The 2004 Institute of Medicine report, Damp Indoor Spaces and Health, found sufficient evidence of an association between exposure to indoor mold and certain adverse health effects-that is, an association between the agent and the outcome has been observed in studies in which chance, bias, and confounding factors can be ruled out with reasonable confidence. These health effects include
• upper respiratory tract symptoms, including nasal congestion, sneezing, runny or itchy nose, and throat irritation;
• exacerbation of pre-existing asthma;
• hypersensitivity pneumonitis in susceptible persons; and
• fungal colonization or opportunistic infections in immune-compromised persons.
Of these health effects, the upper respiratory tract symptoms associated with allergic rhinitis are the most common, according to the American Academy of Pediatrics.12 In addition, the association between indoor mold and exacerbation of asthma symptoms is a particularly significant public health concern because asthma is the most common chronic illness among children in the United States and one of the most common chronic illnesses overall, according to the Institute of Medicine’s 2000 report, Clearing the Air: Asthma and Indoor Air Exposures. Importantly, mold can affect certain populations disproportionately. For example, the 2004 Institute of Medicine report found sufficient evidence of an association between exposure to the mold genus Aspergillus and serious respiratory infections in people with severely compromised immune systems (such as chemotherapy patients and organ transplant recipients). This report also found sufficient evidence of an association between exposure to indoor mold and hypersensitivity pneumonitis-a relatively rare but potentially serious allergic reaction-in susceptible persons. In addition to these more established health effects, this report also found limited or suggestive evidence of an association between indoor mold and lower respiratory illness (for example, bronchitis and pneumonia) in otherwise healthy children.
Most of the 20 reviews of the scientific literature published from 2005 to 2007 that we examined generally agreed with the conclusions of the 2004
Institute of Medicine report.
Indoor Mold: Better Coordination of Research on Health Effects and More Consistent Guidance Would Improve Federal Efforts
United States Government Accountability Office