Toxic Events Were Insufficiently Considered

Letter to the Editor Indoor Mold Important Considerations for Medical Advice to Patients by Dr. rer. nat. Julia Hurraß, Prof. Dr. med. Dennis Nowak, Dr. med. Birger Heinzow, Dr. med. Marcus Joest, Dr. med. Jannik Stemler, and Prof. Dr. med. Gerhard A. Wiesmüller in issue 8/2024

The article, labeled as a review (1), claims to assess the “pertinent” publications and research results on indoor mold as a basis for rational counseling of patients. In our view, the article is flawed and does not adequately represent the relevant literature and research results regarding indoor mold. As clinicians and researchers who have worked in this area for more than 30 years, we think that the focus on infections and allergies as well as the selective literature search fall short and hamper an unbiased evaluation and care of such patients. The often-present indoor exposure to microbial toxins and associated harmful toxic health outcomes—which we have observed over the years in our patient care and studies, and which have been documented extensively (2, 3, 4)—were described inadequately. We observed health problems that should be clearly categorized as non-allergic symptom complexes—for example, non-allergic asthma, sinusitis, dry irritating cough, skin and mucous membrane problems, immune dysregulation, cognitive impairments, and excessive fatigue (2, 3).

The inhalation risks and exposures related to mycotoxins and other metabolites in indoor environments damaged by mold were either ignored or insufficiently considered. Instead, a controversial study (Kelman et al., 2004 in [4]) was cited as proof that mycotoxins in indoor spaces represent a negligible risk. Clinicians may disagree with the presented focus (1), as they did with the old position paper of the American Academy of Allergy, Asthma and Immunology (PMID: 16514772; 2006). In our opinion, the incomplete representation of the indoor air science will be disadvantageous to affected patients.

DOI: 10.3238/arztebl.m2024.0122

Dr. med. Eckardt Johanning, MD, M.Sc.

Facharzt für Arbeits- und Umweltmedizin

Columbia University, New York, N.Y.,
Center for Family and Community Medicine, USA

Prof. Dr. Dr. Manfred Gareis

ehemals Ordinarius, Lehrstuhl für Lebensmittelsicherheit, LMU München

Pierre Auger MD, M.Sc., FRCPC

emeritiert; Public Health Department Quebec, Kanada

Tuula Putus, MD

emeritiert; Fachbereich für Arbeitsmedizin, University of Turku, Finland;
Mitglied (ehemals Chair und Co-Chair) der Finnish Society of Medical Mycology

Harriet M. Ammann, Ph.D.

ehemals Washington Department of Ecology

Conflict of interest statement

TP received financial funding from IndoorAid Ltd. She received honoraria for further professional training in occupational health care from the University of Turku, Finland, and holds shares in the company Orion Pharma Ltd.

The remaining authors declare that no conflict of interest exists.

References

1. Hurraß J, Nowak D, Heinzow B, Joest M, Stemler J, Wiesmüller GA: Indoor mold—important considerations for medical advice to patients. Dtsch Arztebl Int 2024; 121: 265–71

2. Johanning E, Auger P, Morey PR, Yang CS, Olmsted E: Review of health hazards and prevention measures for response and recovery workers and volunteers after natural disasters, flooding, and water damage: mold and dampness. Environ Health Prev Med 2014; 19: 93–9

3. Fromme H, Gareis M, Völkel W, Gottschalk C: Overall internal exposure to mycotoxins and their occurrence in occupational and residential settings—an overview. Int J Hyg Environ Health 2016; 219: 143–65

4. Ammann HM: Inhalation exposure and toxic effects of mycotoxins. In: Li D-W, ed.: Biology of microfungi. Cham: Springer International Publishing; 2016: 495–523