It seems that mould is commonly viewed as just an ugly inconvenience. And even those who suffer the common respiratory symptoms it can cause*, are not always conscious of the connection.

If you’re not yet aware of just how dangerously unhealthy mould is, get ready for an eye-opening read. Because the respiratory issues mould causes is just the tip of the iceberg.

Mould + Respiratory Illness

Respiratory issues are the most universal and recognisable symptoms of a mould issue. Similar to the way in which pollen triggers hay fever in those who are susceptible, mould and its spores also irritate the delicate tissues of our nose, throat, lungs, eyes – and even inner ear!

If you have any of the following symptoms that have been ongoing, and appear unrelated to season or food intolerances – especially if unresponsive to treatment, consider whether mould may be the culprit. Most tellingly, if your symptoms subside or clear up when you’re away on holiday (or staying somewhere else) only to return when you get back home… Houston. We have a problem.

*Respiratory symptoms that mould can cause:

• itchy nose, eyes, and/or throat
• sneezing
• runny or blocked nose
• watery eyes
• sinus congestion
• post-nasal drip
• sore throat
• cough
• asthma*

*From what I have read so far, it is claimed that asthma cannot be caused by mould. However, in speaking to people about it, I have heard many a story where asthma developed as a result of mould exposure and did not resolve when the mould was treated or the person relocated to a mould-free environment. My thoughts are that, at least at this stage, it appears mould may be a catalyst for triggering asthma in those with a predisposition. Whilst that means that the mould is not directly a cause but more an environmental immunological provocateur – in those with a history of atopy/allergy (personal or familial) vigilance is most definitely called for.

In my case, the respiratory symptoms were actually the first sign of problems escalating in my home. In February, after a wardrobe audit with Ivanna Fontana (personal stylist extraordinaire), I was sneezing constantly. On the day she took photos of me in different outfits and clothing combinations, in almost every photo, my face is wrinkled in irritation or I am mid-sneeze! I thought at the time it was because we’d pulled out everything and that perhaps my winter knits were a little dusty. But from that point on I was always congested (at night I couldn’t breath through my nose), my eyes were often itchy and watery (I also had intermittent conjunctivitis-like symptoms), I sneezed a lot, and more days than not I woke up with a sore and itchy throat. It got to the point where I started taking anti-histamines so I could cope. Another sign of mould issues can be dry, scaly skin and, as my skin began to dry out and crack, I even started to get weird itchy rashes from my clothes. In hindsight it wasn’t dust that I had disturbed, but mould spores!

When I was accidentally re-exposed to mould a couple of weeks ago (one night at an Air B’n’B property that was mouldy) I woke up with a runny nose, post-nasal drip, irritated/mildly burning lungs and constantly clearing my throat – along with a migrainous headache, dizziness and nausea.

If exposure to mould is ongoing sinusitis, chest infections, and hypersensitivity pneumonitis are the next likely result – children are even more vulnerable and can experience bleeding in the lungs[1]. People with a chronic lung disease (i.e. COPD) may even develop fungal infections in their lungs[2]. One person I spoke to recently had mould in her car, kept driving in it, and got pneumonia three times and – I quote – thought she was going to die.

Of course, chronic respiratory issues can occur as a result of other things like food intolerances (I find dairy products to be a common congestant), gut/immune issues, and other airborne irritants. And, as always, the appropriate course of action is to find and treat the cause. Having said that, if you have you any issues with damp/condensation, or mould anywhere – no matter how small – sorting that out is your first port of call.

Mould (and the spores it produces when the dampness begins to dry up) do cause respiratory issues. And these are obviously serious enough, but it gets much worse than that…

Mycotoxins + Disease

In addition to being problematic in themselves, moulds also produce mycotoxins (reported to be more toxic than pesticides[3]) and these have even more serious health consequences. The exact nature of mycotoxin exposure differs depending on the types of mould present and the materials they are growing on and consuming – and these vary depending on whether the mould is from poor ventilation/airflow and moisture accumulation, or a water leak/water damaged building (WDB).

To summarise the impact of mycotoxins in a nutshell – they are damaging to cells and may cause cancer. Knowing what moulds you’ve been exposed to, and in turn mycotoxins, is important because:

• certain mycotoxins are linked to certain diseases and this gives you a place to start with assessing any damage that may have been done, and
• as different mycotoxins are excreted via different pathways, it also helps to determine an effective detoxification protocol

To give you an example, I was living in a water-damaged building (unbeknownst to me) for 5 months that was still actively leaking and – as a result – the mould profile that came back from the building biologist was able to show that the issue was a result of water damage (as opposed to poor airflow) and gave me an assessment of what moulds were present.

Now there are a number of different ways to assess mould in a property, with each method having pros and cons, but one of several tests I had done was an ERMI. This involved vacuuming a specified area of carpet, for a specific amount of time, to collect a particular volume of sample – and I had both my bedroom and office tested. The building biologist I used was Carol from Mitey Fresh and, at a time where my health issues were at an all-time high and we were coming up against a managing agent who dismissed the issue – she was a cool, calm, collected and kind specialist to have! She sent the samples up to Mould Lab and here’s what came back: Amie skilton – Manly PCR ERMI Analytical Report

You’ll note that, under section 3.1 PCR Mould Analysis that the mould count for WDB-associated moulds was far greater than the number of common indoor moulds (which can sprout up when conditions are ripe i.e. dampness/condensation and poor ventilation/airflow) which confirmed what I suspected – there was water leaking into the apartment.

To demonstrate the seriousness of mould exposure I have chosen just one of the many moulds I was exposed to and listed the consequences of it’s mycotoxin below.

Aspergillus ochraceus was one of the many WDB-moulds identified as present in my home and it produces the mycotoxin ochratoxin A (OTA). Below is just a selection of some of the grave consequences of OTA exposure:

• OTA is nephrotoxic (poisonous to the kidneys) and is suspected of being the main aetiological agent in Balkan endemic nephropathy (BEN) and associated urinary tract tumours[4]
• The International Agency for Research on Cancer (IARC) has classified OTA as a group 2B carcinogen
• OTA is genotoxic/mutagenic (damages the genetic information within a cell causing mutations, which may lead to cancer) following oxidative metabolism – meaning, as the body metabolises it via oxidation it damages DNA
• In animal studies OTA
  • increased the incidence of liver cancer[5] and kidney cancer[6]
  • caused immunosuppression and immunotoxicity (depressed immune response, immune organ shrinkage, and changes in immune cell numbers/function/cytokine production)[7]
  • crossed the placenta and causes adducts in the liver and kidney DNA of newborns[8] (thank goodness I’m not currently pregnant!)
• In humans, OTA has been detected in blood, urine, and breast milk as well as kidney cancer, breast cancer, astrocytoma (a type of brain cancer), inflamed bladder tissue and transitional cell carcinoma of the bladder, and a skin biopsy sample (OTA can be ingested and inhaled, but is also absorbed by the skin[9] and it may even cause skin cancer[10])
  • in one particular case[11] a couple were exposed to OTA for 8 hours and experienced respiratory distress, retrosternal burning, epigastric tension, and asthenia (muscle weakness) – and I too experienced all of these. The husband’s condition improved within 24 hours; however, the woman’s condition worsened and she was admitted 5 days later with kidney failure, oedema (fluid swelling) in the lung tissue, around the eyes and lower extremities. A biopsy showed acute tubulonecrosis with interstitial oedema with localised infiltration of lymphocytes, granulocytes, and macrophages with thickening of the basement membrane – basically kidney damage. Fortunately, her kidney function returned to normal 40 days after the exposure.
• OTA has a strong affinity for the brain especially the cerebellum (Purkinje cells), ventral mesencephalon, and hippocampal structures[12] which has no doubt been a contributor to what I have affectionately called ‘mould brain’
  • in animal studies OTA causes degeneration of the hippocampus (like Alzheimer’s), causes acute depletion of dopamine (like Parkinson’s) and the developing brain is particularly susceptible (again, thank goodness I’m not currently pregnant!)
• There are other cancers associated with OTA – mostly gastrointestinal – however they are more closely related to the ingestion of OTA from contaminated/mouldy food. All in all, however, it is very bad news[13] – which is why it is among approximately 20 mycotoxins monitored in food. I found this article[14] on OTA particularly enlightening, and frightening.

Particularly dangerous mould species include Stachybotrys chartarum, Aspergillus versicolor, and several toxigenic species of Penicillium – with Stachybotrys, erroneously dubbed ‘Black Mould’, being the most dangerous of them all.

Young children are at even greater risk and one Polish study on 277 children found that early postnatal exposure to indoor moulds (2 years or more) was harmful to cognitive development – tripling the risk of low IQ scoring[15]. We know that mycotoxins significantly impact neurological function and mould-exposed subjects show statistically significant decreases in attention compared to controls[16] which may explain some of the behavioural issues seen in mould-exposed children.

As you can see, mould exposure is much more serious than it first appears and the deleterious effects on your health go far beyond respiratory illness. It appears that chronic mould exposure induces changes in inflammatory and immune system responses that if unaddressed, over time, can have a huge impact on your health[17].

It is also important to reiterate that mycotoxins are processed and eliminated by the body via a number of different pathways and the various mycotoxin binders (therapeutic agents that absorb mycotoxins helping us eliminate them) have an affinity for some mycotoxins and not others. I will cover this in further detail in a later blog post but, in the event of chronic mould exposure, this is why it is important to determine what moulds you’ve been exposed to.

MVOCS

Another issue with mould is the volatile organic compounds (VOCs) they produce (or rather, off-gas). VOCs are chemicals (invisible gases) that are emitted from solids and liquids found in the home and evaporate into the air we breathe, affecting indoor air quality. Common VOCS include acetone, benzene, ethylene glycol, formaldehyde, methylene chloride, perchloroethylene, toluene, xylene, and 1,3-butadiene – and can be found in:

• cleaning supplies
• paint strippers
• paints, varnishes and lacquers
• copiers and printers
• glues and adhesives
• air fresheners + fragrances
• cleaning products
• dry-cleaning
• photographic solutions
• permanent markers
• correction fluids
• pesticides
• personal care products
• carbonless copy paper
• carpet and rugs
• building materials and furnishings like carpeting
• cooking sources
• fuel

These chemicals can build up in houses, especially in the winter and summer months when homes are generally closed up. VOCs are a hidden issue, with the United States Environmental Protection Agency finding the levels of at least 12 commonly used volatile organic compounds to be 2-5 times higher in homes than outside[18].

Most people are not even aware of this problem, even though many of us do realise that paint and varnish fumes usually produce unwell feelings. Repeated exposure to VOCs can cause:

• blurred vision
• headaches
• nausea
• dizziness
• loss of coordination
• coughing
• lethargy
• burning eyes, nose and throat
• skin rashes
• respiratory irritation
• reduced lung function
• respiratory illness
• concentration difficulties
• depression
• in extreme cases, loss of consciousness and suffocation

Higher exposure can lead to liver damage, kidney and central nervous system irregularities. Some VOCs can cause cancer.

Microbial Volatile Organic Compounds (MVOCs) are simply VOCs that are produced by actively growing mould. The musty odour which you may smell from mould is caused by MVOCs. These odours are actually chemicals which are produced by moulds during some parts of the mould’s growth cycle. Laboratory experiments have identified over 200 compounds as MVOCs and there is even a database[19] to catalogue them.

When mould levels are elevated and there is chronic exposure in the home negative health effects, or worsening of existing illnesses, may be experienced. These health effects could include allergies, skin irritations, asthma, respiratory infection, and toxic poisoning. In addition, individuals with suppressed immune systems may be particularly vulnerable to illnesses caused by mould contamination.

Not all moulds generate MVOCs, and even moulds that do generate MVOC’s don’t do so all the time. Production of toxins and microbial volatile organic compounds (MVOCs) by mould is also dependent upon many factors, such as the substrate on which mould is growing[20], relative humidity, light and temperature in the mouldy environment.

CIRS – Chronic Inflammatory Response Syndrome

If you’re lucky enough not to be genetically susceptible to mould, the consequences of mould exposure on your health end there (not particularly comforting, right?). However, around 25% of the population are unable to metabolise and eliminate the effects of mould on the body and that has seriously grave consequences. Unfortunately I am one of them.

Chronic Inflammatory Response Syndrome, or CIRS (pronounced ‘sirs’) for short, is not exclusive to mould illness (also known as biotoxin illness) but for the purpose of  my blog posts on mould – when I say CIRs I am referring to it as it relates to mould or biotoxin illness.

So what on earth is CIRS??

Most of what we know about this condition is the result of practice-based studies done by physician-researcher Dr Ritchie Shoemaker. It was back in 1997 when Shoemaker, a family physician based in the rural coastal town of Pocomoke, Maryland, linked an illness to a toxin produced by a fish-killing dinoflagellate known as Pfiesteria.

Since then, Shoemaker and others have linked the same kind of illness to toxins from moulds commonly found in water-damaged buildings—species of Stachybotris, Aspergillus, Penicillium, Chaetomium, Wallemia, and others[21]—and potentially to toxins associated with tick-borne microbes (Borrelia, Babesia, Bartonella, Anaplasma, and Ehrlichia).

Shoemaker developed an increasingly thorough description of an illness caused by poor clearance of biotoxins produced by certain dinoflagellates, algae, and moulds. He named it Chronic Inflammatory Response Syndrome (CIRS) and he successfully developed methods to diagnose and treat it.

Shoemaker speculates that the neuroimmune, vascular, and endocrine dynamics present in CIRS may play roles in other forms of chronic illness including chronic fatigue syndrome (CFS), fibromyalgia (FM), post-treatment Lyme syndrome (PTLS), and multiple sclerosis (MS). He subsequently mapped out the pathways involved in CIRS and developed a case definition for the condition. The biotoxin-driven multisystem, multisymptom pathway imbalance persists until the culprit biotoxins are effectively cleared from the body and the neuroimmune, vascular, and endocrine imbalances are corrected[22]. Among the sources of biotoxins that can produce CIRS, biotoxins from moulds known to grow in water-damaged buildings (WDB) account for some 80% of the CIRS-related illness burden. In the case of mould toxins, recovery depends on continual effort to avoid re-exposure.

There are many more symptoms that can be a result of CIRS and you can find a very comprehensive list here: http://www.survivingtoxicmold.com/symptoms_list NB: it is important to always identify the cause of your symptoms as other conditions and diseases may also appear like CIRS (i.e. Lyme disease). Appropriate assessment will determine the underlying causes and I will cover CIRS  in much greater depth, and how to accurately assess whether you have it, in an upcoming blog post.

What Next?

Dave Asprey has actually put together a documentary on the perils of mould (Moldy Movie) and you can watch it for free online, here: Moldy Movie. It is only 60 minutes and, whilst it does highlight some fairly extreme cases, it does a great job of showcasing why mould needs to be taken very seriously.

Also, over the coming weeks I will be sharing with you

• The Red Flags – how to identify if something if you have a mould problem
  • what to look for in your home and your possessions
  • signs and symptoms to be mindful of health wise
• The Mould Busters – how to get your home or building properly assessed, diagnosed and remediated
  • what you can do yourself and, when and where to get in the professionals
  • what to do if you own the property or if you are renting (also, your legal rights and responsibilities as a tenant!)
  • appropriate property remediation (and whether it needs to be medically sound) as well as personal effects remediation (what can be treated and what must be thrown away)
• The Health Professionals – how to have your health assessed and therefore an appropriate treatment plan formulated
  • who to see, and why
  • what tests will determine whether you have CIRS
  • what a typical treatment will entail

In the meantime, if you are in urgent need of further information please feel free to contact me here or check out the following resources:

• www.survivingmold.com
• www.moldillnessmadesimple.com
• www.survivingtoxicmold.com
• www.toxicmoldillness.com
• www.townsendletter.com/FebMarch2017/mold0217.html
• www.mycotox.com.au
• www.toxic-mould-support-australia.org

If you have been affected by mould yourself, I’d love to hear your story below – please let me know!

References:

1. Kuhn DM, Ghannoum MA. Indoor Mold, Toxigenic Fungi, and Stachybotrys chartarum: Infectious Disease Perspective. Clin Microbiol Rev. 2003; 16(1): 144–172.
2. https://my.clevelandclinic.org/health/articles/aspergillosis
3. Paterson RR, et al. Toxicology of mycotoxins. EXS. 2010
4. Pfohl-Leszkowicz A, Manderville RA. Ochratoxin A: An overview on toxicity and carcinogenicity in animals and humans. Mol Nutr Food Res. 2007. Volume 51, Issue 9, p1192.
5. Bendale AM et al. Ochratoxin A carcinogenesis in the (C57BL/6J X C3H) F1mouse. J Natl Cancer Inst 1985. 75(4):733-42.
6. Boorman GA. Toxicology and Carcinogenesis studies of Ochratoxin Ain F344/N rats. National Toxicology Program 1989. NTP TR  358.
7. Al-Anati L, Petzinger E. Immunotxic activity of Ochratoxin A. J Vet Pharmacol There 2006. 29(2): 79-90
8. Jennings-Gee JE, Tozlovanu M, Manderville R, et al. Ochratoxin A: In Utero Exposure in Mice Induces Adducts in Testicular DNA. Toxins (Basel). 2010; 2(6): 1428–1444.
9. Duarte et al. 2011
10. Kumar R, Ansari KM, Chaudhari BP, et al. Topical Application of Ochratoxin A Causes DNA Damage and Tumor Initiation in Mouse Skin. PLoS ONE 7 2012(10): e47280.
11. N. Dipaolo, A. Guarnieri, G. Garosi, et al. Inhaled mycotoxins lead to acute renal failure. Nephrology Dialysis Transplantation 1994. Vol. 9, supplement 4, pp. 116–120.
12. Belmadani, A et al. Selective toxicity of ochratoxin A in primary cultures from different brain regions. Arch Toxicol 1999. 73(2):108-114.
13. Malir F, Ostry V, Pfohl-Leszkowicz A, et al. Ochratoxin A: 50 Years of Research. Toxins (Basel). 2016l; 8(7): 191.
14. Hope JH, Hope BE. A Review of the Diagnosis and Treatment of Ochratoxin A Inhalational Exposure Associated with Human Illness and Kidney Disease including Focal Segmental Glomerulosclerosis. Journal of Environmental and Public Health Volume 2012
15. Jedrychowski W, Maugeri U, Stinter L, et al. COGNITIVE FUNCTION OF 6-YEAR OLD CHILDREN EXPOSED TO MOLD-CONTAMINATED HOMES IN EARLY POSTNATAL PERIOD. PROSPECTIVE BIRTH COHORT STUDY IN POLAND. Physiol Behav. 2011; 104(5): 989–995.
16. Ezra N, Dang K, Heuser G. Improvement of attention span and reaction time with hyperbaric oxygen treatment in patients with toxic injury due to mold exposure. Eur J Clin Microbiol Infect Dis. 2011;30(1):1-6. 
17. Rosenblum Lichtenstein JH, Hsu YH, Gavin IM, et al. Environmental mold and mycotoxin exposures elicit specific cytokine and chemokine responses. PLoS One. 2015;10(5):e0126926.
18. United States Environmental Protection Agency. The inside story: a guide to indoor air quality. Publications and Resources.
19. Lemfack MC, Nickel J, Dunkel M, et al. mVOC: a database of microbial volatiles. Nucleic Acids Res. 2014; 42(Database issue): D744–D748.
20. Fiedler K, Schütz E, Geh S. Detection of microbial volatile organic compounds (MVOCs) produced by moulds on various materials. Int J Hyg Environ Health. 2001;204(2-3):111-21.
21. Shoemaker RC, Schaller J, Schmidt P. (2005) Mold Warriors: Fighting America’s Hidden Threat. Gateway Press: Baltimore.
22. Shoemaker RC, Hudnell HK. Possible estuary-associated syndrome: symptoms, vision, and treatment. Environmental Health Perspectives. 2001;109(5):539-545.