Asthma and Allergic Diseases

Asthma and Allergic Diseases

  • American Academy of Allergy, Asthma & Immunology (AAAAI)
    (800) 822-2762 
    www.aaaai.org

    Physician referral directory, information on allergies and asthma
  • Asthma and Allergy Foundation of American (AAFA)
    (800) 7-ASTHMA (800-727-8462)
    www.aafa.org
    Information on allergies and asthma
  • American Lung Association (ALA)
    (800) LUNG-USA (800-586-4872)
    www.lungusa.org
    Information on allergies and asthma
  • Asthma and Allergy Network/Mothers of Asthmatics, Inc. (AAN*MA)
    (800) 878-4403 or (703-641-9595)
    www.aanma.org
    Information on allergies and asthma
  • National Institute of Allergy and Infectious Diseases (NIAID)
    (301) 496-5717 
    www.niaid.nih.gov

    Information on allergies and asthma
  • National Jewish Medical and Research Center
    (800) 222-LUNG (800-222-5864) 
    www.njc.org

    Information on allergies and asthma

Information found at Environmental Protection Agency.

Antimicrobial Information Hotline

Antimicrobial Information Hotline

www.epa.gov/oppad001/
(703) 308-0127/(703) 308-6467(FAX)
Monday-Friday 8:00 AM – 5:00 PM EST
email: Info_Antimicrobial@epa.gov 

The Antimicrobials Information Hotline provides answers to questions concerning current antimicrobial issues (disinfectants, fungicides, others) regulated by the pesticide law, rules and regulations. These cover interpretation laws, rules, and regulations, and registration and re-registration of antimicrobial chemicals and products. The Hotline also provide information health & safety issues on registered antimicrobial products, product label and the proper and safe use of these antimicrobial products.

Information found at Environmental Protection Agency.

Fungal Toxins

Fungal toxins, or mycotoxins, are biomolucules produced by fungi which can be toxic to animals and humans. Many fungal toxins interfere with RNA synthesis and can damage DNA. Aspergillus Flavus and Aspergillus parasiticus are strong carcinogens. Trichothecenes produced by Stachybotrys chartarium and Asperigullus versicolor were present in most samples of tested material and dust from buildings with current or past water damage. Of fifteen samples, nine of these came from buildings without visible damage or mould.

Aspergillus mold culture.

 

 

(Photo available through Environmental Health Perspectives)

 

More Information available at World Health Organization.

Enforcing Codes and Regulations in your Building or Rental

If you are unsure about mold issues in your building or home and your landlord refuses to take responsibility towards remediating the problem, you do have options.  Contact your local board of health or housing authority. Health codes fall under state and local, not federal jurisdiction. Contact your state or county health department in order to read up on local codes and regulation in order to know your legal rights.

More information available at Center for Disease Control.

Mold Remediation–Key Steps

Mold Remediation – Key Steps

  • Consult health professional as appropriate throughout process
  • Select remediation manager
  • Assess size of mold problem and note type of mold-damaged materials
  • Communicate with building occupants throughout process as appropriate to situation
  • Identify source or cause of water or moisture problem
  • Plan remediation, adapt guidelines to fit situation, see Table 1 & Table 2
  • Select personal protective equipment (PPE)
  • Select containment equipment
  • Select remediation personnel or team
  • Choose between outside expertise or in-house expertise
  • Remediate
  • Fix water or moisture problem
  • Clean and dry moldy materials See Table 2
  • Discard moldy items that can’t be cleaned
  • Dry non-moldy items within 48 hours See Table 1
  • Check for return of moisture and mold problem
  • If hidden mold is discovered, reevaluate plan

Information found at Environmental Protection Agency.

Fungal Allergens

Fungal species produce Type I allergens. Common indoor/outdoor species such as Alternaria, Pen icillian, Aspgillus, and Cladosporium cause allergic repertory disease, especially asthma.  Pencillian and Aspgillus are also well-known causes of Type III allergens. And in high concentrations, Type IV allergens, hypersensitivity pneumonitius,  are seen.  Inside airways, germination and mycelia growth occur most which release greater amounts of spores, hyphae, and fungal fragments. Because these are well adapt at airborne dispersal, these are the most harmful fungal issues.

More Information available at World Health Organization.

Mold Prevention Tips

Mold Prevention Tips from the EPA

  • Fix leaky plumbing and leaks in the building envelope as soon as possible.
     
  • Watch for condensation and wet spots. Fix source(s) of moisture problem(s) as soon as possible.
     
  • Prevent moisture due to condensation by increasing surface temperature or reducing the moisture level in air (humidity). To increase surface temperature, insulate or increase air circulation. To reduce the moisture level in air, repair leaks, increase ventilation (if outside air is cold and dry), or dehumidify (if outdoor air is warm and humid).
     
  • Keep heating, ventilation, and air conditioning (HVAC) drip pans clean, flowing properly, and unobstructed.
     
  • Vent moisture-generating appliances, such as dryers, to the outside where possible.
     
  • Maintain low indoor humidity, below 60% relative humidity (RH), ideally 30-50%, if possible.
     
  • Perform regular building/HVAC inspections and maintenance as scheduled.
     
  • Clean and dry wet or damp spots within 48 hours.
     
  • Don’t let foundations stay wet. Provide drainage and slope the ground away from the foundation.

Information found at Environmental Protection Agency.

Physicians for Health Issues Resulting from Mold

If you are concerned about health problems that are associated with exposure to mold, you should first contact your family or general health care provider inorder to determine if you need a refer to see a specialist. Specialist include allergists, physicians who treat mold allergies, or an infectious disease physician, who treats mold infections. If the infection is located in the lungs, a pulmonary physician might be needed.

More information available at Center for Disease Control.

Guidelines from World Health Organization

Review from Executive Summary of The World Health Organization’s publication, The Guidelines for Indoor Air Quality: Dampness and Mould:

On the basis of this review, the following guidelines were formulated. Persistent dampness and microbial growth on interior surfaces and in building structures should be avoided or minimized, as they may lead to adverse health effects.

  • Indicators of dampness and microbial growth include the presence of condensation on surfaces or in structures, visible mould, perceived mouldy odour and a history of water damage, leakage or penetration. Thorough inspection and, if necessary, appropriate measurements can be used to confirm indoor moisture and microbial growth.
  • As the relations between dampness, microbial exposure and health effects cannot be quantified precisely, no quantitative health-based guideline values or thresholds can be recommended for acceptable levels of contamination with microorganisms. Instead, it is recommended that dampness and mould-related problems be prevented. When they occur, they should be remediated because they increase the risk of hazardous exposure to microbes and chemicals.
  • Well-designed, well-constructed, well-maintained building envelopes are critical to the prevention and control of excess moisture and microbial growth, as they prevent thermal bridges and the entry of liquid or vapour-phase water.
  • Management of moisture requires proper control of temperatures and ventilation to avoid excess humidity, condensation on surfaces and excess moisture in materials. Ventilation should be distributed effectively throughout spaces, and stagnant air zones should be avoided.
  • Building owners are responsible for providing a healthy workplace or living environment free of excess moisture and mould, by ensuring proper building construction and maintenance. The occupants are responsible for managing the use of water, heating, ventilation and appliances in a manner that does not lead to dampness and mould growth. Local recommendations for different climatic regions should be updated to control dampness-mediated microbial growth in buildings and to ensure desirable indoor air quality.
  • Dampness and mould may be particularly prevalent in poorly maintained housing for low-income people. Remediation of the conditions that lead to adverse exposure should be given priority to prevent an additional contribution to poor health in populations who are already living with an increased burden of disease.

Schild – Vereinte Nationen-Campus (UN-Campus) Görresstr. 15 in Bonn. United Nations Educational Scientific and Cultural Organization (UNESCO-UNEVOC), World Health Organization (WHO-ECEH), United Nations University (UNU-EHS). (Photo by Michael Z.)

Full publication available at World Health Organization.

Mold Remediation in Schools

Commercial buildings and schools are areas of concern for public health. Mold detection and remediation is pertinent in order to insure the quality of health, especially for our children and elderly populations. When mold is found in public buildings, adverse health problems may be reported by occupants, employees, and general populations. Health issues may include allergies, skin irritations, and breathing problems. Serious problems may occur in circumstances where 1) children or elderly individuals, 2) individual with low immunity systems, 3) individuals with other health issues such as asthma, or 3) toxic molds are present.

Mold in School.

(Photo available through Mold News January, 2003 issue)

Article information found at Environmental Protection Agency.

CDC Does Not Recommend Testing

The Center for Disease Control does not recommend sampling and testing of mold. It is not necessary to identify the species of mold. Most species of mold cause allegies and other health risks of the respiratory systems. If you are susceptible to mold and mold is seen or smelled, you will run significant health risks. Regardless of the type of mold that is present, you should arrange for removal and remediation, which doesn’t involve testing but locating the source of the moisture which allows the mold to cultivate.

More information available at Center for Disease Control.

Health Risk Summary from World Health Organization

Review from Executive Summary of The World Health Organization’s publication, The Guidelines for Indoor Air Quality: Dampness and Mould:

The conditions that contribute to the health risk were summarized as follows.

  • The prevalence of indoor dampness varies widely within and among countries, continents and climate zones. It is estimated to affect 10–50% of indoor environments in Europe, North America, Australia, India and Japan. In certain settings, such as river valleys and coastal areas, the conditions of dampness are substantially more severe than the national averages for such conditions.
  • The amount of water on or in materials is the most important trigger of the growth of microorganisms, including fungi, actinomycetes and other bacteria.
  • Microorganisms are ubiquitous. Microbes propagate rapidly wherever water is available. The dust and dirt normally present in most indoor spaces provide sufficient nutrients to support extensive microbial growth. While mould can grow on all materials, selection of appropriate materials can prevent dirt accumulation, moisture penetration and mould growth.
  • Microbial growth may result in greater numbers of spores, cell fragments, allergens, mycotoxins, endotoxins, β-glucans and volatile organic compounds in indoor air. The causative agents of adverse health effects have not been identified conclusively, but an excess level of any of these agents in the indoor environment is a potential health hazard.
  • Microbial interactions and moisture-related physical and chemical emissions from building materials may also play a role in dampness-related health effects.
  • Building standards and regulations with regard to comfort and health do not sufficiently emphasize requirements for preventing and controlling excess moisture and dampness.
  • Apart from its entry during occasional events (such as water leaks, heavy rain and flooding), most moisture enters a building in incoming air, including that infiltrating through the building envelope or that resulting from the occupants’ activities.
  • Allowing surfaces to become cooler than the surrounding air may result in unwanted condensation. Thermal bridges (such as metal window frames), inadequate insulation and unplanned air pathways, or cold water plumbing and cool parts of air-conditioning units can result in surface temperatures below the dew point of the air and in dampness.

More Information available at World Health Organization.

Mold Removal

First rule: Mold will not grow if moisture is not present. Airborn mold spores spread from the outdoors to the indoors landing on surface material. If any moisture or water vapors are present, mold will cultivate. If you see mold growing in your home, you already have a serious problem that must be addressed. Because the spores are microscopic, only large colonies are visible to the eye. The mold must be removed and the water problem fixed to prevent recurrence.

Information found at Environmental Protection Agency.

Cleaning Visible Mold

If you choose to use bleach to clean up mold:

  • Never mix bleach with ammonia or other household cleaners. Mixing bleach with ammonia or other cleaning products will produce dangerous, toxic fumes.
  • Open windows and doors to provide fresh air.
  • Wear non-porous gloves and protective eye wear.
  • If the area to be cleaned is more than 10 square feet, consult the U.S. Environmental Protection Agency (EPA) guide titled Mold Remediation in Schools and Commercial Buildings. Although focused on schools and commercial buildings, this document also applies to other building types. You can get it by going to the EPA web site at http://www.epa.gov/mold/mold_remediation.html .
  • Always follow the manufacturer’s instructions when using bleach or any other cleaning product.

More information available at Center for Disease Control.

Executive Summary of The World Health Organization

Review from Executive Summary of The  World Health Organization’s publication, The Guidelines for Indoor Air Quality: Dampness and Mould:

  • Sufficient epidemiological evidence is available from studies conducted in different countries and under different climatic conditions to show that the occupants of damp or mouldy buildings, both houses and public buildings, are at increased risk of respiratory symptoms, respiratory infections and exacerbation of asthma. Some evidence suggests increased risks of allergic rhinitis and asthma. Although few intervention studies were available, their results show that remediation of dampness can reduce adverse health outcomes.
  • There is clinical evidence that exposure to mould and other dampness-related microbial agents increases the risks of rare conditions, such as hypersensitivity pneumonitis, allergic alveolitis, chronic rhinosinusitis and allergic fungal sinusitis.
  • Toxicological evidence obtained in vivo and in vitro supports these findings, showing the occurrence of diverse inflammatory and toxic responses after exposure to microorganisms isolated from damp buildings, including their spores, metabolites and components.
  • While groups such as atopic and allergic people are particularly susceptible to biological and chemical agents in damp indoor environments, adverse health effects have also been found in nonatopic populations.
  • The increasing prevalences of asthma and allergies in many countries increase the number of people susceptible to the effects of dampness and mould in buildings.

More Information available at World Health Organization.

What are Molds?

Molds are fungi that are prevalent both indoors and outdoors where moisture is ever present. Although the exact number of species s not know, experts estimate anywhere from tens to hundreds of thousands are uniquely identifiable. Mold reproduce through airborne spores which make it easy to spread and are adaptable enough to lie dormant in cold, dry climates and can amazingly remain dormant for 130 years plus.

More information available at Center for Disease Control.

Indoor Dampness Levels and Fungal Allegens and Toxins

Indoor dampness levels were recorded at a level of 10-50%, prevalent in office buildings, day cares, and schools. High humidity, condensation, and water damage, either past or present, promote the survival and growth of fungi which result in higher exposure to fungal allegens, toxins, and irritants. These damp environments also cause bacteria endotoxins. The damp materials also increase their chemical degradation resulting in more emissions of volatile organic compounds, such as formaldehyde.

More Information available at World Health Organization.

Mold and Health Problems

As many people know, molds are a common cause of outdoor allergies.  However, indoor allergies are also caused by reactions to mold colonies that are not visible to the eye. All molds have the potential to cause health problems, specifically allergies, irritations, and sometimes toxins. Allergic reactions are caused by inhalation of spores. Symptoms include sneezing, runny nose, eye irritation, and sometimes skin rashes in external  reaction.  These reactions may be immediate or delayed. Mold is also a common cause of asthma attacks. The effects of mold on individuals is an ongoing health issue.

Information found at Environmental Protection Agency.

Mold’s Effect on Individuals

Most commonly, molds affect many people by allergenic reactions. Symptoms include nasal stuffiness, eye irritation, sneezing, wheezing, and skin irritation. However, many people report more severe reactions to mold. These symptoms go beyond the basic skin and respiratory irritations to include fever, and asthmatic attacks. Chronic lung disease, such as obstructive lung disease, develop mold infections inside of the lungs. The 2004 Institute of Medicine found evidence to link upper respitory diseases to otherwise healthy individuals.

Mold in lungs.

More information available at Center for Disease Control.

The European World Health Organization

In October, 2007, European specialists met in Bonn in order to discuss the problem of microbial pollution. Indoor pollution is caused by hundreds of species of bacteria and fungi, but most particularly filamentous fungi—mould. The Guidelines for Indoor Air Quality: Dampness and Mould discusses the most recent scientific evidence on health problems caused from mould which concludes that exposure to indoor pollution causes increased respiratory problems, allergies, and asthma, as well as agitation of the immunity system. This document also discusses common conditions in which mould thrives  and ways to control it. The best way to avoid health issues due to microbial pollution is to prevent excessive moisture from accumulating visible or within walls and foundations.

European Health Minister at 60th regional meeting in Moscow (September, 2010)

More Information available at World Health Organization.