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A scientific overview on mold exposure

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. Currently, unanimously accepted laboratory tests are not yet available. Therefore, the diagnosis of DMHS is clinical and is based on the patient’s history and careful examination. In this publication, I reviewed contemporary knowledge on clinical presentations, laboratory methods, and clinical assessment of DMHS. From the literature, I have not found any proposed diagnostic clinical criteria. Therefore, 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. If all the five criteria are met, the patient has a very probable DMHS. To resolve the current problems in assigning correct DMHS diagnosis, we also need novel assays to estimate potential risks of developing DMHS.

In the start of the exposure the patient may experience recurrent sinusitis or bronchitis and neurological manifestations, such as headaches, nausea, and unexplained fatigue.

This further develops into rheumatic symptoms resembling fibromyalgia or neurological symptoms may progress into pains and/or numbness in the legs and arms and the so-called brain fog (). Also asthma-like conditions, such as dyspnea, burning sensation in the respiratory tract, and productive or non-productive cough may appear.

This condition begins with symptoms of irritation in eyes, nose, and respiratory tract. The eyes are itchy and reddened, the nose is blocked, sneezing, and cough are common symptoms at the beginning.

In the early phase, the symptoms may disappear totally when the individual avoids staying in the building for 1 or 2 days but the time period for total recovery seems to become prolonged with each new exposure until, finally, the symptoms become irreversible even though the patient no longer visits the water-damaged building.

A lot of related conditions such as irritation to recurrent infections, such as tonsillitis, reactivations of herpes simplex virus (HSV1 and HSV2), recurrent urinary tract, skin infections, etc. Patients may also experience also episodes of mild, prolonged fever and fatigue and some  develop the so-called chronic fatigue syndrome (), brain fog and fibromyalgia.  Peripheral neurological manifestations, such as transient pains and numbness in the legs and/or arms are also reported.

The diagnosis is hard since IgE-mediated sensitization and skin prick positivity for molds are rare (), however some patients present elevated levels. Genetic differences in cytochrome P450 enzymes activities or glutathione S-transferase might be responsible for an individual’s vulnerability to disease ().

Mycotoxins such as gliotoxin can inhibit the activity of antigen-presenting cells and limit the amount and functions of monocytes and simply kill immune cells and, thus, disarm the body’s immune response ().

Furthermore, decreased immunoglobulin production may be observed in some of heavily exposed individuals.

Treatment

  • Empirically recommended: Low carb but there is no scientific base for that.
  • Avoid exposure to molds.
    Many DMHS patients consume large amounts of l-cysteine amino acid or N-acetylcysteine and they report that they may feel better mainly regarding brain fog.
  • Antioxidants; heat depuration (sauna); physical therapy with massage and exercise under environmentally controlled conditions; oxygen therapy (11).
  • Antioxidant support, systemic, nebulized and intranasal glutathione, probiotics, nutritional support, and the correction of persistent fungal infections or symptomatic colonization. Also, the use of sauna and exercise can be invaluable in helping to restore the health of those injured from their exposure (12).

References:

Article based on: Valtonen V. Clinical Diagnosis of the Dampness and Mold Hypersensitivity Syndrome: Review of the Literature and Suggested Diagnostic Criteria. Frontiers in Immunology. 2017;8:951. doi:10.3389/fimmu.2017.00951.

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