Today’s increasing asthma rates are believed to be related to an increase in environmental exposures such as mold, moisture and other allergens.

The Head-off Environmental Asthma in Louisiana (HEAL) Project is a collaborative research project conducted by the Tulane University Health Sciences Center and the New Orleans Department of Health which is investigating these relationships.

If eligible for the research project, a study investigator will go to your home and take samples for mold and other indoor allergens. The results of this assessment will be provided to you.

The HEAL Asthma Counselor works with families selected for the project to reduce asthma symptoms, understand the nature of asthma and identify appropriate resources and access to healthcare for asthma. The Asthma Counselor can also give the family supplies and education to help reduce allergens in the home.

If eligible for the research project, your child will be given a full examination by a Pediatric Asthma Specialist. The exam will include allergy testing of your child for several allergens, including molds that are present in New Orleans post-Katrina.

The purpose of the project is to learn about the effects of mold and other indoor allergens on children with asthma in post-Katrina New Orleans. Another goal of the HEAL Project is to look at inherited differences in childrens response to mold and indoor allergens. The project is funded by the National Institute of Environmental Health Sciences (NIEHS), the National Center for Minority Health and Health Disparities (NCMHD), the Foundation for the National Institutes of Health (FNIH), and the Merck Childhood Asthma Network, Inc. (MCAN). NIEHS and NCMHD are part of the National Institutes of Health (NIH).

HEAL Investigators:

• *Maureen Lichtveld, MD, MPH, Principal Investigator and Freeport McMoRan Chair of Environmental Policy, Tulane University School of Public Health and Tropical Medicine
• *William Martin II, MD, Principal Investigator and Associate Director, National Institute of Environmental Health Sciences
• *Herman Mitchell, PhD, Principal Investigator and Senior Research Scientist, Rho, Inc.
• *Kevin Stephens, Jr., MD, JD, Principal Investigator and Director, New Orleans Health Department
• Keith Bordelon, MSPH, HEAL Study Coordinator, Constella Group, LLC
• Patricia Chulada, PhD, MHS, Health Scientist Administrator, Program in Clinical Research, National Institute of Environmental Health Sciences
• Richard Cohn, PhD, Vice President, Center for Health Research, Constella Group, LLC
• Jane El Dahr, MD, Professor of Clinical Pediatrics and Clinical Professor of Medicine; Head, Section of Pediatric Allergy/Immunology/Rheumatology, Tulane University Health Sciences Center
• Faye Grimsley, PhD, CIH, Assistant Professor of Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine
• Suzanne Kennedy, PhD, Research Scientist, Rho, Inc.
• Mosanda Mvula, MD, MPH, Chief, Division of Health Disparities, New Orleans Health Department
• Yvonne Sterling, RN, PhD, Professor of Nursing, Louisiana State University Health Sciences Center School of Nursing
• Eleanor Thornton, MS, CHES, AE-C, President and CEO, Visionary Consulting Partners, LLC
• LuAnn White, PhD, Professor of Environmental Health Sciences; Director, Tulane Center for Applied Environmental Public Health, Tulane University School of Public Health and Tropical Medicine

Allergists say this year’s high mold spore count is because of the wet spring and high humidity. The weather that is good for weeds is also good for mold.

So even though the pollen count may be lower, allergic responses may be worse than normal due to the higher than normal mold spore count.

Respiratory Symptoms may include:

• Sneezing.
• Chronic cough.
• Runny nose.
• Nasal congestion.
• Itchy, watery and red eyes.
• Skin rashes and hives.
• Sinus headaches.
• Reduced lung capacity and difficulty breathing.

Unfortunately, repeated exposure may worsen symptoms.

Weather.com provides a general mold spore count /allergen map:

http://www.weather.com/maps/activity/health/allergies/usmoldspores_large.html

If you’re sensitive to mold and pollen, you can keep track of the state of the air with a visit or subscription to http://pollen.com or http://weather.com. Weather.com even provides a list of all the local grasses that are making you sneeze; and if you have a problem with ozone and particulates, the weather.com website even forecasts ozone and particulates. You can sign up with both sites to track your allergies, or just keep informed.

Click to find your forecast AT POLLEN.COM

Click to find your forecast AT WEATHER.COM

Believe it or not, the National Association of Home Builders maintains a website on mold.

The site is called NAHB Household Mold Resource Center

No one out there knows more about remediation than a qualified contractor. (No one knows less than an unqualified one.) The site discusses significant information about mold, conditions, prevention, mediation. Understandably, they don’t focus much on mold testing.

It does make sense that an association of contractors might gloss over the importance of testing. Mold testing can provide a legal record of mold conditions, mold which might have come into being because of shoddy workmanship or materials. So if the homeowner has repairs made, but does not keep a complete record–including testing, photographic proof, etc–the homeowner might find themselves unable to bring a case that they might have otherwise, given proper record-keeping.

However, the National Association of Home Builders can and will recommend “a qualified laboratory, technician or industrial hygienist.”

Testing also can help doctors pin down whether a mycotoxin originated from home or workplace, or even simplify making a diagnosis, especially if a particular allergen or obscure toxin is involved.

Table of Contents

Acknowledgements

We would like to thank Paul Ellringer, PE, CIH, for providing the photo of mold on the back of wallpaper in the Hidden Mold section.  Should you like to use some of the photos used in this guide,
higher quality print versions are available in the
Mold Gallery. 
These photos may be used for presentations and educational purposes
without contacting EPA.

Please note that this document presents recommendations.  EPA does not
regulate mold or mold spores in indoor air.

Petrie dish showing mold growth

src: http://www.epa.gov/mold/moldguide.html

According to a study by the Department of Microbiology of Sri Ramachandra Medical College and Research Institute at Sri Ramachandra University, there is an urgent need to “undertake study of indoor air, to generate baseline data and explore the link to nosocomial infections.”

The study postulates a relationship between mold and sick building syndrome (SBS) and building related illnesses, citing “fungal contamination within wall, ceiling, and floor cavities by movement of cells, spores, and cell fragments via wall openings and gaps at structural joints” as well the building providing a perfect mold breeding ground with: “lack of fresh…poor ventilation, poorly regulated temperature…relative humidity levels contributing to the presence and multiplication of bio-aerosols.

So, like we’ve said a hundred times before, eliminate the water leaks and humidity. Control the environment, and you control the mold.

Srikanth P, Sudharsanam S, Steinberg R. Bio-aerosols in indoor environment: Composition, health effects and analysis. Indian J Med Microbiol [serial online] 2008 [cited 2009 Mar 9];26:302-12. Available from: http://www.ijmm.org/text.asp?2008/26/4/302/43555

Contributing to limitations in the understanding of the relationship between mold and a number of adverse health effects is the variety of potential disease-causing agents-including many species of mold and other biological agents, such as bacteria or dust mites-that are likely to be present in damp indoor environments.

The number of such agents makes it difficult to know which ones are specifically responsible for the adverse health effects attributed to these environments.

For example, of the approximately 1 million species of mold, there are about 200 species of mold to which humans are routinely exposed, although not all of these are commonly identified in indoor environments, and not all types pose the same hazards to human health.

The mold genus Alternaria, for instance, which has been found in moldy building materials, has been linked to severe asthma. Furthermore, several different components or products of mold, such as mycotoxins, may function as disease-causing agents in indoor environments. The release of these mold components or products varies with environmental and other factors, and the individual roles they may play in adverse health effects are not fully understood.

People are also exposed to mold in outdoor environments, where the concentrations, while they vary considerably, are usually higher than those found indoors. While the specific species of mold that grow indoors may differ from those found outdoors, the potential for outdoor exposure further complicates efforts to determine the relationship between adverse health effects and indoor exposure to mold.

In addition to mold, damp indoor areas can support other biological agents that may result in adverse health effects, including bacteria, dust mites, cockroaches, and rodents. Dust mites, for example, are known to cause the development of asthma. Damp conditions may also lead to potentially harmful chemical emissions from building materials and furnishings. For example, excessive indoor humidity may increase the release of formaldehyde, a probable human carcinogen, from building materials such as particle board. Exposure to formaldehyde has been linked to some of the same health effects that have been attributed to indoor mold, such as wheezing, coughing, and exacerbation of asthma symptoms, as well as more severe effects.

Indoor Mold: Better Coordination of Research on Health Effects and More Consistent Guidance Would Improve Federal Efforts
United States Government Accountability Office

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;
• wheeze;
• cough;
• 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

1. Potential health effects and symptoms associated with mold exposures include allergic reactions, asthma and other respiratory complaints.

2. There is no practical way to eliminate all mold and mold spores in the indoor environment; the way to control indoor mold growth is to control moisture.

3. If mold is a problem in your home or school, you must clean up the mold and eliminate sources of moisture.

4. Fix the source of the water problem or leak to prevent mold growth.

5. Reduce indoor humidity to 30 to 60 percent to decrease mold growth by venting bathrooms, dryers, and other moisture-generating sources to the outside; using air conditioners and dehumidifiers; increasing ventilation; and using exhaust fans whenever cooking, dishwashing and cleaning.

6. Clean and dry any damp or wet building materials and furnishings within 24 to 48 hours to prevent mold growth.

7. Clean mold off hard surfaces with water and detergent and dry completely. Absorbent materials, such as ceiling tiles, that are moldy, may need to be replaced.

8. Prevent condensation: Reduce the potential for condensation on cold surfaces (i.e., windows, piping, exterior walls, roof, or floors) by adding insulation.

9. In areas where there is a perpetual moisture problem, do not install carpeting (i.e., by drinking fountains, by classroom sinks or on concrete floors with leaks or frequent condensation).

10. Molds can be found almost anywhere; they can grow on virtually any substance, providing moisture is present. There are molds that can grow on wood, paper, carpet, and foods.

SOURCE: U.S. Environmental Protection Agency

Because molds produce allergens and irritants, it is common for exposed individuals to experience:

For further information, please see our sections, ” The Doctor Says.. ” , and ” Mold Glossary ” ; comments from Certified Property Mold Specialist, George Hatcher, on Stachybotrys sp.; ” Is Indoor Mold Contamination a Threat to Health? ” (by Harriet M. Ammann, Ph.D., D.A.B.T.).