuclear autoantibodies [ANA], autoantibodies against smooth muscle [ASM], and autoantibodies against central nervous system [CNS] and peripheral nervous system [PNS] myelins). A total of 209 adults, 42.7 +/- 16 yr of age (mean +/- standard deviation), were examined and tested with (a) self-administered weighted health history and symptom questionnaires; (b) standardized physical examinations; (c) complete blood counts and blood and urine chemistries; (d) urine and fecal cultures; (e) thyroid function tests (T4, free T3); (f) pulmonary function tests (forced vital capacity [FVC], forced expiratory volume in 1 sec [FEV1.0], and forced expiratory flow at 25%, 50%, 75%, and 25-75% of FVC [FEF25, FEF50, FEF75, and FEF2(25-75)]); (g) peripheral lymphocyte phenotypes (T, B, and NK cells) and mitogenesis determinations; and (h) a 13-item autoimmune panel. The molds-exposed patients reported a greater frequency and intensity of symptoms, particularly neurological and inflammatory symptoms, when compared with controls. The percentages of exposed individuals with increased lymphocyte phenotypes were: B cells (CD20+), 75.6%; CD5+CD25+, 68.9%; CD3+CD26+, 91.2%; CD8+HLR-DR+, 62%; and CD8+CD38+, 56.6%; whereas other phenotypes were decreased: CD8+CD11b+, 15.6% and CD3- CD16+CD56+, 38.5%. Mitogenesis to phytohemagglutinin was decreased in 26.2% of the exposed patients, but only 5.9% had decreased response to concanavalin A. Abnormally high levels of ANA, ASM, and CNS myelin (immunoglobulins [Ig]G, IgM, IgA) and PNS myelin (IgG,IgM, IgA) were found; odds ratios for each were significant at 95% confidence intervals, showing an increased risk for autoimmunity.The authors conclude that exposure to mixed molds and their associated mycotoxins in water-damaged buildings leads to multiple health problems involving the CNS and the immune system, in addition to pulmonary effects and allergies. Mold exposure also initiates inflammatory processes. The authors propose the term \"mixed mold mycotoxicosis\" for the multisystem illness observed in these patients.

1: Appl Neuropsychol. 2002;9(4):193-202. Related Articles, Links

Neuropsychological performance of patients following mold exposure.

Baldo JV, Ahmad L, Ruff R.

Veterans Affairs Northern California Health Care System, Martinez,
California 91711-3948, USA.

This study investigated the effects of mold exposure (ME) on human cognition by analyzing neuropsychological data from patients who were exposed to mold in their homes or workplaces. Compared tonormative data, ME patients were impaired (<10th percentile) on anumber of cognitive measures, with the most consistent deficits in visuospatial learning, visuospatial memory, verbal learning, and psychomotor speed. We also examined emotional functioning and found that a number of ME patients showed evidence of both Axis I and Axis II pathology. Interestingly, there was a significant correlation among patients\' scores on the Beck Depression Inventory-Second Edition and the number of neuropsychological tests falling within the impaired range. Given the limited understanding of ME and its effect on the human central nervous system, we provide a working model that attempts to capture the complex interactions of impaired cognition, psychosocial stressors, poor physical health, and emotional functioning in patients following ME. Keywords: mold exposure, mild traumatic brain injury, toxic exposure

PMID: 12584073 [PubMed - indexed for MEDLINE]

1: ScientificWorldJournal. 2003 Apr 28;3:281-90.

Neurophysiological effects of chronic indoor environmental toxicmold exposure on children.

Anyanwu EC, Campbell AW, Vojdani A.

Cahers Neurosciences Research, 8787 Shenandoah Park Drive, Suite
122, Conroe, TX 77385, USA.

The phenomenon of building-related diseases is attracting much research interest in recent years because of the extent to which it affects people with compromised immune systems, especially children. In this study, we reported the neurological findings in children who attended our Center because of chronic exposure to toxic molds. Clinical neurological and neurobehavioral questionnaires were administered with the cooperation of the children\'s parents. The children then underwent a series of neurophysiological tests including electroencephalogram (EEG), brainstem evoked potential (BAEP), visual evoked potential (VEP), and somatosensory evoked
potential (SSEP). The results showed high levels of abnormalities in the analysis of the subjective responses derived from the questionnaires. The EEG examination was abnormal in seven out of ten of the patients compared to the controls with only one in ten with episodes of bihemispheric sharp activity. In all the patients, there
was frontotemporal theta wave activity that seemed to indicate diffuse changes characteristic of metabolic encephalopathies. Also,there was highly marked 1 to 3 Hz delta activity that was asymmetrical in the right hemisphere of the brain in three out of ten patients. The waveforms of BAEP showed abnormalities in 90% of the patients with both 15\' and 31\' check sizes compared to none in the controls. There were significant delays in waveform V in a majority of the patients representing dysfunctional cognitive process and conductive hearing loss in both ears. VEP showed clear abnormalities in four in ten of the patients with P100 amplitudes and latencies decreased bilaterally. In all the patients, there was slowing of conduction in the right tibial at an average of 36.9 ms and there was significant decrease in amplitude of response at the proximal stimulation site. Sensory latencies obtained in the median, ulnar, and sural nerves bilaterally showed abnormalities in five out of ten compared to none in the controls. The median, ulnar, and sural sensory potentials were abnormal in six out of ten patients. There was prolongation of the median distal sensory latencies bilaterally at an average of 4.55 ms on the right and an average of 6.10 ms on the left as compared to the ulnars of 2.55 ms


Immunopharmacol Immunotoxicol. 2003 Nov;25(4):595-614.



Saliva secretory IgA antibodies against molds and mycotoxins in patients exposed to toxigenic fungi.

Vojdani A, Kashanian A, Vojdani E, Campbell AW.

Immunosciences Lab., Inc., Section of Neuroimmunology, Beverly Hills, California 90211, USA.

Upper respiratory exposure to different environmental antigens results first in the activation of mucosal immunity and production of IgA antibodies in different secretions including saliva. Despite this there is no study, which addresses secretory antibodies against molds and mycotoxins. The purpose of this study was to evaluate mold-specific salivary IgA in individuals exposed to molds and mycotoxins in a water-damaged building environment. Saliva IgA antibody levels against seven different molds and two mycotoxins were studied in 40 patients exposed to molds and in 40 control subjects. Mold-exposed patients showed significantly higher levels of salivary IgA antibodies against one or more mold species. A majority of patients with high IgA antibodies against molds exhibited elevation in salivary IgA against mycotoxins, as well. These IgA antibodies against molds and mycotoxins are specific, since using molds and mycotoxins in immune absorption could reduce antibody levels, significantly. Detection of high counts of molds in water-damaged buildings, strongly suggests the existence of a reservoir of mold spores in the environment. This viable microbial activity with specific mold and mycotoxin IgA in saliva may assist in the diagnosis of mold exposure. Whether mold and mycotoxin specific IgA antibodies detected in saliva are indicative of the role of IgA antibodies in the late phase of type-1 hypersensitivity reaction or in type-2 and type-3 delayed sensitivities is a matter that warrants further investigation.

PMID: 14686801 [PubMed - indexed for MEDLINE]

Arch Environ Health. 2003 Jul;58(7):399-405. Related Articles, Links

Effects of toxic exposure to molds and mycotoxins in building-related illnesses.

Rea WJ, Didriksen N, Simon TR, Pan Y, Fenyves EJ, Griffiths B.

Environmental Health Center-Dallas, Dallas, Texas 75231-4262, USA.

The authors studied 100 patients who had been exposed to toxic molds in their homes. The predominant molds identified were Alternaria, Cladosporium, Aspergillus, Penicillium, Stachybotrys, Curvularia, Basidiomycetes, Myxomycetes, smuts, Epicoccus, Fusarium, Bipolaris, and Rhizopus. A variety of tests were performed on all, or on subgroups of, these patients. Sensitivities and exposures were confirmed in all patients by intradermal skin testing for individual molds (44-98% positive), and by measurement of serum antibodies. Abnormalities in T and B cells, and subsets, were found in more than 80% of the patients. The findings of trichothecene toxin and breakdown products in the urine, serum antibodies to molds, and positive intradermal skin tests confirmed mycotoxin exposure. Respiratory signs (e.g., rhinorrhea, sinus tenderness, wheezing) were found in 64% of all patients, and physical signs and symptoms of neurological dysfunction (e.g., inability to stand on the toes or to walk a straight line with eyes closed, as well as short-term memory loss) were identified in 70% of all patients. Objective abnormal autonomic nervous system tests were positive in all 100 patients tested. Brain scans, conducted using triple-head single photon emission computed tomography, were abnormal in 26 (86%) of 30 (subgroup of the 100) patients tested. Objective neuropsychological evaluations of 46 of the patients who exhibited symptoms of neurological impairment showed typical abnormalities in short-term memory, executive function/judgment, concentration, and hand/eye coordination.

Publication Types:
  • Clinical Trial

PMID: 15143852 [PubMed - indexed for MEDLINE]

1: Arch Environ Health. 2003 Jul;58(7):442-6.  

Health symptoms caused by molds in a courthouse.

Lee TG.

Faculty of Environmental Design, The University of Calgary, Calgary, Alberta, Canada.

A majority of occupants of a newly renovated historic courthouse in Calgary, Alberta, Canada, reported multiple (3 or more) health-related symptoms, and several reported more than 10 persistent symptoms. Most required at least 1 day outside of the building to recover from their symptoms. Molds that produce mycotoxins, such as Stachybotrys chartarum and Emericella nidulans, were identified in the building, along with fungal organisms of the genera Aspergillus, Penicillium, Streptomyces, Cladosporium, Chaetomium, Rhizopus/Mucor, Alternaria, Ulocladium, and Basidiomycetes. Renovations to this historic had building failed to provide adequate thermal and vapor barriers, thus allowing moist indoor air to migrate into the building enclosure, causing condensation to develop. Mold grew on the condensation and was dispersed throughout the courthouse, including on furniture and files. The courthouse was closed and a new facility was modified with low-offgassing materials, better ventilation and air filtration, and strict building maintenance to accommodate those occupants of the older building who had developed multiple chemical sensitivities.

PMID: 15143857 [PubMed - indexed for MEDLINE]


Additionally: A list of Texas Tech University Health Sciences Center, Dept. of Microbiology and Immunology, Center for Indoor Air Research publications


Texas Tech University's Reference Guide for Fungi: A glossary of fungi which features research abstracts from peer-reviewed journals for each species – find out what the type of mold in your school or building can do to humans, according to scientific research, useful for medical and legal


The intro is as follows:


"In this reference guide for fungi we have listed all the fungal species we are aware of that are associated with indoor air quality investigations and more. Please note however, that this reference guide does not cover every known fungal species.


This reference guide for fungi is slightly different than some of the other very good fungal glossaries on the web. We have included detailed references and corresponding abstracts that relate to allergenicity, toxicity and fungal infection for all fungi listed.


We have a number of photographs of fungi in this reference guide. However, we have many more. We are in the process of producing a separate, comprehensive fungal guide from these photographs and the information from this web page. The guide will be available in book format and on CD at a later date. The photos will show the front and  (at times important) reverse shots for several of the reference guide organisms, on 3 different media (Malt Extract Agar, Sabourauds Dextrose Agar and Potato Dextrose Agar). The photos are predominantly taken at 7 days of incubation at 25oC. Accompanying these photos are photomicrographs of these organisms.


One important note: after reading about the properties of these organisms, one can become very concerned. However, susceptibility to them can be dependant on how compromised your immune system is, the amount of fungal spores you are exposed to and how long you have been exposed to them, among other factors. Most of us breathe numerous fungal spores everyday and come to no harm." 


Dr. Stephen Wilson, Director, Texas Tech University, Department of Microbiology, Microbiology and Immunology                                                                                                                                                 



Dr David Straus, Professor, Texas Tech University, Center for Indoor Air Research 


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