John H. Boyles, M.D. James J. Howard, M.D. William E. Rogers, M.D.
For March 2006, "Mold Allergy"
Our patients are initially evaluated by investigating biological inhalants if the attending physician feels that the patient’s symptoms are due to allergies. Biological inhalants are those particles in the air that were, or are alive. These particles are inhaled into the nose, throat, and lungs. They include the pollens of plants that grow in our area, dust and dust mites, animal dander and hair, and mold spores. Because we cannot see them we tend to forget that molds are everywhere. Most patients realize that if food or moist organic material is left out, it will demonstrate mold growth within a short time. Inhalation of the spores of these molds (which function as pollens do in plants) can cause a wide variety of symptoms such as headaches, sinus problems, nasal stuffiness, eczema, asthma, and cough.
Molds are some of the most illusive, and yet important causes of inhalant allergy. No environment is entirely free molds or mold spores. In addition, these airborne mold spores are present all year long, rendering no season of the year entirely free of mold spore inhalation. Patients with severe mold allergy can have symptoms all year long.
Mold spore allergy is frequently blamed on some other cause. Sneezing while dusting is usually blamed on house dust and dust mites, when, in fact, it may be due to stirring up mold spores. Respiratory symptoms in late August and September are usually blamed on ragweed, when it may be due to a mold spore whose concentration peaks at that time of the year. Patients who become symptomatic when mowing the grass will tend to blame the problem on grass allergy when, in fact, it may be molds which have been disturbed by the action of the lawn mower.
The concentration of various molds in each geographic area can change over long periods of time. In the past year, our office has been doing its own evaluation of the particles in the atmosphere of the Dayton area. We have found that many molds we did not consider to be important are in our local environment, and do not always peak in concentration at the times which the textbooks have stated. We also find that there are new molds in our areas that were not present just a few years ago. In addition, there is a great deal of difference between the molds that are important in the city and suburbs, as compared to rural areas.
Previously, we tested our patients for mold allergies by using mixes of various molds, in addition to testing for the four or five molds we thought were most important. We know now that patients respond better if we can find the exact molds to which they are allergic, and correlate them to those molds that are found in our geographic area. For this reason, we have stopped using mold mixes, and we do not test patients for individual species of molds.
In trying to cut down on the number of tests performed, and make diagnosis and treatment more cost effective, we now have a program in which patients expose Petri dishes or special mold growing containers in their homes and work environments. This enables us to determine accurately to which specific molds the patient is exposed. We will be able to culture or grow the type of mold that is found in the various environments in which the patient has the most exposure.
You have been given Petri dishes or mold plates to expose in the areas in which you spend the majority of your time. It is usually best to culture your bedroom, the place where you work, and the place where you spend most of your leisure time. This may include other buildings or other locations, such as an indoor tennis court, barn, health club, etc. You may also want to culture your basement, since this is a common place for mold overgrowth.
You should store your mold plates in the refrigerator when you first bring them home, and remove them at least one hour prior to exposure. When you are ready to expose the plates, remove the top, and set the plate in the middle of the room (waist high) to be cultured for one hour. Do not let anyone touch or occupy the space over the mold plate. It is good, however, to have people move about the room, and engage in their usual activities. After one hour, close the plate, tape it shut all around the edges, and put it in a warm spot where it will not be disturbed until you can bring or mail it back to the office. When you bring it into the office, try not to bounce it around or jar it. Please return it within one week of exposure. The best results are obtained if the plate is returned as soon as it is exposed.
Once the plate is returned, it is inspected daily for four to six weeks, or until it stops growing new mold colonies. When the mold colonies reach maturity, microscopic slides are made to identify the type and species of molds present. All of the slides will be read by a PhD mycologist (a doctor who specializes in identifying molds), and slides which are difficult to read are sent to other consulting mycologists for accurate identification. After the results are known, your doctor will correlate the findings with the test results in your chart. If there are any molds in your environment that have not been tested, you will be asked to return to the office for further testing. This will allow us to treat you more effectively and efficiently.
Mold or mildew is found on many forms of living and dying vegetation. In our climate, as vegetation dies, it is consumed by mold. Mold is plentiful outside throughout the summer months, and tends to peak in the midsummer when grass is dying, and again in autumn when leaves and weeds are dying. Patients who are allergic to mold should avoid mowing and raking grass, and raking and playing in the leaves.
Molds thrive in damp, humid, indoor environments, in basements, cellars, bathrooms, crawl spaces, and other damp areas. It is imperative that all basements be made waterproof. All leaks should be patched, and the walls painted with waterproof mildew-resistant paint. Likewise, any crawl space should be waterproofed.
A dehumidifier in the basement is very helpful. Air conditioning helps reduce indoor mold in the summer months.
Any place where mold is seen should be washed weekly for six weeks with a solution of Zephiran 17% (1 oz. added to one gallon of water). This may be purchased at a pharmacy.
Patients who are allergic to mold should not have house plants, dried cut flowers, or live Christmas trees in their homes.
All foam mattresses should be enclosed in cotton, and foam pillows should be replaced by Dacron polyester pillows or cotton pillows.
All portable vaporizers and humidifiers should be cleaned weekly with Zephiran solution.
In closets where mold exists, a small electric light left on may reduce humidity and decrease mold.
With care, mold growth can be substantially curtailed. Effort should be put into creating one allergen-free room, usually a bedroom for the allergy sensitive patient. In general, house dust precautions will serve well to reduce indoor mold contact.