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Water Damage and Mold Exposure, Hazards to Health


Expert Witness: Dr. John T. Chiu - Allergy Medical Group, Inc
Exposure to water damage can cause illnesses and distressing symptoms in susceptible individuals. Some of the problems are of an allergic or immunologic nature, some from the irritant effects of microbial volatile organic compounds ,but the causes for many other symptoms remain unknown.

Introduction: Water damage to any structure , if left un-remediated in a timely manner, is bad for the integrity of the building and even more so for certain susceptible occupants. In fact, one can get quite sick from continuous exposure to such an environment.

The reasons?
Since a humid indoor environment encourages the growth of molds (fungi) and house dust mites, certain genetically
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susceptible people often develop allergic reactions to these agents. The most frequently detected molds in these structures are Aspergillus, Penicillium, and Stachybotrys, but elevated spore counts of other mold species are often detected as well. Such measurements can be obtained through an environmental assessment firm usually headed by an industrial hygienist or a Ph D in microbiology.

Diseases such as bronchial asthma, allergic rhinitis, allergic conjunctivitis, allergic fungal sinusitis, and occasionally hives (urticaria) are usually the consequence of allergic sensitization ( the production of specific IgE antibodies) to the molds and/or house dust mite droppings.
Diseases such as hypersensitivity pneumonitis (which may present as repeated bouts of pneumonia or pulmonary fibrosis) are believed to be caused by a different immunologic mechanism than allergy.
Allergic bronchopulmonary Aspergillosis (ABPA) is likely based on both allergic and other immunologic factors and often manifests as refractory asthma.

It should be noted that even in the absence of an immunologic reactions, fungal /mold enzymes called proteases and proteinases can induce inflammatory changes in the airways not unlike that of an allergic reaction. However, unlike an allergic reaction, the inflammation only lasts during the actual exposure.
Molds can also produce microbial volatile organic compounds (MVOC) which may irritate the mucous membrane in susceptible individuals. Recently , an epidemiologic study found that living in a damp environment alone increases one's risk in developing allergic rhinitis (hay fever).

On the other hand, not all individuals exposed to water damage will necessarily be sickened by the exposure.

How?
In order to establish whether water damage exposure is the probable cause for the illnesses mentioned above, the most important task is getting an accurate and detailed history paying particular attention to your health prior, during, and after the exposure to the water damage. Having environmental assessment data related to mold spore counts available is immensely helpful. If the history and environmental data point to mold exposure as a suspect, allergy skin testing will be indicated. Since mold extracts are often much lower in allergenic potency when compared to plant pollen and are not standardized, intradermal skin testing (in which a small amount of allergen is injected into the skin layer via a very fine needle) may be required for confirmation should the prick skin test (in which the device is applied on your skin to produce a small puncture) turns out to be equivocal or negative especially when the exposure history is strong. Blood tests by the ImmunoCap (which has mostly replaced the older RAST) method may also be used. However although the ImmunoCap method is reproducible, it may provide false-negative results due to its relatively low sensitivity in detecting mold allergy.

A lung function test will likely be obtained as well especially if there is any respiratory symptoms suggestive of asthma or lung scarring. If the lung function test turns out to be normal but the suspicion of asthma is strong, a methacholine or mannitol inhalation challenge may be considered to rule out asthma.

If chronic sinusitis or allergic fungal sinusitis is suspected, a CT sinus scan will be needed. Permanent scarring of the lung tissue (interstitial fibrosis) which may be present in some cases of hypersensitivity pneumonitis can also be confirmed by obtaining a high-resolution CT scan (HRCT) of the chest.

Blood tests may also be ordered if hypersensitivity pneumonitis, ABPA, or pulmonary fibrosis is suspected.

What?
Obviously the best approach would be avoidance of allergen exposure. We will provide such information to your primary care physician on your request if medications are required to control your conditions as we will usually not serve as your treating doctor.

How much time for an evaluation:
Most evaluation can be completed in less than 4 hours but more complicated cases may take longer.

ABOUT THE AUTHOR: John T Chiu, MD
Undergraduate: University of Vermont, Burlington , VT BA Chemistry 57-60. Harvard 59
American Chemical Society-Freshman Chemistry Achievement Award 1958, Am Academy of Allergy Asthma & Immunolgy, Voluntary Clinical Faculty Award.
Medical school: University of Vermont 64.
Internship: Milwaukee County General Hosp/ Marquette Univ. rotating 64-65
Residency: Marquette Univ. (aka Med. College of Wisconsin) Internal Med. 65-68
Fellowship: Scripps Clinic & Res. Foundation, La Jolla, CA Allergy,Immunology, Rheumatology
1968-1969,
Board certification: National Board of Medical Examiner ’65
American Board of Allergy & Immunology (Conj.ABIM & ABP) 75
Appointments:
Clinical Professor of Medicine, University of Calif. @ Irvine, CA 1997 to date.
Sponsored speaker on respiratory tract infections, New Jersey School of Med & Dentistry, 2005.
Listed as one of America’s best allergists -immunologists by “Top Doctors” and “Top Physician".

Copyright Dr. John T. Chiu - Allergy Medical Group, Inc
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Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer. For specific technical or legal advice on the information provided and related topics, please contact the author.

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