42.

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Mold in Indoor Environments: A Critical Review of Research Studies

Authors: Coreen A. Robbins, Lonie J. Swenson, William T.Geer and Bruce J. Kelman

Since exposure standards for molds or mycotoxins do not exist, it is useful to have broad knowledge of the potential for exposure and health effects associated with mold in the indoor environment. Headlines about “toxic molds” have elevated the level of concern and response for certain species of mold that are known to produce mycotoxins. This article is based on a previous review of the toxic effects of molds associated with the production of mycotoxins, and the negative health effects due to

43.

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Mold prevention and detection: a guide for housing authorities in Indian country

Authors: Steven Winter Associates, Inc. and Building Research Council

News has been spreading about mold problems in Indian Country housing, as it has throughout many parts of North America. There are many questions being raised about how these situations should be handled, how people’s health can be protected, and how costly emergencies can be avoided. Mold that is not attended to can damage homes, and combined with dampness, can lead to sagging walls, ceilings, or floors. It can be unsightly, and can sometimes cause discomfort and health problems. Having mold i

44.

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Fungal Contamination in Public Buildings: Health Effects and Investigation Methods

Authors: Health Canada

The word “mold” is a non-scientific term that in popular parlance generally refers to members of a few dozen filamentous fungi. Mold growth on building surfaces not only damages these surfaces, but also affects air quality as intact spores, as well as spore and mycelial fragments, are dispersed in the air. These can be inhaled depending on their size and concentration. Exposure to mold is associated with increased rates of respiratory disease. This document is a revision of an earlier version pu

45.

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Adverse Human Health Effects Associated with Molds in the Indoor Environment

Authors: American College of Occupational and Environmental Medicine

variety of human ailments and disabilities. So-called "toxic mold" has become a prominent topic in the lay press and is increasingly the basis for litigation when individuals, families, or building occupants believe they have been harmed by exposure to indoor molds. This evidence-based statement from the American College of Occupational and Environmental Medicine (ACOEM) discusses the state of scientific knowledge as to the nature of fungal-related illnesses while emphasizing the possible relati

46.

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Mold Prevention Strategies and Possible Health Effects in the Aftermath of Hurricanes Katrina and Rita

Authors: The CDC Mold Workgroup

The duration and extent of flooding and the number of structures flooded as a result of Hurricanes Katrina and Rita make the likelihood of massive mold contamination in buildings a certainty. Many structures remained flooded weeks after the hurricane and became saturated with water. Some early observers suggested that as many as 60% to 80% of residential structures in New Orleans sustained severe flood damage. Outside New Orleans, extensive hurricane damage without prolonged flooding occurred. T

62.

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A brief guide to mold, moisture, and your home

Authors: U.S. Environmental Protection Agency Office of Air and Radiation Indoor Environments Division

This Guide provides information and guidance for homeowners and renters on how to clean up residential mold problems and how to prevent mold growth. Why is mold growing in my home? Molds are part of the natural environment. Outdoors, molds play a part in nature by breaking down dead organic matter such as fallen leaves and dead trees, but indoors, mold growth should be avoided. Molds reproduce by means of tiny spores; the spores are invisible to the naked eye and float through outdoor and indoor

72.

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Mycotoxin production by indoor molds

Authors: Kristian Fog Nielsen

Fungal growth in buildings starts at a water activity (aw) near 0.8, but significant quantities of mycotoxins are not produced unless aw reaches 0.95. Stachybotrys generates particularly high quantities of many chemically distinct metabolites in water-damaged buildings. These metabolites are carried by spores, and can be detected in air samples at high spore concentrations. Very little attention has been paid to major metabolites of Stachybotrys called spirocyclic drimanes, and the precise struc

73.

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Health Effects of Mycotoxins in Indoor Air: A Critical Review

Authors: Coreen A. Robbins, et al.

Industrial hygienists (IHs) are called upon to investigate exposures to mold in indoor environments, both residential and commercial. Because exposure standards for molds or mycotoxins do not exist, it is important for the industrial hygienist to have a broad knowledge of the potential for exposure and health effects associated with mold in the indoor environment. This review focuses on the toxic effects of molds associated with the production of mycotoxins, and the putative association between

74.

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Building-related respiratory symptoms can be predicted with semi-quantitative indices of exposure to dampness and mold

Authors: J.-H. Park, et al.

Using a semi-quantitative mold exposure index, the National Institute for Occupational Safety and Health (NIOSH) investigated 13 college buildings to examine whether building-related respiratory symptoms among employees are associated with environmental exposure to mold and dampness in buildings. We collected data on upper and lower respiratory symptoms and their building relatedness, and time spent in specific rooms with a self-administered questionnaires. Trained NIOSH industrial hygienists c

75.

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Acute Pulmonary Hemorrhage in Infants Associated With Exposure to Stachybotrys atra and Other Fungi

Authors: Ruth A. Etzel, et al.

Background: A geographic cluster of 10 cases of pulmonary hemorrhage and hemosiderosis in infants occurred in Cleveland, Ohio, between January 1993 and December 1994. Study Design: This community-based case-control study tested the hypothesis that the 10 infants with pulmonary hemorrhage and hemosiderosis were more likely to live in homes where Stachybotrys atra was present than were 30 age- and ZIP code–matched control infants. We investigated the infants' home environments using bioaerosol s

76.

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The Influence of House Characteristics in a Canadian Community on Microbiological Contamination

Authors: Mark D. Lawton, Robert E. Dales and Jim White

Fifty-nine houses in the small Canadian community of Wallaceburg, 39 with high levels of biologically active contaminants and 20 with low levels, were subjected to detailed field inspections: testing to determine house-operating parameters; monitoring of indoor environmental conditions; and simulating to predict the condensation formation potential under winter conditions. It was found that low air leakage and natural ventilation were not associated with higher levels of mold growth, as measured

77.

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Endotoxin and ?(1?3)-Glucan in House Dust and the Relation with Home Characteristics: A Pilot Study in 25 German Houses

Authors: Jeroen Douwes, et al.

Residential microbial exposure has been suggested to be involved in the development of asthma. This paper describes bacterial endotoxin and mold ?(1?3)-glucan levels in house dust and the relationship to selected home characteristics. Dust was sampled from mattresses and living room and bedroom floors of 25 houses in Germany. Endotoxin and ?(1?3)-glucan levels ranged from 200-48,600 EU/g dust (100-32,900 EU/m2 sampled surface) and 182-3,507 ?g/g (157-3,652 ?g/m2), respectively. Bio-contaminant l

78.

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Bacteria, Molds, and Toxins in Water-Damaged Building Materials

Authors: M. A. Andersson, et al.

Microbial toxins and eukaryotic cell toxicity from indoor building materials heavily colonized by fungi and bacteria were analyzed. The dominant colonizers at water-damaged sites of the building were Stachybotrys chartarum (103 to 105 visible conidia cm22), Penicillium and Aspergillus species (104 CFU mg21), gram-negative bacteria (104 CFU mg21), and mycobacteria (103 CFU mg21). The mycobacterial isolates were most similar to M. komossense, with 98% similarity of the complete 16S rDNA sequence.

86.

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Air sampling for fungi in indoor environments

Authors: Brian Flannigan

Mould growth in buildings is a major health issue, but most investigations of the indoor air spora still employ culture-based methods. These are inadequate for assessing exposure, since culturable organisms comprise a small fraction of the total of potentially allergenic/toxigenic units in air. For epidemiological studies, measurement of airborne fungal biomass over extended periods may be more relevant than total counts. Whilst (1+3)-/6D-gkKaU has been used to assess airborne biomass, ergoster

91.

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Fungal extracellular polysaccharides in house dust as a marker for exposure to fungi: Relations with culturable fungi, reported home dampness, and respiratory symptoms

Authors: Jeroen Douwes, et al.

Background: Epidemiologic studies have demonstrated an association between indoor fungal growth and respiratory symptoms. However, in only a few studies was fungal exposure actually measured. Objective: The purpose of this study was to evaluate the measurement by enzyme immunoassay of extracellular polysaccharides of Aspergillus and Penicillium species (EPS-Asp/Pen) in house dust as a marker for fungal exposure and to study the relations between EPS-Asp/Pen levels and home dampness and respira

101.

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Reducing relative humidity is a practical way to control dust mites and their allergens in homes in temperate climates

Authors: Larry G. Arlian, et al.

Background: Maintaining a relative humidity (RH) of less than 50% is one recommendation for reducing numbers of house dust mites and their allergens in homes. Objective: The purpose of this study was to determine whether, in a humid temperate climate, indoor RH could be sufficiently lowered to control dust mites and their allergens. Methods: During a period spanning 2 humid summers (May 1998 to October 1999), dust mite and allergen densities were determined in 3 groups of homes. One group (lo

106.

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Quantitation of the major fungal allergens, Alt a 1 and Asp f 1, in commercial allergenic products

Authors: Lisa Vailes, et al.

Background: Alternaria is one of the most important fungi associated with allergic disease, whereas Aspergillus fumigatus is involved in a broad spectrum of pulmonary diseases. Currently, fungal extracts used for diagnosis in the United States are unstandardized, and their allergenic content cannot be compared directly. Objective: The goal of this study was to compare the variability of major allergen levels among US allergenic products derived from fungi: specifically, Alt a 1 levels in Altern

119.

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Mycotoxin production by indoor molds

Authors: Kristian Fog Nielsen

Fungal growth in buildings starts at a water activity (aw) near 0.8, but significant quantities of mycotoxins are not produced unless aw reaches 0.95. Stachybotrys generates particularly high quantities of many chemically distinct metabolites in water-damaged buildings. These metabolites are carried by spores, and can be detected in air samples at high spore concentrations. Very little attention has been paid to major metabolites of Stachybotrys called spirocyclic drimanes, and the precise struc

127.

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Health risk assessment of fungi in home environments

Authors: Arnoud P. Verhoeff and Harriet A. Burge

Learning Objectives: Reading this article will enable the readers to recognize the public health importance of fungi in the home environment. In view of the recognized impact of fungi on human health, the large population being exposed to fungi, and the large population at risk for developing allergic diseases, there is a need to establish guidelines for allowable exposure to fungi based on a health risk assessment. The aim of this study was to evaluate the status of the data on the relationship

130.

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Symptoms of wheeze and persistent cough in the first year of life: associations

Authors: Kathleen Belanger, et al.

In a cohort of 849 infants with an asthmatic sibling, the authors examined the relations of exposure to allergens (dust mite, cockroach, cat, and dog), nitrogen dioxide, and mold with symptoms of wheeze and persistent cough in the first year of life (1998–2000). Among infants whose mothers had physician-diagnosed asthma, neither dust mite allergen nor dog allergen was associated with either symptom. Exposure to cockroach allergen (Bla g 1 at ?2 U/g) modestly increased the risk for wheeze (odds r

132.

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Endotoxin Exposure Is a Risk Factor for Asthma - The National Survey of Endotoxin in United States Housing

Authors: Peter S. Thorne, et al.

Background: Although research has shown that early life exposure to household endotoxin protects against development of allergies, studies are less clear on the relationship between household endotoxin exposure and prevalence of wheezing and asthma. We assayed 2,552 house dust samples in a representative nationwide sample to explore relationships between endotoxin exposures and risk factors for asthma, asthma symptoms, and medication use. Methods: House dust was vacuum-sampled from five locati

135.

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The relation between fungal propagules in indoor air and home characteristics

Authors: P. Ren, T. M. Jankun, K. Belanger, B. P. Leaderer

Background: Questionnaires are commonly used in epidemiologic studies to obtain information about house characteristics in order to predict the household aeroallergen exposure levels. However, the reliability of the predictions made with the questionnaires has not been evaluated. To address this issue, we compared objectively measured fungal propagules including the most frequently isolated mold genera (i.e., Alternaria, Aspergillus, Cladosporium, Penicillium, etc.) in a large sample of homes a

136.

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Dustborne and airborne fungal propagules represent a different spectrum of fungi with differing relations to home characteristics

Authors: G. L. Chew, C. Rogers, H. A. Burge

Background: Exposure to fungi is often assessed by culturing floor dust or air samples. Our objective was to evaluate the relationships between dustborne and airborne fungi and to identify factors that modify these relationships. Methods: From November 1994 to September 1996 sequential duplicate 45-l air samples were collected in bedrooms of 496 homes in the Boston area, using a Burkard culture plate sampler. After air sampling, bedroom floors were sampled with a vacuum cleaner that was modi

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Update: Pulmonary Hemorrhage/Hemosiderosis Among Infants --- Cleveland, Ohio, 1993-1996

Authors: Centers for Disease Control and Prevention

Ohio, with acute idiopathic pulmonary hemorrhage, also referred to as pulmonary hemosiderosis (1,2). The children resided in seven contiguous postal tracts and had had one or more hemorrhagic episodes, resulting in one death, during January 1993-December 1994. Preliminary results of a CDC case-control study (2) indicated that hemorrhage was associated with 1) major household water damage during the 6 months before illness and 2) increased levels of measurable household fungi, including the tox

199.

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Infant Pulmonary Hemorrhage in a Suburban Home with Water Damage and Mold

Authors: Susan M. Flappan, Jay Portnoy, Patricia Jones, and Charles Barnes

The American Academy of Pediatrics recently issued guidelines regarding the potential toxic effect of indoor molds. We now report another case of an infant with pulmonary hemorrhage whose residential environmental assessment revealed the presence of the toxigenic mold Stachybotrys atra. We used a questionnaire to identify environmental factors that could predispose the home to fungal contamination. We collected air samples from multiple locations in the home that we felt would reflect areas o

200.

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The Environment and Asthma in U.S. Inner Cities

Authors: Peyton A. Eggleston, Timothy J. Buckley, Patrick N. Breysse, Marsha Wills-Karp, Steven R. Kleeberger, and Jouni J. K. Jaakkola

The prevalence and severity of asthma has increased in the last 20 years, and the greatest increase has been seen among children and young adults living in U.S. inner cities. The reasons for this increase are obviously complex, but include environmental exposures to allergens and pollutants, changing patterns of medication, and the psychosocial stresses of living in poor inner-city neighborhoods. This paper presents an overview of environmental, immunologic, and genetic factors associated wit

201.

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Fungal Spores: Hazardous to Health?

Authors: W.G. Sorenson

Fungi have long been known to affect human well being in various ways, including disease of essential crop plants, decay of stored foods with possible concomitant production of mycotoxins, superficial and systemic infection of human tissues, and disease associated with immune stimulation such as hypersensitivity pneumonitis and toxic pneumonitis. The spores of a large number of important fungi are less than 5 µm aerodynamic diameter, and therefore are able to enter the lungs. They also may co

202.

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Microfungal Contamination of Damp Buildings--Examples of Risk Constructions and Risk Materials

Authors: Suzanne Gravesen, Peter A. Nielsen, Randi Iversen, and Kristian Fog Nielsen

To elucidate problems with microfungal infestation in indoor environments, a multidisciplinary collaborative pilot study, supported by a grant from the Danish Ministry of Housing and Urban Affairs, was performed on 72 mold-infected building materials from 23 buildings. Water leakage through roofs, rising damp, and defective plumbing installations were the main reasons for water damage with subsequent infestation of molds. From a score system assessing the bioavailability of the building material

203.

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Review of Methods Applicable to the Assessment of Mold Exposure to Children

Authors: H. Kenneth Dillon, J. David Miller, W.G. Sorenson, Jeroen Douwes, and Robert R. Jacobs

This article presents discussion of the assessment of the exposure of children to fungi, substances derived from fungi, and the environmental conditions that may lead to exposure. The principles driving investigations of fungal contamination and subsequent exposure are presented as well as guidelines for conducting these investigations. A comprehensive description of available research sampling and analysis techniques is also presented. Key words: (1 3)-ß-d-glucans, children, ergosterol, exposu

208.

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Levels of Household Mold Associated with Respiratory Symptoms in the

Authors: Janneane F. Gent, et al.

We assessed prospectively the risk of increased incidence of respiratory symptoms after exposure to particular fungal genera in a susceptible population—namely, infants (n = 880) at high risk for developing asthma. Days of wheeze or persistent cough, information on maternal allergy and asthma, socioeconomic variables, and housing characteristics were collected over the course of the infant’s first year of life. Exposure to mold was assessed by airborne samples collected at one time early in the

214.

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Indoor Exposure to Molds and Allergic Sensitization

Authors: Beate Jacob, Beate Ritz, Ulrike Gehring, Andrea Koch, Wolfgang Bischof, H. E. Wichmann and Joachim Heinrich for the INGA-Study Group

Evidence that indoor dampness and mold growth are associated with respiratory health has been accumulating, but few studies have been able to examine health risks in relation to measured levels of indoor mold exposure. In particular, little is known about the contribution of indoor molds to the development of allergic sensitization. As a part of an ongoing study examining the effects of ambient air pollutants on respiratory health and atopic diseases in German school children, we examined the r

218.

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Controlling and Preventing Household Mold and Moisture Problems: Lessons Learned and Strategies for Disseminating Best Practices - A Report to Congress

Authors: U.S. Department of Housing and Urban Development (HUD)

This Report to Congress describes ongoing and recently completed residential mold- and moisture-related work conducted by different offices within the Department of Housing and Urban Development (HUD). The results of that work are presented, and the Department's strategies for reaching out to key groups with information about moisture control and mold prevention are discussed. Mold and moisture problems in housing are not new phenomena, but they are receiving more attention than in the past.

246.

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Mold Factsheet

Authors: U.S. Department of Housing and Urban Development Office of Healthy Homes and Lead Hazard Control

Does your home have...? Stains or discoloration on your walls, ceiling, or furniture? A damp or musty smell? Water problems like a leaky roof or water in the basement? What is it? Molds are alive. There are hundreds of thousands of different types of mold. They are living organisms that grow naturally, particularly in warm, damp, humid conditions where there is little air movement. Often called “mildew,” molds are related to mushrooms and yeast but are much smaller—we can only see or smel

251.

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Mold and Moisture Prevention: A Guide for Residents in Indian Country

Authors: U.S. Department of Housing and Urban Development

Mold is a fungus, along with mushrooms and yeasts. Outdoors, mold is an important part of nature, because it breaks down dead trees and fallen leaves. But mold growing indoors should be avoided, because it can damage belongings, carpets, sofas, and mattresses. Mold can weaken floors and walls, making a house unsafe. Mold can ruin clothes and shoes in damp closets. All houses have some mold in them, but if your house is moldy, this is a sign of that it has a problem with dampness or water. Wh

258.

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Association of Housing Disrepair Indicators with Cockroach and Rodent Infestations in a Cohort of Pregnant Latina Women and Their Children

Authors: Asa Bradman, Jonathan Chevrier, Ira Tager, et al.

Health burdens associated with poor housing and indoor pest infestations are likely to affect young children in particular, who spend most of their time indoors at home. We completed environmental assessments in 644 homes of pregnant Latina women and their children living in the Salinas Valley, California. High residential densities were common, with 39% of homes housing > 1.5 persons per room. Housing disrepair was also common: 58% of homes had peeling paint, 43% had mold, 25% had water damage

259.

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Home Dampness and Molds, Parental Atopy, and Asthma in Childhood: A Six-Year Population-Based Cohort Study

Authors: Jouni J. K. Jaakola, Bing-Fange Hwang, Niina Jaakkola

Previous studies of how parental atopy and exposure to dampness and molds contribute to the risk of asthma have been mainly cross-sectional or prevalent case–control studies, where selection and information bias and temporality constitute problems. We assessed longitudinally the independent and joint effects of parental atopy and exposure to molds in dwellings on the development of asthma in childhood. We conducted a population-based, 6-year prospective cohort study of 1,984 children 1–7 years

269.

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Airborne Endotoxin Predicts Symptoms in Non–Mouse-sensitized Technicians and Research Scientists Exposed to Laboratory Mice

Authors: Karin A. Pacheco, Charles McCammon, Andrew H. Liu, et al.

Research scientists, laboratory technicians, and animal handlers who work with animals frequently report respiratory and skin symptoms from exposure to laboratory animals (LA). However, on the basis of prick skin tests or RASTs, only half are sensitized to LA. We hypothesized that aerosolized endotoxin from mouse work is responsible for symptoms in nonsensitized workers. We performed a cross-sectional study of 269/310 (87%) workers at a research institution. Subjects completed a questionnaire an