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Page IS tt adverse effects? (4)Did the exposure to mold spores and mycotoxin occur before the onset of the building occupants' symptoms? (5) Are there alternative known causes of the claimed health effects? Signs and symptoms (such as those reported by the building occupants in the absence of medical tests and diagnostics, e.g. headaches, itchiness,watery eyes, stuffy nose, sinus congestion) cannot be used alone to establish exposure.8 a) Allergy Molds are common allergens. About 5%of individuals are expected to have some allergy related symptoms from molds over their lifetime.If an individual is allergic to a specific mold and is exposed to that specific mold,they may have an allergic response. Typical symptoms include sneezing, runny nose, irritation of the nose, mouth, or throat,red, itchy or watery eyes, or asthma symptoms, such as shortness of breath,wheezing,or cough.9 Allergic responses to inhaled mold antigens are a recognized factor in lower airway disease,that is, asthma, in sensitized individuals.10 The diagnosis of an environmental allergen can be confirmed by skin testing.t t Because mold spores are present in both indoor and outdoor environments, allergic responses can result from exposures to mold spores both indoors and/or outdoors. Although indoor fungal allergen exposure occurs, outdoor exposure is generally more relevant in terms of sensitization and effects.12 Importantly, allergy symptoms, such as those from"hay fever," do not persist after the exposure to the allergen ceases.Unless mold types to which an individual is allergic are present indoors at levels in the air substantially higher than outdoors, it is usually not possible to conclude that allergic symptoms are due to spores originating from an indoor source(as opposed to spores from outdoors). Moreover,an allergic reaction upon exposure to a specific mold must be viewed in the context of the other allergens and exposure which the individual is experiencing at the particular time, such as animals, house dust mites, pollen or other allergen,which could be present in the environment. b) Infection Fungi (a designation that includes molds) are rarely significant pathogens for humans with intact immune systems. Although some superficial fungal infections(e.g. ring worm or athlete's foot) occur in healthy persons,the fungi causing these infections are not generally classed as "typical molds."Due to the ubiquity of fungi in the environment,it is not possible to prevent immunocompromised individuals from being exposed to molds and fungi outside the confines of hospital isolation units.13 Individuals who are immunocompromised or have a Klaassen,C.D.(2013).Casarett and Doull's Toxicology:The Basic Science of Poisons, 8th ed.McGraw-Hill, New York.,p1392-1393. NIOSH.(2010).Indoor Environmental Quality.Dampness and Mold in Buildings.Accessed on:7/1/2010. 10 Bush,R.K.et al.(2006).loc. cit.;NIOSH.(2010)loc. cit. Austen,K.F.(2008).Allergies,anaphylaxis,and systemic mastocytosis.In(Fauci,A.S.et al.),Harrison's Principles of Internal Medicine, 17th McGraw Hill Medical,New York. 12 Bush,R.K.et al. (2006).Position paper--The medical effects of mold exposure.J Allergy Clin lmmunol. 117(2):326-333. 13 ACOEM.(2011).Adverse human health effects associated with molds in the indoor environment.Revised Position Statement.www.acoem.org.Accessed on:2/28/2011.;Bush,R.K.et al. (2006).loc. cit. 57