NEW YORK — Despite what many parents think, inhaling mold spores
generally does not cause severe disease. Severe disease occurs only after mold
spores are ingested, according to a presenter at the recent 24th Annual
Infectious Diseases in Children Symposium.
Cyrus Rangan, MD, director of the Bureau of Toxicology at the Los
Angeles County Department of Public Health, spoke about the myths that
typically surround molds and fungus. He said reasonable evidence exists that
links exacerbation of allergies and asthma to mold inhalation, but true
systemic disease tends to occur after a patient ingests mold species such as
Fusarium and Aspergillus.
According to Rangan, historical reports of cases of systemic poisoning
in humans were found to be linked to ingestion and absorption of mold or the
reports have since been proven false, including the original 10 cases of
idiopathic pulmonary hemosiderosis among infants in Cleveland that were
supposedly caused by Stachybotrys atra. Contact with inhaled or
aerosolized mold causes only minor respiratory or dermal complaints in most.
Mold may be a red herring
Rangan, who also serves as an assistant medical director at the
California Poison Control System and is a medical toxicology consultant for
Children’s Hospital Los Angeles, said mold grows almost everywhere if the
temperature is ideal (which it is in most of the United States) and a nutrition
and water source is present.
The key point, he said, is that the conditions that are ideal for the
mold are also ideal conditions for growth of mites, roaches
“All of these have much more proven background in causing human
disease. Ultimately, mold may be more of a red herring when you look at indoor
environments because all these other things are growing at the same time,”
He said allergy testing may be useful in some patients who have
respiratory symptoms, but mold antibody screening tests are
not approved by the FDA and are commonly misinterpreted.
“CLA testing is only for allergic conditions and not for
‘toxic exposure’ evaluation,” he said. “There is little
evidence to support other evaluations.”
What to tell the parents
If parents of a child present to the office with concerns about mold
exposure in the residence, Rangan said he advises the parents that they should
clean the mold, which can be done through normal household cleaning methods and
generally does not require the help of a third party unless structural damage
or water intrusion has occurred.
Air sampling is also not typically required because it is “highly
variable and does not impact plans for remediation,” Rangan said.
Disclosure: Dr. Rangan reports no relevant financial
Mold is a ubiquitous indoor and outdoor environmental allergen that most
individuals are exposed to on a daily basis. We are exposed to these indoors on
a daily basis (most without any awareness of the exposure, given how common
this is in the environment), as well as outdoors except when the ground is
frozen and covered with snow.
The term “black mold” is often a source of confusion and
unnecessary worry for patients. The case report from Cleveland with
Stachybotrys atra represents the exception, not the rule, and no other
such similar cases have been reported. In fact, most people who are exposed to
so-called “black mold” suffer no symptoms at all, because most mold
appears black and few of these colonies are Stachybotrys. Unfortunately
there is a hysteria associated with this term and a connotation that this is
somehow highly toxic. Instead, it is easier to focus on mold’s most
notorious health problem — allergic disease. The highest risk groups for
mold exposure are those who are allergic or have allergic asthma. Mold exposure
has been proven to exacerbate both allergic rhinitis and asthma, and sensitive
patients are generally placed on prophylactic medication therapy (eg,
antihistamines, nasal or inhaled steroids) and/or allergen immunotherapy.
While there have been numerous reports of the so-called phenomenon of
“sick building syndrome,” this is rare and exceptionally difficult to
prove. Other mold-related immunologic conditions, such as allergic
bronchopulmonary aspergillosis, occupation asthma or allergic fungal sinusitis,
can arise. However, these tend to be rare, and related to specific medical
conditions (eg, nasal polyps, chronic lung disease, asthma or cystic fibrosis)
or to specific occupations (eg, farm/silo workers, home
As was mentioned by the presenter, mold abatement is relatively simple,
and can be accomplished with bleach and water. For patients where there is a
concern for mold-triggered or mold-attributed respiratory symptoms,
consultation with a board-certified allergist/immunologist is recommended for
testing and assistance with appropriate treatment.
Matthew J. Greenhawt, MD
in Children Editorial Board
Disclosure: Dr. Greenhawt reports no relevant financial
For more information:
- Rangan C. Mold myths and fungal fallacies: sorting out “toxic
mold.” Presented at: 24th Annual Infectious Diseases in
Children Symposium; Nov. 19-20, 2011; New York.