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Appendix B - Introduction to Molds Molds in the Environment Health Effects and Symptoms Associated with Mold Exposure   -  Allergic Reactions   -  Asthma   -  Hypersensitivity Pneumonitis   -  Irritant Effects   -  Opportunistic Infections Mold Toxins (Mycotoxins)   -  Toxic Molds Microbial Volatile Organic Compounds (mVOCs) Glucans or Fungal Cell Wall Components (also known as ?-(1-->3)-D-Glucans) Spores Molds in the Environment Molds live in the soil, on plants, and on dead or decaying matter. Outdoors, molds play a key role in the breakdown of leaves, wood, and other plant debris. Molds belong to the kingdom Fungi, and unlike plants, they lack chlorophyll and must survive by digesting plant materials, using plant and other organic materials for food. Without molds, our environment would be overwhelmed with large amounts of dead plant matter. Molds produce tiny spores to reproduce, just as some plants produce seeds.   These mold spores can be found in both indoor and outdoor air, and settled on  indoor and outdoor surfaces. When mold spores land on a damp spot, they may begin growing and digesting whatever they are growing on in order to survive.  Since molds gradually destroy the things they grow on, you can prevent damage to building materials and furnishings and save money by eliminating mold growth. Moisture control is the key to mold control. Molds need both food and water to survive; since molds can digest most things, water is the factor that limits mold growth. Molds will often grow in damp or wet areas indoors. Common sites for   indoor mold growth include bathroom tile, basement walls, areas around windows where moisture condenses, and near leaky water fountains or sinks. Common sources or causes of water or moisture problems include roof leaks, deferred maintenance, condensation associated with high humidity or cold spots in the building, localized flooding due to plumbing failures or heavy rains, slow leaks in plumbing fixtures,   and malfunction or poor design of humidification systems. Uncontrolled humidity   can  also be a source of moisture leading to mold growth, particularly in hot, humid climates. Health Effects and Symptoms Associated with Mold Exposure When moisture problems occur and mold growth results, building occupants may begin to report odors and a variety of health problems, such as headaches,  breathing difficulties, skin irritation, allergic reactions, and aggravation of asthma symptoms; all of these symptoms could potentially be associated with mold exposure. All molds have the potential to cause health effects. Molds produce allergens, irritants, and in some cases, toxins that may cause reactions in humans. The types and severity of symptoms depend, in part, on the types of mold present, the extent of an individual's exposure, the ages of the individuals, and their existing sensitivities or allergies.  Specific reactions to mold growth can include the following: Allergic Reactions Inhaling or touching mold or mold spores may cause allergic reactions in sensitive individuals. Allergic reactions to mold are common - these reactions can be immediate or delayed. Allergic responses include hay fever-type symptoms, such as sneezing, runny nose, red eyes, and skin rash (dermatitis). Mold spores and fragments can produce allergic reactions in sensitive individuals regardless of whether the mold is dead or alive. Repeated or single exposure to mold or mold spores may cause previously non-sensitive individuals to become sensitive. Repeated exposure has the potential to increase sensitivity.   Asthma Molds can trigger asthma attacks in persons who are allergic (sensitized) to molds. The irritants produced by molds may also worsen asthma in non-allergic (non-sensitized) people.   Hypersensitivity Pneumonitis Hypersensitivity pneumonitis may develop following either short-term (acute) or long-term (chronic) exposure to molds. The disease resembles bacterial pneumonia and is uncommon.   Irritant Effects Mold exposure can cause irritation of the eyes, skin, nose, throat, and lungs, and sometimes can create a burning sensation in these areas.   Opportunistic Infections People with weakened immune systems (i.e., immune-compromised or immune-suppressed individuals) may be more vulnerable to infections by molds (as well as more vulnerable than healthy persons to mold toxins). Aspergillus fumigatus, for example, has been known to infect the lungs of immune-compromised individuals. These individuals inhale the mold spores which then start growing in their lungs. Trichoderma has also been known to infect immune-compromised children. Healthy individuals are usually not vulnerable to opportunistic infections from airborne mold exposure. However, molds can cause common skin diseases, such as athlete's foot, as well as other infections such as yeast infections. Potential Health Effects Associated with Inhalation Exposure to Molds and Mycotoxins Allergic Reactions (e.g., rhinitis and dermatitis or skin rash);  Asthma; Hypersensitivity Pneumonitis; Other Immunologic Effects Research on mold and health effects is ongoing. This list is not intended to be all-inclusive. The health effects listed above are well documented in humans. Evidence for other health effects in humans is less substantial and is primarily based on case reports or occupational studies. Mold Toxins (Mycotoxins) Molds can produce toxic substances called mycotoxins. Some mycotoxins cling to the surface of mold spores; others may be found within spores. More than 200 mycotoxins have been identified from common molds, and many more remain to be identified. Some of the molds that are known to produce mycotoxins are commonly found in moisture-damaged buildings. Exposure pathways for mycotoxins can include inhalation, ingestion, or skin contact. Although some mycotoxins are well known to affect humans and have been shown to be responsible for human health effects, for many mycotoxins, little information is available. Aflatoxin B1 is perhaps the most well known and studied mycotoxin. It can be produced by the molds Aspergillus flavus and Aspergillus parasiticus and is one of the most potent carcinogens known. Ingestion of aflatoxin B1 can cause liver cancer. There is also some evidence that inhalation of aflatoxin B1 can cause lung cancer. Aflatoxin B1 has been found on contaminated grains, peanuts, and other human and animal foodstuffs. However, Aspergillus flavus and Aspergillus parasiticus are not commonly found on building materials or in indoor environments. Much of the information on the human health effects of inhalation exposure to mycotoxins comes from studies done in the workplace and some case studies or case reports.* Many symptoms and human health effects attributed to inhalation of mycotoxins have been reported including: mucous membrane irritation, skin rash, nausea, immune system suppression, acute or chronic liver damage, acute or chronic central nervous system damage, endocrine effects, and cancer. More studies are needed to get a clear picture of the health effects related to most mycotoxins. However, it is clearly prudent to avoid exposure to molds and mycotoxins. Some molds can produce several toxins, and some molds produce mycotoxins only under certain environmental conditions. The presence of mold in a building does not necessarily mean that mycotoxins are present or that they are present in large quantities. ___________________ * Information on ingestion exposure, for both humans and animals, is more abundant -- wide range of health effects has been reported following ingestion of moldy foods including liver damage, nervous system damage, and immunological effects. Toxic Molds Some molds, such as Aspergillus versicolor and Stachybotrys atra (chartarum), are known to produce potent toxins under certain circumstances.  Although some mycotoxins are well known to affect humans and have been shown to be responsible for human health effects, for many mycotoxins, little information is available, and in some cases research is ongoing.  For example, some strains of Stachybotrys atra can produce one or more potent toxins.  In addition, preliminary reports from an investigation of an outbreak of pulmonary hemorrhage in infants suggested an association between pulmonary hemorrhage and exposure to Stachybotrys chartarum.  Review of the evidence of this association at CDC resulted in an a published clarification stating that such an association was not established.  Research on the possible causes of pulmonary hemorrhage in infants continues.  Consult the Centers for Disease Control and Prevention (CDC) for more information on pulmonary hemorrhage in infants.  (See Resources list for CDC contact and other information.)   Microbial Volatile Organic Compounds (mVOCs) Some compounds produced by molds are volatile and are released directly into the air. These are known as microbial volatile organic compounds (mVOCs). Because these compounds often have strong and/or unpleasant odors, they can be the source of odors associated with molds. Exposure to mVOCs from molds has been linked to symptoms such as headaches, nasal irritation, dizziness, fatigue, and nausea. Research on MVOCs is still in the early phase. Glucans or Fungal Cell Wall Components (also known as ?-(1-->3)-D-Glucans) Glucans are small pieces of the cell walls of molds which may cause inflammatory lung and airway reactions. These glucans can affect the immune system when inhaled. Exposure to very high levels of glucans or dust mixtures including glucans may cause a flu-like illness known as Organic Dust Toxic Syndrome (ODTS). This illness has been primarily noted in agricultural and manufacturing settings. Spores Mold spores are microscopic (2-10 um) and are naturally present in both indoor and outdoor air. Molds reproduce by means of spores. Some molds have spores that are easily disturbed and waft into the air and settle repeatedly with each disturbance. Other molds have sticky spores that will cling to surfaces and are dislodged by brushing against them or by other direct contact. Spores may remain able to grow for years after they are produced. In addition, whether or not the spores are alive, the allergens in and on them may remain allergenic for years