The Roles of Autoimmunity and Biotoxicosis in Sick Building Syndrome as a "Starting Point" for Irreversible Dampness and Mold Hypersensitivity Syndrome

AWMF mold guideline "Medical clinical diagnostics for indoor mold exposure" - Update 2023 AWMF Register No. 161/001

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Moisture damage and fungal contamination in buildings are a massive health threat - a surgeon's perspective

OBJECTIVES

Indoor air toxicity is of major public health concern due to the increase in humidity-induced indoor mould exposure and associated health changes. The objective is to present evidence for the causality of health threats and indoor mould exposure.

METHODS

PubMed search on the following keywords: dampness, mould, indoor air quality, public health, dampness, and mould hypersensitivity syndrome, sick building syndrome, and building-related illness as well as information from the health authorities of Bavaria and North Rhine-Westphalia, the Center of Disease Control (CDC), World Health Organisation (WHO), and guidelines of professional societies.

RESULTS

The guidelines of professional societies published in 2017 are decisive for the assessment of the impact of mould pollution caused by moisture damage on human health and for official regulations in Germany. Until 2017, a causal connection between moisture damage and mould exposure could usually only be established for pulmonary diseases. The health risk of fungal components is apparent as documented in the fungal priority pathogens list (FPPL) of the WHO. Since 2017, studies, especially in Scandinavia, have proved causality between moisture and mould exposure not only for pulmonary diseases but also for extrapulmonary diseases and symptoms. This was made possible by new test methods for determining the toxicity of fungal components in indoor air. Environmental medical syndromes, e.g., dampness and mould hypersensitivity syndrome (DMHS), sick building syndrome (SBS), building-related symptoms (BRS), and building-related illness (BRI), and fungal pathogens, e.g., Aspergillus fumigatus, pose a major threat to public health.

CONCLUSION

There is evidence for the causality of moisture-induced indoor moulds and severe health threats in these buildings. According to these findings, it is no longer justifiable to ignore or trivialize the mould contamination induced by moisture damage and its effects on pulmonary and extrapulmonary diseases. The health and economic implications of these attitudes are clear.

Prevalence, Risk Factors and Impacts Related to Mould-Affected Housing: An Australian Integrative Review

In response to an Australian governmental inquiry into biotoxin-related illness, the purpose of this integrative review is to bring together the current state of evidence on the prevalence, risk factors and impacts related to mould-affected housing in an Australian context, in order to inform building, housing and health research, practice and policy. The robust integrative review methodology simultaneously sought quantitative and qualitative studies and grey literature from multiple disciplines, identifying only 45 studies directly relating to Australian housing and indoor mould. Twenty-one studies highlight negative health impacts relating to indoor residential mould, with asthma, respiratory, allergy conditions and emerging health concerns for chronic multiple-symptom presentation. The majority of studies reported risk factors for indoor mould including poor housing conditions, poor-quality rental accommodation, socioeconomic circumstance, age-related housing issues and concerns for surface/interstitial condensation and building defects in newer housing. Risks for indoor mould in both older and newer housing raise concerns for the extent of the problem of indoor mould in Australia. Understanding the national prevalence of housing risks and “root cause” associated with indoor mould is not conclusive from the limited existing evidence. Synthesis of this evidence reveals a lack of coverage on: (1) national and geographical representation, (2) climatical coverage, (3) housing typologies, (4) housing defects, (5) maintenance, (6) impact from urbanisation, and (7) occupant’s behaviour. This integrative review was key in identifying emerging housing and health concerns, highlighting gaps in data and implications to be addressed by researchers, practice and policy and acts as a comprehensive holistic review process that can be applied to other countries.

Toxic Indoor Air Is a Potential Risk of Causing Immuno Suppression and Morbidity—A Pilot Study

We aimed to establish an etiology-based connection between the symptoms experienced by the occupants of a workplace and the presence in the building of toxic dampness microbiota. The occupants (5/6) underwent a medical examination and urine samples (2/6) were analyzed by LC-MS/MS for mycotoxins at two time-points. The magnitude of inhaled water was estimated. Building-derived bacteria and fungi were identified and assessed for toxicity. Separate cytotoxicity tests using human THP-1 macrophages were performed from the office’s indoor air water condensates. Office-derived indoor water samples (n = 4/4) were toxic to human THP-1 macrophages. Penicillium, Acremonium sensu lato, Aspergillus ochraceus group and Aspergillus section Aspergillus grew from the building material samples. These colonies were toxic in boar sperm tests (n = 11/32); four were toxic to BHK-21 cells. Mycophenolic acid, which is a potential immunosuppressant, was detected in the initial and follow-up urine samples of (2/2) office workers who did not take immunosuppressive drugs. Their urinary mycotoxin profiles differed from household and unrelated controls. Our study suggests that the presence of mycotoxins in indoor air is linked to the morbidity of the occupants. The cytotoxicity test of the indoor air condensate is a promising tool for risk assessment in moisture-damaged buildings.

Multiple Chemical Sensitivity

Multiple Chemical Sensitivity (MCS), a condition also known as Chemical Sensitivity (CS), Chemical Intolerance (CI), Idiopathic Environmental Illness (IEI) and Toxicant Induced Loss of Tolerance (TILT), is an acquired multifactorial syndrome characterized by a recurrent set of debilitating symptoms. The symptoms of this controversial disorder are reported to be induced by environmental chemicals at doses far below those usually harmful to most persons. They involve a large spectrum of organ systems and typically disappear when the environmental chemicals are removed. However, no clear link has emerged among self-reported MCS symptoms and widely accepted objective measures of physiological dysfunction, and no clear dose-response relationship between exposure and symptom reactions has been observed. In addition, the underlying etiology and pathogenic processes of the disorder remain unknown and disputed, although biologic and psychologic hypotheses abound. It is currently debated whether MCS should be considered a clinical entity at all. Nevertheless, in the last few decades MCS has received considerable scientific and governmental attention in light of the many persons reporting this illness. In this review, we provide a general overview of the history, definition, demographics, prevalence, and etiologic challenges in defining and understanding MCS.