Friday, August 24, 2007

Allergy / Asthma Related to Mold?

I often have clients that relay to me that they or their children have asthma. I also had a client that worked in a maintenance department that complained of "asthma like symptoms". His desk was in the basement of a building that was infected with mold. Often we hear of complaints of allergy symptoms from our clients. Often these same clients will report their allergy symptoms diminishing or completely going away. This should not be a surprise since molds are directly related to pulmonary illnesses.

Last year I received a call from a gentleman in Boston that had sewage backup into his basement. The sewage level was almost 1ft. high. He also stated that his young son had developed asthma over the past year. Is it related to the sewage problem? Let me break it down for you.

The sewage flood happened a few years prior to his call to me, and he complained his basement now smelled musty. He had a nice finished basement, complete with a bar and big screen tv. He had a raised wooden floor in the basement laid over wooden 2x4's. Which means he had a perfect breeding ground for mold under that floor. Upon visual inspection, we noticed mold on different materials in different areas of the basement including a bathroom. Our lab tests confirmed the presence of Stachybotrys (black mold) and another strain. It didn't surprise us that he had Stachy, since the flooding was sewage related and the fact it stayed wet for an extented amount of time.

What is the basic definition of asthma?

Asthma is a chronic disease that affects your airways, which are the tubes that carry air in and out of your lungs.

Here is an interesting article published by the CDC. (condensed)

Health Concerns Associated with Mold in Water-Damaged Homes After Hurricanes Katrina and Rita --- New Orleans Area, Louisiana, October 2005
After Hurricanes Katrina and Rita made landfall on August 29 and September 24, 2005, respectively, large sections of New Orleans (Orleans Parish) and the three surrounding parishes (Jefferson, Plaquemines, and St. Bernard) were flooded for weeks, leading to extensive mold growth in buildings. As residents reoccupied the city, local health-care providers and public health authorities were concerned about the potential for respiratory health effects from exposure to water-damaged homes. On October 6, CDC was invited by the Louisiana Department of Health and Hospitals (LDHH) to assist in documenting the extent of potential exposures. This report summarizes the results of that investigation, which determined that 46% of inspected homes had visible mold growth and that residents and remediation workers did not consistently use appropriate respiratory protection. Public health interventions should emphasize the importance of safe remediation practices and ensure the availability of recommended personal protective equipment.

Of 112 homes inspected (Table), flood levels had been high (>6 feet) in 21 (18.8%) homes, medium (3--6 feet) in 19 (17.0%), and low (<3>50% coverage on interior wall of most-affected room). The distribution of homes with heavy mold coverage was 10 (52.6%), seven (36.8%), and two (10.5%) in high, medium, and low flood areas, respectively.
Participants reported being indoors doing heavy cleaning an average of 13 hours since the hurricanes (range: 0--84 hours) and 15 hours doing light cleaning (range: 0--90 hours). Sixty-eight (60.7%) participants reported inhabiting their homes overnight for an average of 25 (standard deviation: +13.7) nights since the hurricanes.
Indoor air samples were collected nonrandomly at 20 (16%) homes; outdoor air samples were also collected for 11 of these homes. Predominant fungi indoors and outdoors were Aspergillus spp. and Penicillium spp. Geometric mean (1®3,1®6)-b-D-glucan air levels were 1.6 µg/m3 (geometric standard deviation [GSD]: 4.4) indoors and 0.9 µg/m3 (GSD: 2.0) outdoors; endotoxin levels were 23.3 EU/m3 (GSD: 5.6) indoors and 10.5 EU/m3 (GSD: 2.5) outdoors. Glucan and endotoxin levels were significantly correlated (correlation coefficient r = 0.56; p = 0.0095). The geometric mean glucan and endotoxin levels were higher indoors compared with outdoors but the differences were not statistically significant.

In 2004, the Institute of Medicine (IOM) reviewed the literature regarding health outcomes related to damp indoor spaces (4). In addition to the risk for opportunistic fungal infections in immunocompromised persons, IOM found sufficient evidence for an association between both damp indoor spaces and mold and upper respiratory symptoms (nasal congestion and throat irritation) and lower respiratory symptoms (cough, wheeze, and exacerbation of asthma). The findings of this report indicate that, in the New Orleans area post-hurricane, indoor environmental conditions and personal practices provided exposures that potentially put residents and remediation workers at risk for these negative health effects.
This study used markers that have been used in exposure assessments in water-damaged buildings, including cultured fungi and microbial structural components (bacterial endotoxins and fungal glucans). Interpreting the significance of these measures is not straightforward, and health-based indoor exposure limits for these compounds have not been established (4,5). Previous measurements of airborne endotoxin in homes have averaged <1.0 EU/m3, with indoor levels generally lower than outdoor ones (6). In post-hurricane New Orleans homes, mean indoor endotoxin levels were more than 20 times higher than the 1.0 EU/m3 average, with an inversion of the expected indoor-outdoor relationship. This mean level exceeds that associated with respiratory symptoms in one study (7). In five New Orleans homes, the measured indoor endotoxin levels were comparable to those of certain industrial settings in which declines in pulmonary function have been demonstrated (8). Exposure to (1®3)-b-D-glucan, a cell-wall component not specific to fungi, has also been linked to respiratory health effects in certain studies (5). In this assessment, a newer assay for (1®3,1®6)-b-D-glucan (2), a different glucan with higher specificity for fungi, yielded higher indoor than outdoor levels in New Orleans homes. Although differences in the two glucan assays preclude direct comparisons, the findings of this assessment indicated that mold growth inside homes was likely at or above a level sometimes reported to be associated with certain health effects (e.g., cough; airway hyper-reactivity; influenza-like symptoms; ear, nose, and throat irritation; decreased lung function; and skin rash) (5).
As you know I don't like this blog full of medical terms, however I felt it was important to have this article, based on the merits of the professionals involved. It's important you know the facts.

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