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Clinical Reviews in Allergy & Immunology

, Volume 57, Issue 3, pp 449–455 | Cite as

The Myth of Mycotoxins and Mold Injury

  • Christopher ChangEmail author
  • M. Eric GershwinEmail author
Article

Abstract

In recent years, mold has been blamed for many symptoms or a constellation of symptoms. These symptoms are usually vague and subjective and difficult or impossible to measure or quantify. Moreover, there is no scientific evidence that mold has anything to do with these symptoms. In particular, the concept of toxic mold syndrome has permeated the public consciousness, and mycotoxins have falsely been associated with autoimmune diseases and a variety of other conditions. In fact, there is no evidence that the presence of mycotoxins in the air is enough to cause any disease known to man. Molds legitimately can cause allergies and can be a trigger for asthma. Certain specific molds such as Aspergillus can be a cause of hypersensitivity pneumonitis. In immunocompromised hosts, both dermatologic and systemic infections can result from various fungi and can be associated with significant morbidity or even mortality. However, the existence of toxic mold syndrome has been disproven, despite the numerous disreputable practices such as testing homes for mold spores, measuring “mycotoxins” in the urine, and testing patients for IgG to mold. In truth, none of these techniques have been validated, nor do they have any relevance to any clinical disease. All that these tests that are being performed by laboratories of disrepute does is to further propagate misinformation and inflict unnecessary and often exorbitant costs on patients desperate for a clinical diagnosis, right or wrong, for their constellation of maladies.

Keywords

Mycotoxins Mold spores Allergic rhinitis Allergic fungal sinusitis Allergic bronchopulmonary aspergillosis Stachybotrys Toxic black mold 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

There is no funding so no ethical approval is required.

Informed Consent

No informed consent is required.

References

  1. 1.
    Centers for Disease C, Prevention (1994) Acute pulmonary hemorrhage/hemosiderosis among infants—Cleveland, January 1993–November 1994. MMWR Morb Mortal Wkly Rep 43(48):881–883Google Scholar
  2. 2.
    Centers for Disease C, Prevention (2000) Update: pulmonary hemorrhage/hemosiderosis among infants—Cleveland, Ohio, 1993–1996. MMWR Morb Mortal Wkly Rep 49(9):180–184Google Scholar
  3. 3.
    Verhoeff AP, van Wijnen JH, Brunekreef B, Fischer P, van Reenen-Hoekstra ES, Samson RA (1992) Presence of viable mould propagules in indoor air in relation to house damp and outdoor air. Allergy. 47(2 Pt 1):83–91CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Brandt M, Brown C, Burkhart J, Burton N, Cox-Ganser J, Damon S et al (2006) Mold prevention strategies and possible health effects in the aftermath of hurricanes and major floods. MMWR Recomm Rep 55:RR–8):1-27Google Scholar
  5. 5.
    NIOSH alert: Preventing occupational respiratory disease from exposures caused by dampness in office buildings, schools and other nonindustrial buildings. In: US Department of Health and Human Services C, editor. Cincinnati, OH 2012Google Scholar
  6. 6.
    Sahoo AK, Mahajan R (2016) Management of tinea corporis, tinea cruris, and tinea pedis: a comprehensive review. Indian Dermatol Online J 7(2):77–86CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Smith RJ, Klieger SB, Sulieman SE, Berger E, Treat JR, Fisher BT (2018) Retrospective review of immunocompromised children undergoing skin biopsy for suspected invasive infection: analysis of factors predictive of invasive mold. Pediatr Dermatol 35(1):104–111CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Saxena S, Gee J, Klieger S, Kajon A, Petersen H, Zaoutis T, Fisher B (2018) Invasive fungal disease in pediatric solid organ transplant recipients. J Pediatric Infect Dis Soc. 7(3):219–225CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Fisher BT, Robinson PD, Lehrnbecher T, Steinbach WJ, Zaoutis TE, Phillips B, Sung L (2018) Risk factors for invasive fungal disease in pediatric cancer and hematopoietic stem cell transplantation: a systematic review. J Pediatric Infect Dis Soc 7(3):191–198CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Kisand K, Boe Wolff AS, Podkrajsek KT, Tserel L, Link M, Kisand KV et al (2010) Chronic mucocutaneous candidiasis in APECED or thymoma patients correlates with autoimmunity to Th17-associated cytokines. J Exp Med 207(2):299–308CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Andersen B, Nielsen KF, Thrane U, Szaro T, Taylor JW, Jarvis BB (2003) Molecular and phenotypic descriptions of Stachybotrys chlorohalonata sp. nov. and two chemotypes of Stachybotrys chartarum found in water-damaged buildings. Mycologia. 95(6):1227–1238CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Andersen B, Nielsen KF, Jarvis BB (2002) Characterization of Stachybotrys from water-damaged buildings based on morphology, growth, and metabolite production. Mycologia. 94(3):392–403CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Gottschalk C, Bauer J, Meyer K (2008) Detection of satratoxin g and h in indoor air from a water-damaged building. Mycopathologia. 166(2):103–107CrossRefPubMedCentralGoogle Scholar
  14. 14.
    Polizzi V, Delmulle B, Adams A, Moretti A, Susca A, Picco AM, Rosseel Y, Kindt R', van Bocxlaer J, de Kimpe N, van Peteghem C, de Saeger S (2009) JEM spotlight: fungi, mycotoxins and microbial volatile organic compounds in mouldy interiors from water-damaged buildings. J Environ Monit 11(10):1849–1858CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Bloom E, Bal K, Nyman E, Must A, Larsson L (2007) Mass spectrometry-based strategy for direct detection and quantification of some mycotoxins produced by Stachybotrys and Aspergillus spp. in indoor environments. Appl Environ Microbiol 73(13):4211–4217CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Githang'a D, Anzala O, Mutegi C, Agweyu A (2019) The effects of exposures to mycotoxins on immunity in children: a systematic review. Curr Probl Pediatr Adolesc Health Care 49(5):109–116CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Liew WP, Mohd-Redzwan S (2018) Mycotoxin: its impact on gut health and microbiota. Front Cell Infect Microbiol 8:60CrossRefPubMedCentralGoogle Scholar
  18. 18.
    Du K, Wang C, Liu P, Li Y, Ma X (2017) Effects of dietary mycotoxins on gut microbiome. Protein Pept Lett 24(5):397–405CrossRefGoogle Scholar
  19. 19.
    Duringer J, Fombonne E, Craig M (2016) No association between mycotoxin exposure and autism: a pilot case-control study in school-aged children. Toxins (Basel) 8(7)CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Kawamoto M, Page E, Centers for Disease C, Prevention (2015) Notes from the field: use of unvalidated urine mycotoxin tests for the clinical diagnosis of illness—United States, 2014. MMWR Morb Mortal Wkly Rep 64(6):157–158Google Scholar
  21. 21.
    Ahn J, Kim D, Kim H, Jahng KY (2010) Quantitative determination of mycotoxins in urine by LC-MS/MS. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 27(12):1674–1682CrossRefPubMedCentralGoogle Scholar
  22. 22.
    Duarte SC, Pena A, Lino CM (2011) Human ochratoxin a biomarkers—from exposure to effect. Crit Rev Toxicol 41(3):187–212CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Health hazard evaluation report: evaluation of health concerns in a public middle school—Virginia, Cincinnati, OH. US Department of Health and Human Services, CDC, National Institute for Occupational Safety and Health 2010Google Scholar
  24. 24.
    Allen JA, Lewis RA (2015) CIDP diagnostic pitfalls and perception of treatment benefit. Neurology. 85(6):498–504CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Teruel M, Alarcon-Riquelme ME (2016) The genetic basis of systemic lupus erythematosus: what are the risk factors and what have we learned. J Autoimmun 74:161–175CrossRefPubMedCentralGoogle Scholar
  26. 26.
    Reponen T, Singh U, Schaffer C, Vesper S, Johansson E, Adhikari A, Grinshpun SA, Indugula R, Ryan P, Levin L, LeMasters G (2010) Visually observed mold and moldy odor versus quantitatively measured microbial exposure in homes. Sci Total Environ 408(22):5565–5574CrossRefPubMedCentralGoogle Scholar
  27. 27.
    Niemeier RT, Sivasubramani SK, Reponen T, Grinshpun SA (2006) Assessment of fungal contamination in moldy homes: comparison of different methods. J Occup Environ Hyg 3(5):262–273CrossRefPubMedCentralGoogle Scholar
  28. 28.
    Grimsley LF, Wildfire J, Lichtveld M, Kennedy S, El-Dahr JM, Chulada PC et al (2012) Few associations found between mold and other allergen concentrations in the home versus skin sensitivity from children with asthma after hurricane Katrina in the head-off environmental asthma in Louisiana study. Int J Pediatr 2012:427358CrossRefPubMedCentralGoogle Scholar
  29. 29.
    Bush RK, Portnoy JM, Saxon A, Terr AI, Wood RA (2006) The medical effects of mold exposure. J Allergy Clin Immunol 117(2):326–333CrossRefPubMedCentralGoogle Scholar
  30. 30.
    Edmondson DA, Barrios CS, Brasel TL, Straus DC, Kurup VP, Fink JN (2009) Immune response among patients exposed to molds. Int J Mol Sci 10(12):5471–5484CrossRefPubMedCentralGoogle Scholar
  31. 31.
    Richardson MD, Page ID (2017) Aspergillus serology: have we arrived yet? Med Mycol 55(1):48–55CrossRefPubMedCentralGoogle Scholar
  32. 32.
    Borchers AT, Chang C, Eric Gershwin M (2017) Mold and human health: a reality check. Clin Rev Allergy Immunol 52(3):305–322CrossRefPubMedCentralGoogle Scholar
  33. 33.
    Chang C, Gershwin ME (2004) Indoor air quality and human health: truth vs mass hysteria. Clin Rev Allergy Immunol 27(3):219–239CrossRefPubMedCentralGoogle Scholar
  34. 34.
    Hendrix KS, Finnell SM, Zimet GD, Sturm LA, Lane KA, Downs SM (2014) Vaccine message framing and parents' intent to immunize their infants for MMR. Pediatrics. 134(3):e675–e683CrossRefPubMedCentralGoogle Scholar
  35. 35.
    Wilbur C, Bitnun A, Kronenberg S, Laxer RM, Levy DM, Logan WJ, Shouldice M, Yeh EA (2019) PANDAS/PANS in childhood: controversies and evidence. Paediatr Child Health 24(2):85–91CrossRefPubMedCentralGoogle Scholar
  36. 36.
    Chang C, McDonnell P, Gershwin ME (2019) Complex regional pain syndrome—false hopes and miscommunications. Autoimmun Rev 18(3):270–278CrossRefPubMedCentralGoogle Scholar
  37. 37.
    Hauser W, Sarzi-Puttini P, Fitzcharles MA (2019;37 Suppl 116) Fibromyalgia syndrome: under-, over- and misdiagnosis. Clin Exp Rheumatol 37 Suppl 116(1):90–97PubMedPubMedCentralGoogle Scholar
  38. 38.
    Nelson DH, Perchaluk JM, Logan AC, Katzman MA (2019) The bell tolls for homeopathy: time for change in the training and practice of North American naturopathic physicians. J Evid Based Integr Med 24:2515690X1882369CrossRefGoogle Scholar
  39. 39.
    Family L, Zheng G, Cabezas M, Cloud J, Hsu S, Rubin E, Smith LV, Kuo T (2019) Reasons why low-income people in urban areas do not drink tap water. J Am Dent Assoc 150(6):503–513CrossRefPubMedCentralGoogle Scholar
  40. 40.
    Kohn A, Chang C (2019) The relationship between Hypermobile Ehlers-Danlos Syndrome (hEDS), Postural Orthostatic Tachycardia Syndrome (POTS), and Mast Cell Activation Syndrome (MCAS). Clin Rev Allergy ImmunolGoogle Scholar
  41. 41.
    Mansueto P, Seidita A, D’Alcamo A, Carroccio A (2014) Non-celiac gluten sensitivity: literature review. J Am Coll Nutr 33(1):39–54CrossRefPubMedCentralGoogle Scholar
  42. 42.
    Carroccio A, Rini G, Mansueto P (2014) Non-celiac wheat sensitivity is a more appropriate label than non-celiac gluten sensitivity. Gastroenterology. 146(1):320–321CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Rheumatology, Allergy and Clinical ImmunologyUniversity of California at DavisDavisUSA
  2. 2.Division of Pediatric Immunology and AllergyJoe DiMaggio Children’s HospitalHollywoodUSA

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