The Answer to the Mold Illness Questions Is: All of the Above

Does Mold Really Cause Sickness?

By Michael A. Pinto, CSP, CMP

I don’t often crow, “I told you so!”, but regarding the continuing developments of medical research related to mold exposure I really did tell you so. Readers who have followed my work in various industry publications for a long time know that I have always advocated a holistic, comprehensive understanding of potential health effects related to fungal exposures. In fact, even in the first edition of our textbook, Fungal Contamination: A Comprehensive Guide for Remediation, I included descriptive information about bacterial contaminants as well as fungal organisms. The rationale for this additional information is that fungal contaminants such as mold do not occur in isolation but as a response to wet or damp environments.

This understanding of the world as a complex and inter-related place where problems have multiple factors to be juggled simultaneously works extremely well for cleaning and restoration contractors offering services beyond standard fire and water loss. As it turns out, it is also the most appropriate approach to understanding how exposures from fungal contamination and wet structures lead to the symptoms reported by occupants.

A Plethora of New Medical Information

Over the past two and a half years individual medical studies have provided compelling evidence to answer the question, “How does exposure to contaminated environments lead to the reported/observed symptoms?” More important, the combination of these individual studies through a research method called meta-analysis has provided clear direction for individuals seeking to understand the potential health impact of such exposures.

One of the latest and most blunt interpretations of this growing body of medical evidence was released by the California Department of Public Health. This document clearly states: “CDPH has concluded that the presence of water damage, dampness, visible mold or mold odor in schools, workplaces, residences and other indoor environments is unhealthy.”

The new California document does not get into the nitty-gritty of why such environments are hazardous; rather, its primary purpose is to alert individuals to potential dangers so that illnesses can be avoided by correcting problems or removing occupants from the source of the problems.

As mentioned previously, the statement from the California Department of Public Health builds upon reports released over the last few years by credible groups including the Institute of Medicine (IOM) and the World Health Organization (WHO).   These documents are substantially longer than the California warning.

A Shift in Thinking

The understanding of diseases associated with mold exposure and damp environments has followed a pattern that is common to a host of contaminants. Medical knowledge about the effects of radiation, cigarettes, asbestos, lead, PCBs, and other natural and man-made substances went through a process similar to what we have lived through with mold. Initially, medical professionals and other interested parties have a hard time understanding how the symptoms reported by exposed individuals can be caused by the contaminant. As awareness of a potential problem grows, early medical studies have to be very limited in scope as researchers control variables in order to isolate the primary causative factor.

For example, early medical studies trying to explain mold related illnesses focused almost exclusively on the toxigenic properties of certain chemical compounds naturally produced as part of the fungal life cycle. These mycotoxins are, indeed, very powerful poisons but could not be shown to be the primary reason for many of the symptoms. Research efforts then bounced back to examining the infectious and allergenic nature of mold exposures. While these studies could answer some of the questions they were not able to explain all of the documented health problems.

More recent studies have identified secondary reactions that occur in the body after exposure to fungal spores and metabolites. There is now good science that documents that exposure to fungal contaminants and damp environments not only triggers standard allergenic responses, but pushes certain parts of the immune system into overdrive. In essence, the body’s defense system ends up attacking the host as well as the biological invaders. This was a common theme of many of the presentations given by scientists from around the world at the 6th International Scientific Conference on Bioaerosols, Fungi, Bacteria, Mycotoxins in Indoor and Outdoor Environments and Human Health, which was held September 6-9, 2011, in Saratoga Springs, New York.

The Sum is Greater Than the Whole

A simple analogy to explain all of this is a multiple choice test. In the early days of medical research scientists were trying to figure out which aspect of fungal contamination was the primary cause of the reported symptoms:

• Allergenic
• Infectious potential
• Mycotoxins
• Hyper response of the immune system

As they tried to determine which was the correct answer they were not necessarily looking for the fifth bubble on the score sheet that said “All of the above”. Now, fortunately, most of the researchers in the field of fungal health effects understand that it is not an either/or proposition, but a multi-factorial situation.

One last piece of the puzzle that is helping to explain health effects from biological contamination is the concept of synergy. While each of the mold impacts described previously can be debilitating in its own right, it is now clear that the combination of these health effects is worse than their additive results. This connection was first publicized by some fascinating research conducted in 2004 by the Finnish National Public Health Institute that demonstrated synergism between various indoor fungi and the bacterium Streptomyces californicus. Their study showed an increase in production of chemicals in the immune system that typically fight tumors (known as tumor necrosis factor) but can damage body systems when produced in excessive concentrations. This was followed two years later by a report from Michigan State University describing exacerbated damage when exposure to a mycotoxin was preceded by exposure to a bacterial fragment. (See the article entitled “A Spreading Concern; Inhalation Health Effects of Mold” in the June 2007 edition of Environmental Health Perspectives for a good layperson’s description of some of the early research that explains the synergistic effects of mold and bacteria.)

It is important to note that more and more studies are examining the connection between fungal and bacterial contaminants and the way that multiple contaminants compound potential health effects in a multiplicative rather than additive way.

What Does It All Mean for the Cleaning and Restoration Contractor?

Keeping abreast of the current trends in health research can be valuable for contractors dealing with water losses and fungal contamination situations. If nothing else, understanding that there is a growing body of evidence that connects fungal contaminant exposure to a wide assortment of health symptoms makes the contractor more emphathetic to the occupant’s plight. It should also cause them to think more seriously about protecting their employees from both short term and long term health problems by instituting appropriate engineering controls for projects involving damp environments and mold. A strengthened policy regarding the use of personal protective equipment should also be a direct outcome of increased knowledge regarding current medical research.

Finally, a greater awareness of health problems resulting from mold and wet buildings can be shared with those who are suffering in order to give them hope that proper remediation can indeed have a positive impact on their life.

The Answer to the #Mold Illness Questions Is: All of the Above @moldsensitized http://t.co/RBtPNqlQEZ PLEASE RETWEET

— Mold Sensitized (@moldsensitized) March 18, 2015