- The Washington Times - Tuesday, February 19, 2008

Immunotherapy did not prepare Susan McFeaters for her move from Pennsylvania to Maryland. Her allergic and asthmatic symptoms landed her in the emergency department.

“Clearly, the mold, dust and pollens are different in western Pennsylvania than in Baltimore,” says Ms. McFeaters, 46, who lives in Rockville.

Ms. McFeaters, who had allergy injections for 24 years until she was 36 years old, went to a local allergist and was put on different medications for her symptoms.

The medication alone was not enough, she says. She has to keep her house clean, particularly the bathroom, where mold can grow in the humid conditions. She uses an air purifier, the air conditioner in the summer, and allergen-free bedding.

“I try to keep the dust and mold to a limit by keeping my bedroom and bathroom very clean,” Ms. McFeaters says.

Mold, a fungus that grows both indoors and outdoors, is more common in humid climates, like that of the Washington metro area, says Dr. Peter Francis, chief of the department of medicine at Inova Alexandria Hospital.

“Molds can be floating around in the air. They can get in pipes. They can get in vents. They can be in walls,” Dr. Francis says. “They literally can be anywhere.”

There are 100,000 species of indoor and outdoor molds, says Ram Tripathi, toxicologist for the Virginia Department of Health.

“Every home has mold,” says Mr. Tripathi, who holds a doctorate in toxicology.

Molds found indoors are of four main types, with the technical names of cladosporium, alternaria, aspergillus and penicillium, says Dr. Clifford W. Bassett, vice chairman of the public education committee of the American Academy of Allergy, Asthma & Immunology (AAAAI), a membership organization based in Milwaukee.

Exposure to molds, whether indoor or outdoor, can cause a variety of allergic symptoms. These symptoms will need to be treated and the source of mold eliminated by cleaning or, in more severe cases, removing the affected material.

Molds, which have inactive and active phases, start from spores, or tiny seeds, that need moisture and humidity to germinate, says Dr. Clifford S. Mitchell, director of the environmental health coordination program at the Maryland Department of Health & Mental Hygiene in Baltimore.

Once active, the multicelled organisms require constant moisture and a food source of organic material, Dr. Mitchell says.

Indoor molds tend to grow where there is a leak, condensation or a high moisture content, particularly in basements, kitchens and bathrooms, according to metro-area physicians and allergists. Molds can grow on and in construction materials, such as tile, drywall, wood, insulation and carpeting, and in faucets and drains, they say.

“If you look at mold as a symptom, it generally is a symptom of a failure to maintain and take care of the physical structure,” Dr. Mitchell says. “You just don’t look for mold, you look for the thing that led to the mold.”

Mold often can be identified with a visual inspection or by odor, which is usually a mildewy, musty smell, Dr. Bassett says. If mold is behind tile or other construction material, possibly from a leak or water damage, it will not be easily apparent, he says.

Indoor molds, whether readily visible or not, are most commonly black, white, green and brown, Dr. Francis says.

Approximately 10 percent of Americans produce antibodies when exposed to mold, says Dr. Anupama Kewalramani, assistant professor of pediatrics and director of allergy and pulmonology at the University School of Medicine in Baltimore.

Half of those, or 5 percent of the population, have symptoms related to allergens from mold, Dr. Kewalramani says. Exposure to mold can cause allergic rhinitis, or hay fever, including runny nose, eye irritation, sneezing and congestion, and an exacerbation of asthmatic symptoms of coughing, wheezing, chest tightness and shortness of breath, she says.

“The only way to know if it’s a mold allergy versus something else is to get allergy testing,” she says.

Molds that are toxigenic produce toxins called mycotoxins, Dr. Bassett says. One type, a greenish-black mold called Stachybotrys chartarum, is uncommon and requires constant moisture to grow, presenting in areas with severe flooding or water damage to tiles, insulation, wall boards and other soft construction materials, he says.

Toxigenic molds can cause more severe health effects, Dr. Francis says, overwhelming a weakened or suppressed immune system and causing lung infections and severe sinusitis, he says.

Whether toxigenic molds cause toxic mold syndrome — which has symptoms including memory changes, dizziness, weakness, shaking, headaches, breathing difficulty and intestinal problems — is controversial and has not been proved, says Dr. Sanjay C. Patel, AAAAI member and director of Allergy and Asthma Specialists in Willowbrook, Ill.

“Many of these patients are allergic to mold,” Dr. Patel says. “The link between the toxic mold and the symptoms is highly unclear. It doesn’t seem to be a cause-and-effect relationship.”

When reactions are allergic, they can be treated with allergy shots; medications to control nasal, sinus and respiratory symptoms; and environmental modifications, Dr. Bassett says.

One such modification includes installing a high-efficiency particulate air (HEPA) filter in the air-handling system or using a free-standing air purifier to remove mold spores and a dehumidifier to remove excess moisture from the air to control humidity levels, Dr. Francis says.

If mold is found, a bleach-and-water solution can be used to denature, or break down the proteins, in molds, Dr. Kewalramani says.

“Controlling moisture, that’s the most important thing,” she says.

Cleaning also needs to be done on a consistent basis, Mr. Tripathi says.

“It keeps coming back because you can’t eliminate mold,” he says.

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