Mold Related Illness
High levels of mold exposure can cause widespread negative health effects such as asthma, sinusitis, fatigue, headaches, gastrointestinal symptoms, itchy unusual rashes and “brain fog” among others. These symptoms are caused by both allergy to mold and reactions to mycotoxins. Mycotoxins are byproducts of mold metabolism and known to be neurotoxic, immunotoxic and inflammatory, which can either upregulate or downregulate immune system function.
Mold problems can occur in the home, workplace or school due to water intrusion from a leaky roof, washing machine, dishwasher, water tank, wet crawlspaces and excessive levels of humidity. The first step for mold exposed patients is to get away from the area of mold contamination. Remediation of a mold contaminated environment can be quite challenging and should not be undertaken lightly, especially if someone is already having symptoms caused by mold. Bleach should not be used to clean surfaces, but rather HEPA vacuum and Borax.
If the damage is even close to moderately severe it is best to call in a professional firm experienced in mold remediation. Frequently belongings such as furniture, books, and mattresses cannot be sufficiently “demolded” and have to be abandoned or risk contaminating a safe environment. Extensive remediation can be successful, but at times the damage is too much to deal with and it's best to just move on to a safer, dryer place.
The goal of remediation or moving to a new location is to have the home as mold free as possible. Probably the most cost effective and reliable method of testing would be the Environmental Relative Moldiness Index (ERMI). ERMI testing was developed by the EPA and is based on PCR DNA technology, which is used to measure mycotoxins in dust samples. Submitting dust samples from the home is simple, straightforward and reliable. Ideally the score should be less than 2 before assuming that the environment is safe enough to live in. Various laboratories are able to carry these tests out. Real-Time Laboratories-855-692-6767. Mycometrics-732-355-9018 are two of them.
Mold exposed patients often become colonized. Colonization generally only involves the superficial tissues that line the body; which is the skin and mucosal system. The mucosal system includes the nose, sinuses, throat, bronchial tree, esophagus, stomach and intestinal tract. Rarely does mold invade the organs, which only occurs in someone who is severely immunocompromised, such as patients with AIDS or those going through chemotherapy for metastatic cancer.
Mold and mycotoxins trigger activate eosinophils and other immune cells in the nose and sinuses. These cells induce inflammatory responses causing localized symptoms such as congestion, headaches, postnasal drip, as well as, systemic symptoms such as fatigue, pain and brain fog. Invariably these exposures result in becoming hypersensitive to mold. This hypersensitivity spreads to other allergens, such as dust mites, pollens, foods and chemicals. Avoidance of excessive levels mold will probably be necessary for lifetime because of the likelihood of developing allergy to mold.
Diagnosing Mold Related Illness
Typically the history of the patient's illness coincides with mold exposure after water damage of some sort. More often than not patients suspect they have been feeling sick because of mold. On the other hand, many patients are totally unaware that mold has been the cause of their health problems until a physician or someone else brings this possibility to light. That being said, mold-induced illness is generally not recognized by most physicians, but they are readily diagnosed by physicians, who have been trained in environmental medicine.
Urinary mycotoxin testing can assess the degree of exposure and what types of fungus the patient has been exposed to. Mycotoxins can also be tested from nasal and sinus swabs and/or lavage.
Sinus cultures for fungus are notoriously unreliable in the usual clinical setting. Only research facilities have the specific techniques to collect, transfer and process nasal and sinus specimens that can effectively culture and identify various types of fungi. Stool cultures are often done to see if there has been colonization of the intestinal tract, but these are not consistently reliable.
Antibody testing using blood tests can determine whether or not the person has allergy to mold, but doesn't necessarily mean recent exposure. Skin testing is usually done, not only to assess degree of allergy to mold, but also to determine the proper dose to begin desensitization, which most patients need.
Typical Treatment Program
The basic therapeutic program involves:
- Eliminating the source of mold exposure
- Detoxifying mycotoxins
- Treating mold colonization-using antifungal medication
- Immunotherapy-allergy desensitization
- Improving immune function
- Eventually restoration of healthy mitochondrial function.
Patients will experience increased symptoms during the treatment process, i.e. they will feel worse before they get better.
- Liposomal Glutathione-to remove mycotoxins from the cell
- Liver Support-to detoxify mycotoxins through the liver using nutrients such as Mediclear, Sulforophane glucosinolate.
- Mycotoxin Binding Agents-bind to mycotoxins for removal from the intestinal tract using agents such as cholestyramine, bentonite and charcoal.
- External Enhanced Counterpulsation (EECP) and Oxygen Therapy-stimulates liver, kidney and lymphatic circulation, as well as, cellular detoxification of mycotoxins. Mycotoxins damage the endothelium, the inner lining of the blood vessels leading to impaired blood flow in the vascular beds. EECP improves endothelial function, microcirculation, blood flow and oxygen delivery to all tissues and cells.
- Nasal or nebulized antifungal drugs- amphotericin, itraconazole, fluconazole, nystatin or voriconazole. Usually these are given with something to break up biofilm and sometimes with an antibacterial medication.
- Oral antifungals are generally recommended. This includes amphotericin, itraconazole, nystatin or voriconazole and sometimes ketoconazole or terbinafine. Both amphotericin and nystatin are very poorly absorbed and safely used. Itraconazole, ketoconazole, fluconazole and terbinafine are well absorbed and have systemic effects and reported to possibly cause liver dysfunction. I have rarely if ever seen any evidence of liver damage using these medications. That being said I rarely prescribe ketoconazole anymore
Most patients who have been overly exposed to mold usually become allergic to mold and other allergens such as dust mites, pollens and sometimes foods. They become hypersensitive to normal levels of mold that never previously bothered them and frequently develop chemical sensitivities reacting to fragrances, detergents, fabric softeners, etc. Allergy testing and desensitization to mold is generally recommended. Sublingual desensitization immunotherapy is preferred to injections since it is most often the mucosal immunity that has become sensitized.
Counseling - from a specially trained medical marriage and family therapist familiar with environmentally induced medical conditions. The effects of the resulting health problems, disrupted home environment, loss of home and belongings can have a devastating effect on patients and their families mentally, socially and spiritually. Counseling can support and nurture patients as they go through this difficult time in their lives.