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<br /> adverse effects? (4) Did the exposure to mold spores and mycotoxin occur before the onset of
<br /> the building occupants' symptoms? (5) Are there alternative known causes of the claimed
<br /> health effects?
<br /> Signs and symptoms (such as those reported by the building occupants in the absence of
<br /> medical tests and diagnostics, e.g. headaches, itchiness, watery eyes, stuffy nose, sinus
<br /> congestion) cannot be used alone to establish exposure.$
<br /> a) Allergy
<br /> Molds are common allergens. About 5%of individuals are expected to have some allergy
<br /> related symptoms from molds over their lifetime. If an individual is allergic to a specific mold
<br /> and is exposed to that specific mold,they may have an allergic response. Typical symptoms
<br /> include sneezing, runny nose, irritation of the nose, mouth, or throat,red, itchy or watery
<br /> eyes, or asthma symptoms, such as shortness of breath, wheezing, or cough.9 Allergic
<br /> responses to inhaled mold antigens are a recognized factor in lower airway disease, that is,
<br /> asthma, in sensitized individuals.10 The diagnosis of an environmental allergen can be
<br /> confirmed by skin testing.'I
<br /> Because mold spores are present in both indoor and outdoor environments, allergic
<br /> responses can result from exposures to mold spores both indoors and/or outdoors. Although
<br /> indoor fungal allergen exposure occurs, outdoor exposure is generally more relevant in terms
<br /> of sensitization and effects.12 Importantly, allergy symptoms, such as those from "hay fever,"
<br /> do not persist after the exposure to the allergen ceases. Unless mold types to which an
<br /> individual is allergic are present indoors at levels in the air substantially higher than outdoors,
<br /> it is usually not possible to conclude that allergic symptoms are due to spores originating from
<br /> an indoor source(as opposed to spores from outdoors). Moreover, an allergic reaction upon
<br /> exposure to a specific mold must be viewed in the context of the other allergens and exposure
<br /> which the individual is experiencing at the particular time, such as animals, house dust mites,
<br /> pollen or other allergen, which could be present in the environment.
<br /> b) Infection
<br /> Fungi (a designation that includes molds) are rarely significant pathogens for humans with
<br /> intact immune systems. Although some superficial fungal infections (e.g. ring worm or
<br /> athlete's foot) occur in healthy persons, the fungi causing these infections are not generally
<br /> classed as "typical molds." Due to the ubiquity of fungi in the environment, it is not possible
<br /> to prevent immunocompromised individuals from being exposed to molds and fungi outside
<br /> the confines of hospital isolation units.13 Individuals who are immunocompromised or have a
<br /> "Klaassen,C.D. (2013).Casarett and Doull's Toxicology:The Basic Science of Poisons, 8th ed.McGraw-Hill,
<br /> New York.,p 1392-1393.
<br /> NIOSH. (2010).Indoor Environmental Quality.Dampness and Mold in Buildings.Accessed on:7/1/1010.
<br /> 10 Bush,R.K.et al. (2006).loc. cit.;NIOSH.(20 10)loc. cit.
<br /> Austen,K.F.(2008).Allergies,anaphylaxis,and systemic mastocytosis. In(Fauci,A.S.et at),Harrison's
<br /> Principles of Internal Medicine, 17th McGraw Hill Medical,New York.
<br /> "Bush,R.K. et al. (2006). Position paper--The medical effects of mold exposure. J Allergy Clin Immunol.
<br /> 117(2):326-333.
<br /> "ACOEM. (2011).Adverse human health effects associated with molds in the indoor environment, Revised
<br /> Position Statement. www.acoem.org. Accessed on: 2/28/2011.;Bush,R.K. et al. (2006). loc. cit.
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