Health Effects of Moldy Buildings – Respiratory Issues

 

This page lists medical journal articles discussing the relationship between respiratory issues and moldy buildings.

The Health Effects of Moldy Buildings page of the Paradigm Change site provides further information on this topic.

 

Caillaud D, Leynaert B, Keirsbulck M, Nadif R; mould ANSES working group. Indoor mould exposure, asthma and rhinitis: findings from systematic reviews and recent longitudinal studies. Eur Respir Rev. 2018 May 15;27(148). PMID: 29769295

Starting from the Institute of Medicine (IOM) and World Health Organization (WHO) reports, this review provides an overview of the literature published from 2006 to 2017 on the associations between indoor mould exposure and asthma and rhinitis separately in children and adults with a focus on longitudinal epidemiological studies. In children, visible mould and mould odour were associated with the development and exacerbations of asthma, providing sufficient evidence of a causal relationship. Results from population-based studies in adults were too few and divergent to conclude at more than a limited level of evidence. Exposure to mould in a work building was associated with the incidence and exacerbations of occupational asthma, and we concluded at a sufficient evidence for an association.

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Shorter C, Crane J, Pierse N, Barnes P, Kang J, Wickens K, Douwes J, Stanley T, Täubel M, Hyvärinen A, Howden-Chapman P; Wellington Region General Practitioner Research Network. Indoor visible mold and mold odor are associated with new-onset childhood wheeze in a dose-dependent manner. Indoor Air. 2018 Jan;28(1):6-15. PMID: 28779500

We conducted an incident case-control study involving 150 children with new-onset asthma wheeze, aged between 1 and 7 years, each matched to two control children with no history of wheezing. Each participant’s home was assessed for moisture damage, condensation, and mold growth by researchers, an independent building assessor and parents. Strong positive associations were found between observations of visible mold and new-onset wheezing in children. Visible mold and mold odor were consistently associated with new-onset wheezing in a dose-dependent manner. The association between mold and new-onset wheeze was not modified by atopic status, suggesting a non-allergic association.

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Järvi K, Hyvärinen A, Täubel M, Karvonen AM, Turunen M, Jalkanen K, Patovirta R, Syrjänen T, Pirinen J, Salonen H, Nevalainen A, Pekkanen J. Microbial growth in building material samples and occupants’ health in severely moisture-damaged homes. Indoor Air. 2018 Mar;28(2):287-297. PMID: 29151276

In 39 single-family homes with severe moisture damage, we studied whether concentrations of viable microbes in building material samples are associated with health among 71 adults and 68 children. Highest group of actinomycete counts was associated with more general symptoms, worse perceived health, and higher daily PEF variability among adults, and with an increase in lower respiratory symptoms in children, but the confidence intervals were wide. We observed significant associations of fungal counts and total microbial score with worse perceived health in adults.

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Abou-Donia MB, Lieberman A, Curtis L. Neural autoantibodies in patients with neurological symptoms and histories of chemical/mold exposures. Toxicol Ind Health. 2018 Jan;34(1):44-53. PMID: 29069985

Elevated neural autoantibodies are biomarkers for many diseases such as multiple sclerosis and Parkinson’s disease. Our study reports levels of six types of neural autoantibodies in a group of 24 toxicant-exposed patients. The patients were exposed to a variety of toxicants including contaminated drinking water, building water/mold damage, pesticides, and other assorted toxic chemicals. Levels of all six neural autoantibodies were significantly elevated in most patients and in the patient group at large.

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Mendell MJ, Macher JM, Kumagai K. Measured moisture in buildings and adverse health effects: A review. Indoor Air. 2018 Jul;28(4):488-499. PMID: 29683210

An overlooked target for assessing indoor dampness or mold is moisture in building materials, the critical factor allowing microbial growth. A search for studies of quantified building moisture and occupant health effects identified 3 eligible studies. Two studies assessed associations between measured wall moisture content and respiratory health in the UK. Both reported dose-related increases in asthma exacerbation with higher measured moisture. The third study assessed relationships between infrared camera-determined wall moisture and atopic dermatitis in South Korea, reporting an adjusted odds ratio of 14.5 for water-damaged homes and moderate or severe atopic dermatitis.

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Park JH, Cox-Ganser JM, White SK, Laney AS, Caulfield SM, Turner WA, Sumner AD, Kreiss K. Bacteria in a water-damaged building: associations of actinomycetes and non-tuberculous mycobacteria with respiratory health in occupants. Indoor Air. 2017 Jan;27(1):24-33. PMID: 26717439

We examined microbial correlates of health outcomes in building occupants with a sarcoidosis cluster and excess asthma. Thermophilic actinomycetes and non-tuberculous mycobacteria may have played a role in the occupants’ respiratory outcomes in this water-damaged building.

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Valtonen V. Clinical Diagnosis of the Dampness and Mold Hypersensitivity Syndrome: Review of the Literature and Suggested Diagnostic Criteria. Front Immunol. 2017 Aug 10;8:951. PMID: 28848553

A great variety of non-specific symptoms may occur in patients living or working in moisture-damaged buildings. In the beginning, these symptoms are usually reversible, mild, and present irritation of mucosa and increased morbidity due to respiratory tract infections and asthma-like symptoms. Later, the disease may become chronic and a patient is referred to a doctor where the assessment of dampness and mold hypersensitivity syndrome (DMHS) often presents diagnostic challenges. I propose five clinical criteria to diagnose DMHS: (1) the history of mold exposure in water-damaged buildings, (2) increased morbidity to due infections, (3) sick building syndrome, (4) multiple chemical sensitivity, and (5) enhanced scent sensitivity.

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Norbäck D, Cai GH, Kreft I, Lampa E, Wieslander G. Fungal DNA in dust in Swedish day care centres: associations with respiratory symptoms, fractional exhaled nitrogen oxide (FeNO) and C-reactive protein (CRP) in serum among day care centre staff. Int Arch Occup Environ Health. 2016 Feb;89(2):331-40. PMID: 26183154

This study looked at associations between fungal DNA in day care centres, fractional exhaled nitric oxide (FeNO) and inflammatory markers in day care centre staff. The researchers concluded that fungal contamination in day care centres, measured as fungal DNA, can be a risk factor for airway inflammation.

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Baxi SN, Portnoy JM, Larenas-Linnemann D, Phipatanakul W; Environmental Allergens Workgroup. Exposure and Health Effects of Fungi on Humans. J Allergy Clin Immunol Pract. 2016 May-Jun;4(3):396-404. PMID: 26947460

We reviewed recent articles focused on fungal exposure and dampness as risk factors for respiratory disease development, symptoms, and hypersensitivity. In particular, we reviewed the evidence suggesting that early exposure to dampness or fungi is associated with the development of asthma and increased asthma morbidity. Although outdoor exposure to high concentrations of spores can cause health effects such as asthma attacks in association with thunderstorms, most people appear to be relatively unaffected unless they are sensitized to specific genera. Indoor exposure and dampness, however, appears to be associated with an increased risk of developing asthma in young children and asthma morbidity in individuals who have asthma.

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Huang C, Wang X, Liu W, Cai J, Shen L, Zou Z, Lu R, Chang J, Wei X, Sun C, Zhao Z, Sun Y, Sundell J. Household indoor air quality and its associations with childhood asthma in Shanghai, China: On-site inspected methods and preliminary results. Environ Res. 2016 Nov;151:154-167. PMID: 27479712

During 2013-2014, we conducted a case-control study with home inspection among 454 children (186 asthma children and 268 non-asthma children) in Shanghai, China. Our results indicated that air quality among most residences in Shanghai could meet the national standard for indoor air quality in warm seasons; but household air quality and ventilation status in winter should be greatly improved.

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Wåhlén K, Fornander L, Olausson P, Ydreborg K, Flodin U, Graff P, Lindahl M, Ghafouri B. Protein profiles of nasal lavage fluid from individuals with work-related upper airway symptoms associated with moldy and damp buildings. Indoor Air. 2016 Oct;26(5):743-54. PMID: 26451694

Upper airway irritation is common among individuals working in moldy and damp buildings. The aim of this study was to investigate effects on the protein composition of the nasal lining fluid. The prevalence of symptoms in relation to work environment was examined in 37 individuals working in two damp buildings. Microbial growth was confirmed in one of the buildings. The results show that protein profiles in nasal lavage fluid can be used to monitor airway mucosal effects in personnel working in damp buildings and indicate that the profile may be separated when the dampness is associated with the presence of molds.

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Norbäck D, Hashim JH, Cai GH, Hashim Z, Ali F, Bloom E, Larsson L. Rhinitis, Ocular, Throat and Dermal Symptoms, Headache and Tiredness among Students in Schools from Johor Bahru, Malaysia: Associations with Fungal DNA and Mycotoxins in Classroom Dust. PLoS One. 2016 Feb 1;11(2):e0147996. PMID: 26829324

There are few studies on rhinitis and sick building syndrome (SBS) among students in tropical countries. We studied associations between levels of five fungal DNA sequences, two mycotoxins (sterigmatocystin and verrucarol) and cat allergen (Fel d 1) levels in schools and rhinitis and other weekly SBS symptoms in the students. In conclusion, total fungal contamination, measured as total fungal DNA) in the classrooms, Aspergillus versicolor and verrucarol can be risk factors for rhinitis and SBS symptoms among students in the tropical country Malaysia.

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Lee RJ, Workman AD, Carey RM, Chen B, Rosen PL, Doghramji L, Adappa ND, Palmer JN, Kennedy DW, Cohen NA. Fungal Aflatoxins Reduce Respiratory Mucosal Ciliary Function. Sci Rep. 2016 Sep 14;6:33221. PMID: 27623953

Because many respiratory pathogens secrete toxins to impair mucociliary immunity, we examined the effects of acute exposure to aflatoxins on airway cell physiology. Aflatoxins secreted by respiratory A. flavus may impair motile and chemosensory functions of airway cilia, contributing to pathogenesis of fungal airway diseases.

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Vesper S, Wymer L. The relationship between environmental relative moldiness index values and asthma. Int J Hyg Environ Health. 2016 May;219(3):233-8. PMID: 26861576

Six epidemiological studies of the relationship between ERMI values and asthma, in cities across the U.S., showed that both children and adults with asthma were living in homes with significantly higher ERMI values than the control or comparison homes. Based on these six studies, the accuracy of the ERMI value’s link to occupant asthma was analyzed using receiver operating characteristic (ROC) curve and area under the curve (AUC) statistical analysis. The AUC was 0.69 which places the test accuracy in the “fair to good” range for a medical diagnostic test.

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Nayak AP, Green BJ, Lemons AR, Marshall NB, Goldsmith WT, Kashon ML, Anderson SE, Germolec DR, Beezhold DH. Subchronic exposures to fungal bioaerosols promotes allergic pulmonary inflammation in naïve mice. Clin Exp Allergy. 2016 Jun;46(6):861-70. PMID: 26892490

Aspergillus fumigatus spores were delivered to the lungs of naïve BALB/cJ mice housed in a multi-animal nose-only chamber twice a week for a period of 13 weeks. Mice were evaluated at 24 and 48 h post-exposure for histopathological changes in lung architecture, recruitment of specific immune cells to the airways, and serum antibody responses. Repeated inhalation of fungal aerosols resulted in significant pulmonary pathology mediated by dynamic shifts in specific immune populations and their cytokines.

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Sharpe RA, Thornton CR, Nikolaou V, Osborne NJ. Higher energy efficient homes are associated with increased risk of doctor diagnosed asthma in a UK subpopulation. Environ Int. 2015 Feb;75:234-44. PMID: 25498485

Energy efficiency may increase the risk of current adult asthma in a population residing in social housing. This association was not significantly modified by the presence of visible mould growth.

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Kielb C, Lin S, Muscatiello N, Hord W, Rogers-Harrington J, Healy J. Building-related health symptoms and classroom indoor air quality: a survey of school teachers in New York State. Indoor Air. 2015 Aug;25(4):371-80. PMID: 25196499

This investigation assessed building-related health symptoms and classroom characteristics via telephone survey of New York State school teachers. The most commonly reported symptoms included sinus problems (16.8%), headache (15.0%), allergies/congestion (14.8%), and throat irritation (14.6%). Experiencing one or more symptoms was associated most strongly with reported dust, dust reservoirs, paint odors, mold and moldy odors.

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Pekkanen J, Lampi J. Moisture and mold damages of buildings in relation to health. Duodecim. 2015;131(19):1749-55. PMID: 26638659

Moisture damages of buildings increase respiratory symptoms and the risk of development of new cases of asthma. Scientific evidence of possible other health effects of moisture damages is scanty but they cause plenty of concern. The management of indoor air problems is further hampered by the lack of health-based limit values. Although the factors increasing asthma and respiratory symptoms in buildings with moisture damage are not known in detail, every attempt should be made to prevent and correct the moisture damages.

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Karottki DG, Spilak M, Frederiksen M, Jovanovic Andersen Z, Madsen AM, Ketzel M, Massling A, Gunnarsen L, Møller P, Loft S. Indoor and outdoor exposure to ultrafine, fine and microbiologically derived particulate matter related to cardiovascular and respiratory effects in a panel of elderly urban citizens. Int J Environ Res Public Health. 2015 Feb 2;12(2):1667-86. PMID: 25648225

To explore associations of exposure to ambient and indoor air particulate and bio-aerosol pollutants with cardiovascular and respiratory disease markers, we utilized seven repeated measurements from 48 elderly subjects participating in a 4-week home air filtration study. Multiple comparisons demand cautious interpretation of results, which suggest that outdoor PNC have adverse effects on MVF, and outdoor and indoor PM2.5 and bio-aerosols are associated with markers of inflammation and lung cell integrity.

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Vacher G, Niculita-Hirzel H, Roger T. Immune responses to airborne fungi and non-invasive airway diseases. Semin Immunopathol. 2015 Mar;37(2):83-96. PMID: 25502371

The goal of the present review is to present the current knowledge on the interaction between airborne fungal particles and the host immune system, to illustrate the differences of immune sensing of different fungal species and to emphasise the importance of conducting research on non-conventional mesophilic fungal species. Indeed, the diversity of fungal species we inhale and the complexity of their composition have a direct impact on fungal particle recognition and immune system decision to tolerate or respond to those particles, eventually leading to collateral damages promoting airway pathologies.

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Hu Y, Liu W, Huang C, Zou ZJ, Zhao ZH, Shen L, Sundell J. Home dampness, childhood asthma, hay fever, and airway symptoms in Shanghai, China: associations, dose-response relationships, and lifestyle’s influences. Indoor Air. 2014 Oct;24(5):450-63. PMID: 24571077

In this study of 13,335 parent-reported questionnaires, we analyzed associations between home dampness and asthma and related symptoms in 4- to 6-year-old children in a cross-sectional study of Shanghai. Indicators of home dampness were strongly and significantly associated with dry cough, wheeze, and rhinitis symptoms. In the current residence, children with visible mold spots (VMS) exposure had 32% higher risk of asthma; damp clothing and/or bedding (frequently) was strongly associated with dry cough; condensation on windows was strongly associated with hay fever.

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Karvala K, Nordman H, Luukkonen R, Uitti J. Asthma related to workplace dampness and impaired work ability. Int Arch Occup Environ Health. 2014 Jan;87(1):1-11. PMID: 23208737

Adverse work ability outcomes are associated with asthma in relation to workplace dampness.

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Norbäck D, Lampa E, Engvall K. Asthma, allergy and eczema among adults in multifamily houses in Stockholm (3-HE study) — associations with building characteristics, home environment and energy use for heating. PLoS One. 2014 Dec 5;9(12):e112960. PMID: 25479551

Risk factors for asthma, allergy and eczema were studied in a stratified random sample of adults in Stockholm. Asthma, allergy or eczema were more common in buildings using less energy for heating, in larger buildings and in dwellings with redecorations, mould odour, dampness and humid air.

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Cho SJ, Cox-Ganser JM, Kreiss K, Park JH. Evaluation of individual-based and group-based exposure estimation of microbial agents in health effects associated with a damp building. J Expo Sci Environ Epidemiol. 2013 Jul;23(4):409-15. PMID: 22968350

We evaluated attenuation in linear associations between microbial exposure and respiratory symptoms occurring when individual measurements of microbial agents were used for estimating employees’ exposure compared with group means. Symptoms, which improved when away from the building (building-related, BR), and measurements of culturable fungi, ergosterol, and endotoxin in floor dust were obtained between 2001 and 2007 from four cross-sectional studies on occupants of a water-damaged building.

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Cummings KJ, Fink JN, Vasudev M, Piacitelli C, Kreiss K. Vocal cord dysfunction related to water-damaged buildings. J Allergy Clin Immunol Pract. 2013 Jan;1(1):46-50. PMID: 24229821

Vocal cord dysfunction (VCD) can occur with exposure to water-damaged buildings and should be considered in exposed patients with asthma-like symptoms.

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White SK, Cox-Ganser JM, Benaise LG, Kreiss K. Work-related peak flow and asthma symptoms in a damp building. Occup Med (Lond). 2013 Jun;63(4):287-90. PMID: 23599177

This study describes the relationship of peak flow measurements to work-related asthma (WRA) symptoms and WRA among occupants in a damp office building. We found evidence of work-related changes in serial peak flows among some occupants of an office building with a history of dampness. Serial peak flows may be a useful measure to determine WRA in office settings.

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Akpinar-Elci M, White SK, Siegel PD, Park JH, Visotcky A, Kreiss K, Cox-Ganser JM. Markers of upper airway inflammation associated with microbial exposure and symptoms in occupants of a water-damaged building. Am J Ind Med. 2013 May;56(5):522-30. PMID: 23390064

In this study, we documented an association between endotoxin and nasal inflammatory markers among office workers. The results of our study suggest that a non-allergic response may contribute to symptoms occurring among occupants in this water-damaged building.

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Sahlberg B, Gunnbjörnsdottir M, Soon A, Jogi R, Gislason T, Wieslander G, Janson C, Norback D. Airborne molds and bacteria, microbial volatile organic compounds (MVOC), plasticizers and formaldehyde in dwellings in three North European cities in relation to sick building syndrome (SBS). Sci Total Environ. 2013 Feb 1;444:433-40. PMID: 23280302

As a follow-up of the European Community Respiratory Health Survey (ECRHS II), indoor measurements were performed in homes in three North European cities. Some MVOCs like 1-octen-3-ol, formaldehyde and the plasticizer Texanol, may be a risk factor for sick building syndrome. Moreover, concentrations of airborne molds, bacteria and some other MVOCs were slightly higher in homes with reported dampness and mold.

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Żukiewicz-Sobczak W, Sobczak P, Krasowska E, Zwoliński J, Chmielewska-Badora J, Galińska EM. Allergenic potential of moulds isolated from buildings. Ann Agric Environ Med. 2013;20(3):500-3. PMID: 24069854

The literature and own research clearly shows that moulds and their secondary metabolites can evoke toxic effects on human and animal health, and cause symptoms similar to allergic diseases. These allergens have been noted in spores as well as other fungal fragments; however, most allergens are located in germinating spores, in the hyphal tips and in mycelia. Fungal allergy can express in different ways: asthma, rhinitis, conjunctivitis, urticaria and atopic dermatitis. Fungal allergy antigen is bound to IgE-dependent reactions but also to reactions independent of IgE.

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Sauni R, Uitti J, Jauhiainen M, Kreiss K, Sigsgaard T, Verbeek JH. Remediating buildings damaged by dampness and mould for preventing or reducing respiratory tract symptoms, infections and asthma (Review). Evid Based Child Health. 2013 May;8(3):944-1000. PMID: 23877912

We found moderate to very low-quality evidence that repairing mould-damaged houses and offices decreases asthma-related symptoms and respiratory infections compared to no intervention in adults. There is very low-quality evidence that although repairing schools did not significantly change respiratory symptoms in staff or children, pupils’ visits to physicians due to a common cold were less frequent after remediation of the school.

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Bellanger AP, Pallandre JR, Borg C, Loeffert S, Gbaguidi-Haore H, Millon L. Human monocyte-derived dendritic cells exposed to microorganisms involved in hypersensitivity pneumonitis induce a Th1-polarized immune response. Clin Vaccine Immunol. 2013 Aug;20(8):1133-42.

Hypersensitivity pneumonitis (HP) is an immunoallergic disease characterized by a prominent interstitial infiltrate composed predominantly of lymphocytes secreting inflammatory cytokines. This study aimed to investigate the initial interactions between human monocyte-derived dendritic cells (MoDCs) and four microorganisms that are different in nature (Saccharopolyspora rectivirgula [actinomycetes], Mycobacterium immunogenum [mycobacteria], and Wallemia sebi and Eurotium amstelodami [filamentous fungi]) and are involved in HP. E. amstelodami-exposed (EA) MoDCs expressed higher percentages of costimulatory molecules than did W. sebi-exposed (WS), S. rectivirgula-exposed (SR), or M. immunogenum-exposed (MI) MoDCs (P < 0.05, Wilcoxon signed-rank test). EA-MoDCs, WS-MoDCs, SR-MoDCs, and MI-MoDCs induced CD4(+) T cell proliferation and a Th1-polarized immune response. The present study provides evidence that, although differences were initially observed between MoDCs exposed to filamentous fungi and MoDCs exposed to bacteria, a Th1 response was ultimately promoted by DCs regardless of the microbial extract tested.

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Fabian MP, Stout NK, Adamkiewicz G, Geggel A, Ren C, Sandel M, Levy JI. The effects of indoor environmental exposures on pediatric asthma: a discrete event simulation model. Environ Health. 2012 Sep 18;11:66. PMID: 22989068

We describe the design and evaluation of a discrete event simulation model of pediatric asthma for children living in low-income multi-family housing. Our model simulates the effect of environmental factors (combustion pollutants and allergens), medication compliance, seasonality, and medical history on asthma outcomes (symptom-days, medication use, hospitalizations, and emergency room visits).

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Mihinova D, Pieckova E. Moldy buildings, health of their occupants and fungal prevention. Bratisl Lek Listy. 2012;113(5):314-8. PMID: 22616593

Exposure to fungi in indoor environments (esp. in water-damaged buildings) can cause adverse health effects, such as allergy, asthma, hypersensitivity pneumonia, mucous membrane irritation, different toxic effects, or even mycoses (in immunocompromised individuals) – alone or in combination. As serious adverse health effects could be caused antifungal prevention is an absolute need. This review article summarizes the occurrence of fungi in the indoor environment of buildings and their contribution to occupants´ health problems, and preventive measures against molds.

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Thomas G, Burton NC, Mueller C, Page E, Vesper S. Comparison of work-related symptoms and visual contrast sensitivity between employees at a severely water-damaged school and a school without significant water damage. Am J Ind Med. 2012 Sep;55(9):844-54. PMID: 22566108

The National Institute for Occupational Safety and Health (NIOSH) conducted a health hazard evaluation (HHE) of a water-damaged school in New Orleans (NO), Louisiana. Our aim in this evaluation was to document employee health effects related to exposure to the water-damaged school, and to determine if VCS testing could serve as a biomarker of effect for occupants who experienced adverse health effects in a water-damaged building. Employees exposed to an extensively water-damaged environment reported adverse health effects, including rashes and nasal, lower respiratory, and constitutional symptoms. VCS values were lower in the employees at the water-damaged school, but we do not recommend using it in evaluation of people exposed to mold.

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Park JH, Kreiss K, Cox-Ganser JM. Rhinosinusitis and mold as risk factors for asthma symptoms in occupants of a water-damaged building. Indoor Air. 2012 Oct;22(5):396-404. PMID: 22385263

Our findings suggest that occurrence of BR upper respiratory illness in water-damaged buildings may presage future endemic asthma.

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Zhang X, Sahlberg B, Wieslander G, Janson C, Gislason T, Norback D. Dampness and moulds in workplace buildings: associations with incidence and remission of sick building syndrome (SBS) and biomarkers of inflammation in a 10 year follow-up study. Sci Total Environ. 2012 Jul 15;430:75-81. PMID: 22634552

We studied associations between dampness and indoor moulds in workplace buildings and selected biomarkers as well as incidence and remission of sick building syndrome (SBS). The study was based on a ten-year prospective study (1992-2002) in a random sample of adults (N=429) from the Uppsala part of the European Community Respiratory Health Survey (ECRHS). In general, dampness and moulds in the workplace building is associated with increased incidence and decreased remission of SBS, as well as increased bronchial responsiveness and eosinophilic inflammation.

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Sauni R, Uitti J, Jauhiainen M, Kreiss K, Sigsgaard T, Verbeek JH. Remediating buildings damaged by dampness and mould for preventing or reducing respiratory tract symptoms, infections and asthma. Cochrane Database Syst Rev. 2011 Sep 7;(9):CD007897. PMID: 21901714

The authors found moderate to very low-quality evidence that repairing mould-damaged houses and offices decreases asthma-related symptoms and respiratory infections compared to no intervention in adults. They found low-quality evidence that although repairing schools did not significantly change respiratory symptoms in staff or children, pupils’ visits to physicians due to a common cold were less frequent after remediation of the school.

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Mendell MJ, Mirer AG, Cheung K, Tong M, Douwes J. Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence. Environ Health Perspect. 2011 Jun;119(6):748-56. PMID: 21269928

We reviewed eligible peer-reviewed epidemiologic studies or quantitative meta-analyses, up to late 2009, on dampness, mold, or other microbiologic agents and respiratory or allergic effects. Evidence from epidemiologic studies and meta-analyses showed indoor dampness or mold to be associated consistently with increased asthma development and exacerbation, current and ever diagnosis of asthma, dyspnea, wheeze, cough, respiratory infections, bronchitis, allergic rhinitis, eczema, and upper respiratory tract symptoms. Associations were found in allergic and nonallergic individuals. Evidence strongly suggested causation of asthma exacerbation in children.

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Breysse J, Jacobs DE, Weber W, Dixon S, Kawecki C, Aceti S, Lopez J. Health outcomes and green renovation of affordable housing. Public Health Rep. 2011 May-Jun;126 Suppl 1:64-75. PMID: 21563714

We investigated resident health and building performance outcomes at baseline and one year after the rehabilitation of low-income housing using Enterprise Green Communities green specifications, which improve ventilation; reduce moisture, mold, pests, and radon; and use sustainable building products and other healthy housing features. We found significant health improvements following low-income housing renovation that complied with green standards.

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Cai GH, Hashim JH, Hashim Z, Ali F, Bloom E, Larsson L, Lampa E, Norbäck D. Fungal DNA, allergens, mycotoxins and associations with asthmatic symptoms among pupils in schools from Johor Bahru, Malaysia. Pediatr Allergy Immunol. 2011 May;22(3):290-7. PMID: 21457336

Fungal DNA and cat allergen contamination were common in schools from Malaysia and there was a high prevalence of respiratory symptoms among pupils. Moreover, there were associations between levels of some fungal DNA and reported respiratory health in the pupils.

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Park JH, Cox-Ganser JM. Mold exposure and respiratory health in damp indoor environments. Front Biosci (Elite Ed). 2011 Jan 1;3:757-71. PMID: 21196349

Respiratory diseases and symptoms which may be produced by exposure to indoor fungi include asthma development, exacerbation of asthma, hypersensitivity pneumonitis, cough, wheeze, dyspnea (shortness of breath), nasal and throat symptoms, and respiratory infections. In addition to these illnesses, rhinosinusitis and sarcoidosis in water-damaged building occupants are also drawing more scientific attention. In this article, we explore the evidence for adverse effects of fungal exposure on respiratory health in damp indoor environments and potential disease mechanisms related to the exposure.

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Saijo Y, Kanazawa A, Araki A, Morimoto K, Nakayama K, Takigawa T, Tanaka M, Shibata E, Yoshimura T, Chikara H, Kishi R. Relationships between mite allergen levels, mold concentrations, and sick building syndrome symptoms in newly built dwellings in Japan. Indoor Air. 2011 Jun;21(3):253-63. PMID: 21198888

This study investigated the possible relationships between exposures to mite allergen and airborne fungi with sick building syndrome (SBS) symptoms for residents living in newly built dwellings in Japan. Airborne Rhodotorula concentrations were significantly associated with higher rates of any symptoms, and Aspergillus concentrations were significantly associated with higher rates of eye symptoms.

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Rand TG, Dipenta J, Robbins C, Miller JD. Effects of low molecular weight fungal compounds on inflammatory gene transcription and expression in mouse alveolar macrophages. Chem Biol Interact. 2011 Apr 25;190(2-3):139-47. PMID: 21356202

The results not only indicate that low molecular weight compounds from fungi that grow in damp built environments are potently pro-inflammatory in vitro, it further highlights the important role AMs play in innate lung defence, and against exposure to low molecular weight fungal compounds. These observations further support our position that exposure to low molecular weight compounds from indoor-associated fungi may provoke some of the inflammatory health effects reported from humans in damp building environments. They also open up a hypothesis building process that could explain the rise of non-atopic asthma associated with fungi.

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Saijo Y, Nakagi Y, Ito T, Sugioka Y, Endo H, Yoshida T. Dampness, food habits, and sick building syndrome symptoms in elementary school pupils. Environ Health Prev Med. 2010 Sep;15(5):276-84. PMID: 21432556

We investigated dampness/mold in schools and dwellings, and food habits and subjective symptoms in elementary school pupils, in order to clarify the effect of dampness and food habits on subjective symptoms in elementary school pupils. Both home and classroom dampness can affect pupils’ health. Home dampness, in particular, was significantly related to cough and general symptoms, and classroom dampness was significantly related to nasal symptoms.

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Miller JD, Sun M, Gilyan A, Roy J, Rand TG. Inflammation-associated gene transcription and expression in mouse lungs induced by low molecular weight compounds from fungi from the built environment. Chem Biol Interact. 2010 Jan 5;183(1):113-24. PMID: 19818335

In this study, mice were intratracheally instilled with a single dose comprising 4×10(-5)moletoxin/kg lung wt dose of either atranone C, brevianamide, cladosporin, mycophenolic acid, neoechinulin A & B, sterigmatocystin or TMC-120A. These toxins are from fungi common on damp building materials. The dose used was comparable to the estimated doses of possible human exposure. The results confirm the inflammatory nature of metabolites/toxins from such fungi can contribute to the development of non-allergenic respiratory health effects.

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Karvala K, Toskala E, Luukkonen R, Lappalainen S, Uitti J, Nordman H. New-onset adult asthma in relation to damp and moldy workplaces. Int Arch Occup Environ Health. 2010 Dec;83(8):855-65. PMID: 20127354

Exposure to damp and moldy workplaces can induce new-onset adult asthma. IgE mediation is a rare mechanism, whereas other mechanisms are unknown.

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Holme J, Hägerhed-Engman L, Mattsson J, Sundell J, Bornehag CG. Culturable mold in indoor air and its association with moisture-related problems and asthma and allergy among Swedish children. Indoor Air. 2010 Aug;20(4):329-40. PMID: 20557376

In a nested case-control study with 198 children with asthmatic and allergic symptoms (cases) and 202 healthy controls in Värmland, Sweden, this investigation could not find any associations between the spore concentrations in indoor air and signs of dampness and moldy odor reported by parents or observed by professional inspectors. Neither was there any association between the indoor spore concentration and asthma/allergy among children.

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Cox-Ganser JM, Rao CY, Park JH, Schumpert JC, Kreiss K. Asthma and respiratory symptoms in hospital workers related to dampness and biological contaminants. Indoor Air. 2009 Aug;19(4):280-90. PMID: 19500175

Our data imply new-onset of asthma in relation to water damage, and indicate that work-related respiratory symptoms in hospital workers may be associated with diverse biological contaminants.

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Karvonen AM, Hyvärinen A, Roponen M, Hoffmann M, Korppi M, Remes S, von Mutius E, Nevalainen A, Pekkanen J. Confirmed moisture damage at home, respiratory symptoms and atopy in early life: a birth-cohort study. Pediatrics. 2009 Aug;124(2):e329-38. PMID: 19651571

The aim of this study was to evaluate the impact of objectively observed moisture damage and visible mold in the homes on early-life respiratory morbidity and atopic sensitization in a birth cohort. This birth-cohort study supports previous observations that moisture mold problems in the kitchen and in the main living area increase the risk for wheezing in early childhood.

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WHO Guidelines Approved by the Guidelines Review Committee. WHO Guidelines for Indoor Air Quality: Dampness and Mould. Geneva: World Health Organization; 2009. PMID: 23785740

This document provides a comprehensive review of the scientific evidence on health problems associated with building moisture and biological agents. The review concludes that the most important effects are increased prevalences of respiratory symptoms, allergies and asthma as well as perturbation of the immunological system. The most important means for avoiding adverse health effects is the prevention (or minimization) of persistent dampness and microbial growth on interior surfaces and in building structures.

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Hägerhed-Engman L, Sigsgaard T, Samuelson I, Sundell J, Janson S, Bornehag CG. Low home ventilation rate in combination with moldy odor from the building structure increase the risk for allergic symptoms in children. Indoor Air. 2009 Jun;19(3):184-92. PMID: 19298228

In a nested case-control study of 400 Swedish children, observations and measurements were performed in their homes by inspectors, and the children were examined by physicians for diagnoses of asthma, eczema, and rhinitis. In conclusion, we found an association between moldy odor along the skirting board and allergic symptoms among children, mainly rhinitis. Such odor at that specific place can be seen as a proxy for some kind of hidden moisture or mold problem in the building structure, such as the foundation or wooden ground beam.

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Wiszniewska M, Walusiak-Skorupa J, Gutarowska B, Krakowiak A, Pałczyński C. Is the risk of allergic hypersensitivity to fungi increased by indoor exposure to moulds? Int J Occup Med Environ Health. 2009;22(4):343-54. PMID: 20197261

The association between indoor fungal exposure and the development of fungal allergy was not confirmed in our study.

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Allard JB, Rinaldi L, Wargo MJ, Allen G, Akira S, Uematsu S, Poynter ME, Hogan DA, Rincon M, Whittaker LA. Th2 allergic immune response to inhaled fungal antigens is modulated by TLR-4-independent bacterial products. Eur J Immunol. 2009 Mar;39(3):776-88. PMID: 19224641

The authors show that oropharyngeal aspiration of fungal lysates (Candida albicans, Aspergillus fumigatus) promotes airway eosinophilia, secretion of Th2 cytokines and mucus cell metaplasia. In contrast, oropharyngeal exposure to bacterial lysates (Pseudomonas aeruginosa) promotes airway inflammation characterized by neutrophils, Th1 cytokine secretion and no mucus production. More importantly, administration of bacterial lysates together with fungal lysates deviates the adaptive immune response to a Th1 type associated with neutrophilia and diminished mucus production.

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Laney AS, Cragin LA, Blevins LZ, Sumner AD, Cox-Ganser JM, Kreiss K, Moffatt SG, Lohff CJ. Sarcoidosis, asthma, and asthma-like symptoms among occupants of a historically water-damaged office building. Indoor Air. 2009 Feb;19(1):83-90. PMID: 19191928

Our investigation identified a high prevalence of new-onset sarcoidosis, and asthma among workers of a water damaged building with a history of indoor environmental quality complaints. Removal of all individuals from such environments until completion of building diagnostics, environmental sampling and complete remediation is a prudent measure when feasible.

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Park JH, Cox-Ganser JM, Kreiss K, White SK, Rao CY. Hydrophilic fungi and ergosterol associated with respiratory illness in a water-damaged building. Environ Health Perspect. 2008 Jan;116(1):45-50. PMID: 18197298

Our findings extend the 2004 conclusions of the Institute of Medicine [Human health effects associated with damp indoor environments. In: Damp Indoor Spaces and Health. Washington DC:National Academies Press, 183-269] by showing that mold levels in dust were associated with new-onset asthma in this damp indoor environment. Hydrophilic fungi and ergosterol as measures of fungal biomass may have promise as markers of risk of building-related respiratory diseases in damp indoor environments.

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Karvala K, Nordman H, Luukkonen R, Nykyri E, Lappalainen S, Hannu T, Toskala E. Occupational rhinitis in damp and moldy workplaces. Am J Rhinol. 2008 Sep-Oct;22(5):457-62. PMID: 18954502

This is the first clinically investigated series on occupational rhinitis in relation to a moldy environment. Based on our findings, we conclude that molds growing in conjunction with moisture damages can induce occupational rhinitis. Atopy and significant exposure level increased IgE sensitization to molds.

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Mudarri D, Fisk WJ. Public health and economic impact of dampness and mold. Indoor Air. 2007 Jun;17(3):226-35. PMID: 17542835

The public health risk and economic impact of dampness and mold exposures was assessed using current asthma as a health end point. Of the 21.8 million people reported to have asthma in the USA, approximately 4.6 (2.7-6.3) million cases are estimated to be attributable to dampness and mold exposure in the home. By applying the attributable fraction to the updated national annual cost of asthma, the national annual cost of asthma that is attributable to dampness and mold exposure in the home is estimated to be $3.5 billion ($2.1-4.8 billion).

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Fisk WJ, Lei-Gomez Q, Mendell MJ. Meta-analyses of the associations of respiratory health effects with dampness and mold in homes. Indoor Air. 2007 Aug;17(4):284-96. PMID: 17661925

The Institute of Medicine (IOM) of the National Academy of Sciences recently completed a critical review of the scientific literature pertaining to the association of indoor dampness and mold contamination with adverse health effects. Based on the results of the meta-analyses, building dampness and mold are associated with approximately 30-50% increases in a variety of respiratory and asthma-related health outcomes.

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Hope AP, Simon RA. Excess dampness and mold growth in homes: an evidence-based review of the aeroirritant effect and its potential causes. Allergy Asthma Proc. 2007 May-Jun;28(3):262-70. PMID: 17619553

Exposure to fungi produces respiratory disease in humans through both allergic and nonallergic mechanisms. The preponderance of epidemiological data supports a link between exposure to dampness and excess mold growth and the development of aeroirritant symptoms.

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Tham KW, Zuraimi MS, Koh D, Chew FT, Ooi PL. Associations between home dampness and presence of molds with asthma and allergic symptoms among young children in the tropics. Pediatr Allergy Immunol. 2007 Aug;18(5):418-24. PMID: 17617809

Indoor dampness and mold in children’s bedroom are important risk factors associated with allergic symptoms in young children in Singapore.

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Fenoglio CM, Reboux G, Sudre B, Mercier M, Roussel S, Cordier JF, Piarroux R, Dalphin JC. Diagnostic value of serum precipitins to mould antigens in active hypersensitivity pneumonitis. Eur Respir J. 2007 Apr;29(4):706-12. PMID: 17182654

Serum precipitins have a controversial diagnostic value in hypersensitivity pneumonitis (HP). Five antigens from the panel were selected for the serological scores (Absidia corymbifera, Eurotium amstelodami, Wallemia sebi, Saccharopolyspora rectivirgula and mesophilic Streptomyces sp.).Serological scores using a panel of relevant antigens may guide both biological and clinical practice in areas of high prevalence of hypersensitivity pneumonitis.

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Mi YH, Norbäck D, Tao J, Mi YL, Ferm M. Current asthma and respiratory symptoms among pupils in Shanghai, China: influence of building ventilation, nitrogen dioxide, ozone, and formaldehyde in classrooms. Indoor Air. 2006 Dec;16(6):454-64. PMID: 17100666

Asthma symptoms among pupils in Shanghai can be influenced by lack of ventilation and outdoor air pollution from traffic. Building dampness and indoor mold growth should be avoided.

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Park JH, Cox-Ganser J, Rao C, Kreiss K. Fungal and endotoxin measurements in dust associated with respiratory symptoms in a water-damaged office building. Indoor Air. 2006 Jun;16(3):192-203. PMID: 16683938

Using floor dust measures, we found significantly increased odds for lower respiratory symptoms [wheeze, chest tightness, attacks of shortness of breath, and attacks of cough], throat irritation, and rash/itchy skin in the highest fungal exposure group compared to the lowest, with generally linear exposure-response relationships. Nonlinear relationships were observed for many of these symptoms and endotoxin in floor dust. Interaction models showed that endotoxin modified effects of fungi on respiratory symptoms.

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Kovesi T, Creery D, Gilbert NL, Dales R, Fugler D, Thompson B, Randhawa N, Miller JD. Indoor air quality risk factors for severe lower respiratory tract infections in Inuit infants in Baffin Region, Nunavut: a pilot study. Indoor Air. 2006 Aug;16(4):266-75. PMID: 16842607

Inuit infants have extremely high rates of lower respiratory tract infection (LRTI).  Mattress fungal levels were markedly increased, although building fungal concentrations were low. We found reduced air change rates and high occupancy levels in houses in Cape Dorset, which may increase the risk of respiratory infections.

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Orman A, Korcan E, Konuk M, Kurt E, Toprak D, Ay A. Determination of fungal frequency and comparison of allergic symptoms related with buildings and fungi in Afyon, Turkey. Saudi Med J. 2006 Aug;27(8):1146-51. PMID: 16883442

Using simple random sampling, 301 school children aged 16-19 years attending a high school in 2 different school buildings (old and new buildings) in Turkey were recruited and agreed to participate in the study. When the 2 groups were compared, it was observed that there were no statistically significant differences between them in regards with asthma, allergic diseases, building related symptoms, and respiratory symptoms. No significant difference was determined between these 2 buildings in accordance to fungus concentration, although the humidity rate was higher in new buildings.

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Edmondson DA, Nordness ME, Zacharisen MC, Kurup VP, Fink JN. Allergy and “toxic mold syndrome”. Ann Allergy Asthma Immunol. 2005 Feb;94(2):234-9. PMID: 15765738

The study reviewed patients presenting to an allergy and asthma center with the chief complaint of toxic mold exposure. Symptoms were recorded, and physical examinations, skin prick/puncture tests, and intracutaneous tests were performed. Allergic, rather than toxic, responses seemed to be the major cause of symptoms in the studied group.

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Vesper SJ, McKinstry C, Yang C, Haugland RA, Kercsmar CM, Yike I, Schluchter MD, Kirchner HL, Sobolewski J, Allan TM, Dearborn DG. Specific molds associated with asthma in water-damaged homes. J Occup Environ Med. 2006 Aug;48(8):852-8. PMID: 16902378

A relative moldiness index was developed to predict the likely development of asthma in water-damaged homes in Cleveland. The mold concentrations in the dust in asthmatic children’s bedrooms in water-damaged homes (N = 60) and control homes (N = 22) were measured by mold-specific quantitative polymerase chain reaction. Two molds, Scopulariopsis brevicaulis and Trichoderma viride, had significantly (P < 0.05) higher concentrations in asthmatics’ homes compared with control homes and three other molds (Penicillium crustosum group, Stachybotrys chartarum, and Wallemia sebi) had P values <0.1.

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Berghout J, Miller JD, Mazerolle R, O’Neill L, Wakelin C, Mackinnon B, Maybee K, Augustine D, Levi CA, Levi C, Levi T, Milliea B. Indoor environmental quality in homes of asthmatic children on the Elsipogtog Reserve (NB), Canada. Int J Circumpolar Health. 2005 Feb;64(1):77-85. PMID: 15776995

This study analyzed settled dust from 26 homes with asthmatic children in the Elsipogtog Reserve, New Brunswick, for contaminants known to be associated with respiratory symptoms. The percentage of homes in this study that had mould damage was slightly higher than in much larger studies in other parts of Canada. Although the range of mould damage observed in this study was similar to that seen elsewhere in Canada, the underlying causes tended to reflect more serious maintenance problems.

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Jaakkola JJ, Hwang BF, Jaakkola N. Home dampness and molds, parental atopy, and asthma in childhood: a six-year population-based cohort study. Environ Health Perspect. 2005 Mar;113(3):357-61. PMID: 15743728

We assessed longitudinally the independent and joint effects of parental atopy and exposure to molds in dwellings on the development of asthma in childhood. The results of this cohort study with assessment of exposure before the onset of asthma strengthen the evidence on the independent effects of parental atopy and exposure to molds on the development of asthma.

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Newman LS, Rose CS, Bresnitz EA, Rossman MD, Barnard J, Frederick M, Terrin ML, Weinberger SE, Moller DR, McLennan G, Hunninghake G, DePalo L, Baughman RP, Iannuzzi MC, Judson MA, Knatterud GL, Thompson BW, Teirstein AS, Yeager H Jr, Johns CJ, Rabin DL, Rybicki BA, Cherniack R; ACCESS Research Group. A case control etiologic study of sarcoidosis: environmental and occupational risk factors. Am J Respir Crit Care Med. 2004 Dec 15;170(12):1324-30. PMID: 15347561

We conducted a case control study to test a priori hypotheses that environmental and occupational exposures are associated with sarcoidosis. We identified several exposures associated with sarcoidosis risk, including insecticides, agricultural employment, and microbial bioaerosols.

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Bornehag CG, Sundell J, Sigsgaard T. Dampness in buildings and health (DBH): Report from an ongoing epidemiological investigation on the association between indoor environmental factors and health effects among children in Sweden. Indoor Air. 2004;14 Suppl 7:59-66. PMID: 15330773

With the aim of identifying health-relevant exposures in buildings, an epidemiological study “Dampness in Buildings and Health” (DBH) started in the year 2000 in Sweden. The health focus of the study is on asthma and allergic symptoms among small children and their parents. Self-reported moisture-related problems in the building were strongly associated with asthma, allergic symptoms, and airway infections among children and adults.

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Park JH, Schleiff PL, Attfield MD, Cox-Ganser JM, Kreiss K. Building-related respiratory symptoms can be predicted with semi-quantitative indices of exposure to dampness and mold. Indoor Air. 2004 Dec;14(6):425-33. PMID: 15500636

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 found that conditions suggestive of indoor mold exposure at work were associated with building-related respiratory symptoms.

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Hynes, H.P., Brugge, D., Osgood, N.D. et al. Investigations into the indoor environment and respiratory health in Boston public housing. Rev Environ Health. 2004; 19: 271–289. PMID: 15742674

The self-reported prevalence of asthma in the United States increased by 75% from 1980 to 1994, a trend found to be significant and evident in every region of the country. Attention has turned to the role of indoor environmental risk factors, especially in homes and schools. Such factors include moisture and mold growth, pest infestation, dust mites, the building envelope, heating systems, inadequate ventilation, nitrogen dioxide, and environmental tobacco smoke. This article summarizes the significant research findings from four pilot studies in housing developments that laid the foundation for the larger HPHI asthma-related environmental intervention study.

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Spengler JD, Jaakkola JJ, Parise H, Katsnelson BA, Privalova LI, Kosheleva AA. Housing characteristics and children’s respiratory health in the Russian Federation.  Am J Public Health. 2004 Apr;94(4):657-62. PMID: 15054021

The authors studied the respiratory health of a population of 5,951 children from 9 Russian cities. Respiratory allergy and dry cough increased in association with the home being adjacent to traffic. Consistent positive associations were observed between some health conditions and maternal smoking during pregnancy, many health conditions and lifetime exposure to environmental tobacco smoke (ETS), and nearly all health conditions and water damage and molds in the home.

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Hynes HP, Brugge D, Osgood ND, Snell J, Vallarino J, Spengler J. “Where does the damp come from?” Investigations into the indoor environment and respiratory health in Boston public housing. J Public Health Policy. 2003;24(3-4):401-26. PMID: 15015872

This article summarizes the significant research findings from four pilot studies in housing developments that lay the foundation for the larger HPHI asthma-related environmental intervention study.

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Belanger, K., Beckett, W., Triche, E. et al. Symptoms of wheeze and persistent cough in the first year of life: associations with indoor allergens, air contaminants, and maternal history of asthma. Am J Epidemiol. 2003; 158: 195–202. PMID: 12882940

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). Persistent mold affected both infants of mothers with asthma and infants of mothers without asthma Reported exposure was confirmed by an association of measured fungi with wheeze.

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Brugge D, Vallarino J, Ascolillo L, Osgood ND, Steinbach S, Spengler J. Comparison of multiple environmental factors for asthmatic children in public housing. Indoor Air. 2003 Mar;13(1):18-27. PMID: 12608922

Nine families of a public housing development in Boston were enrolled in a pilot asthma intervention program designed to gather dense environmental data and generate hypotheses about the relative importance of different contaminants and the viability of interventions. We hypothesize that our findings are consistent with a multifactorial model for exacerbation of asthma in this population and that no single problem dominates.

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Gunnbjörnsdottir MI, Norbäck D, Plaschke P, Norrman E, Björnsson E, Janson C. The relationship between indicators of building dampness and respiratory health in young Swedish adults. Respir Med. 2003 Apr;97(4):302-7. PMID: 12693790

In this study we investigated the relationship between building dampness and respiratory symptoms in young Swedish adults.

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Gent, J.F., Ren, P., Belanger, K. et al. Levels of household mold associated with respiratory symptoms in the first year of life in a cohort at risk for asthma. Environ Health Perspect. 2002; 110: A781–A786. PMID: 12460818

The study 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. The authors conclude that infants in this high-risk group who are exposed to high levels of Penicillium are at significant risk for wheeze and persistent cough.

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Jussila J, Komulainen H, Kosma VM, Nevalainen A, Pelkonen J, Hirvonen MR. Spores of Aspergillus versicolor isolated from indoor air of a moisture-damaged building provoke acute inflammation in mouse lungs. Inhal Toxicol. 2002 Dec;14(12):1261-77. PMID: 12454790

Microbial growth in moisture-damaged buildings has been associated with respiratory health effects, and the spores of the mycotoxin producing fungus Aspergillus versicolor are frequently present in the indoor air. The spores of A. versicolor caused acute inflammation in mouse lungs. This indicates that they have potential to provoke adverse health effects in the occupants of moisture-damaged buildings.

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Zock, J.P., Jarvis, D., Luczynska, C. et al. Housing characteristics, reported mold exposure, and asthma in the European Community Respiratory Health Survey. J Allergy Clin Immunol. 2002; 110: 285–292. PMID: 12170270

The researchers investigated the associations between housing characteristics related to dampness, mold exposure, and house dust mite levels and adult asthma in 38 study centers from the European Community Respiratory Health Survey. Reported moldexposure in the last year was associated with asthma symptoms and bronchial responsiveness. In centers with a higher prevalence of asthma, the prevalence of reported indoor mold exposure was also high. This association was observed for reported mold exposure by asthmatic subjects, as well as reported mold exposure by nonasthmatic subjects. The authors concluded that indoor mold growth has an adverse effect on adult asthma.

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Trout D, Bernstein J, Martinez K, Biagini R, Wallingford K. Bioaerosol lung damage in a worker with repeated exposure to fungi in a water-damaged building. Environ Health Perspect. 2001 Jun;109(6):641-4. PMID: 11445520

We report the case of a worker with a respiratory illness related to bioaerosol exposure in a water-damaged building with extensive fungal contamination.

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Taskinen, T., Hyvarinen, A., Meklin, T. et al. Asthma and respiratory infections in school children with special reference to moisture and mold problems in the school. Acta Paediatr. 1999; 88: 1373–1379. PMID: 10626525

The authors found evidence of an association between moisture or mold problems in the school building and the occurrence of respiratory infections, repeated wheezing and prolonged cough in school children.

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Jedrychowski, W. and Flak, E. Separate and combined effects of the outdoor and indoor air quality on chronic respiratory symptoms adjusted for allergy among preadolescent children. Int J Occup Med Environ Health19981119–35. PMID: 9637993

The survey targeted 1,129 school children, nine years of age, attending schools in Cracow, located in the areas with different levels of the outdoor air pollution. After adjustment for air pollution and allergy, the presence of molds or dampness in the house was significantly related to hay fever (OR = 2.1, 95% CI: 1.5-3.0), wheezing (OR = 1.6, 95% CI: 1.1-2.5), and difficulty in breathing (OR = 2.0, 95% CI: 1.2-3.3). The impact of allergy on the occurrence of respiratory symptoms (two or more respiratory symptoms) was stronger (AF(pop) = 52.1%) than that of the outdoor air pollution level (AF(pop) = 21.6%) or that of molds/dampness at home (AF(pop) = 14.1%).

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Peat, J.K., Dickerson, J., and Li, J. Effects of damp and mould in the home on respiratory health: a review of the literature. Allergy. 1998; 53: 120–128. PMID: 9534909

This review examines whether there is a direct or indirect relation between damp or mould in the home and respiratory health. The increased risk of children having symptoms of cough and wheeze if the home has damp or mould is fairly small with an odds ratio that is generally in the range 1.5-3.5. This range is consistent with the measured effects of other environmental exposures which are considered important to health, such as environmental tobacco smoke or outdoor air pollutants.

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Perzanowski, M.S., Sporik, R., Squillace, S.P. et al. Association of sensitization to Alternaria allergens with asthma among school-age children. J Allergy Clin Immunol. 1998; 101: 626–632. PMID: 9600499

Molds in the Alternaria genus, normally found on outdoor vegetation, produce some of the most common fungal allergens to elicit a skin test response. Although not as important as sensitization to dominant local indoor allergens, sensitization to Alternaria allergens appears to be a significant independent risk factor for asthma in children in some locations of the United States.

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American Academy of Pediatrics, Committee on Environmental Health. Toxic effects of indoor molds. Pediatrics. 1998;101:712–714. 4. PMID: 9521963

This statement describes molds, their toxic properties, and their potential for causing toxic respiratory problems in infants. Guidelines for pediatricians are given to help reduce exposures to mold in homes of infants.

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Montana, E., Etzel, R.A., Allan, T. et al. Environmental risk factors associated with pediatric idiopathic pulmonary hemorrhage and hemosiderosis in a Cleveland community. Pediatrics. 1997; 99: E5. PMID: 9096173

Unexplained pulmonary hemorrhage and hemosiderosis are rarely seen in infancy. A geographic cluster of 10 infants with this illness was identified in a large pediatric referral hospital in Cleveland, Ohio, during the period of January 1993 through December 1994. One infant died of severe respiratory failure. The results of this investigation of a cluster of infants with massive, acute pulmonary hemorrhage and hemosiderosis suggest that the affected infants may have been exposed to contaminants in their homes. Epidemiologic clues, such as water damage in the case infants’ homes, suggest that environmental risk factors may contribute to pulmonary hemorrhage.

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Husman T. Health effects of indoor-air microorganisms. Scand J Work Environ Health. 1996 Feb;22(1):5-13. PMID: 8685674

The review provides a summary and discussion of current data on exposure to indoor-air microorganisms and their health effects, for example, respiratory irritation and nonspecific symptoms, respiratory infections, asthma and allergy, alveolitis and organic dust toxic syndrome, and chronic bronchitis, as well as a summary and discussion of the health effects of mycotoxins.

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Spengler J, Neas LM, Nakai C, et al. Respiratory symptoms and housing characteristics. Indoor Air. 1994; 4:72–82.

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Institute of Medicine (US) Committee on the Health Effects of Indoor Allergens; Pope AM, Patterson R, Burge H, editors. Indoor Allergens: Assessing and Controlling Adverse Health Effects. Washington (DC): National Academies Press (US); 1993. PMID: 25144066

Developed by medical, public health, and engineering professionals working together, this unique volume summarizes what is known about indoor allergens, how they affect human health, the magnitude of their effect on various populations, and how they can be controlled. The volume discusses sources of allergens, from fungi and dust mites to allergenic chemicals, plants, and animals, and examines practical measures for their control.

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Dales, R.E., Burnett, R., and Zwanenburg, H. Adverse health effects among adults exposed to home dampness and molds. Am Rev Respir Dis. 1991; 143: 505–509. PMID: 2001058

To investigate the association between home dampness and mold and health, questionnaires were administered through the primary school system to parents of school-aged children in six regions of Canada. The presence of home dampness and/or molds (that is, damp spots, visible mold or mildew, water damage, and flooding) was reported by 38% of respondents. The prevalence of lower respiratory symptoms (any cough, phlegm, wheeze, or wheeze with dyspnea) was increased among those reporting dampness or mold compared with those not reporting dampness or mold as follows: 38 versus 27% among current smokers, 21 versus 14% among ex-smokers, and 19 versus 11% among nonsmokers (all p values less than 0.001). The researchers concluded that exposure to home dampness and mold may be a risk factor for respiratory disease in the Canadian population.

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Brunekreef, B., Dockery, D.W., Speizer, F.E. et al. Home dampness and respiratory morbidity in children. Am Rev Respir Dis. 1989; 140: 1363–1367. PMID: 2817598

This study examined the relationship between measures of home dampness and respiratory illness and symptoms in a cohort of 4,625 eight- to 12-yr-old children living in six U.S. cities. Home dampness was characterized from questionnaire reports of mold or mildew inside the home, water damage to the home, and the occurrence of water on the basement floor. Symptoms of respiratory and other illness were collected by questionnaire. Pulmonary function was measured by spirometry. Signs of home dampness were reported in a large proportion of the homes. In five of the six cities, one or more of the dampness indicators were reported in more than 50% of the homes. The association between measures of home dampness and both respiratory symptoms and other non-chest illness was both strong and consistent.

 

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