From Cheryl Wisecup
This submission is dedicated to the millions of families, teachers, employees, and school children throughout the world who have been harmed by exposure to molds and mycotoxins…and to the countless advocates, doctors, scientists and others who have been working tirelessly for years to bring this very important issue to the forefront.
I recently contacted the WHO and mentioned that their 2009 report was missing some publications relating to the health effects of molds and mycotoxins. They invited me to submit a list of publications that may have been omitted. The attached information was sent today to the World Health Organization.
Please keep in mind as you review this information that there are thousands of documents available relating to the health effects of molds and mycotoxins. The attached lists are not intended to include every possible publication. I cross-checked my lists against the lists of references included in the 2009 WHO “Guidelines for Indoor Air Quality–Dampness and Mould” and the 2004 IOM report on “Damp Indoor Spaces and Health” to ensure I wasn’t duplicating their sources.
Please feel free to share this with others.
Subject: Submission of additional publications regarding mold and mycotoxins
Date: Wed, 7 Oct 2009
Dear Mr. Krzyzanowski,
The 2009 WHO “Guidelines for Indoor Air Quality–Dampness and Mould” is an excellent report. The report is making a significant difference in the international understanding of the health effects of moulds and mycotoxins. It is specifically noted that the WHO did an outstanding job of highlighting the immunological effects.
As I mentioned in my previous communication, there are several additional publications that were not included in the literature review for the WHO report. There are also several items that were excluded from the IOM review when they prepared their 2004 report on “Damp Indoor Spaces and Health.” I appreciate your invitation to provide a list of additional literature items for your consideration. As you are aware, there are thousands of publications on this topic. The attached lists are not intended to consist of all possible documents, but I hope you find it helpful and hope it leads you to additional sources of information.
I would like to provide a few brief comments:
1. There are two files attached. The first file includes literature items that were published prior to the WHO cutoff date of June 2007 and prior to the IOM cutoff date of 2003. The second file has a few select items that have been published since July 2007. I included only a few of the newer items because I am sure you will do an extensive search when you are ready to update your report.
2. I included the report by Etzel et al titled “Acute Pulmonary Hemorrhage in Infants Associated with Exposure to Stachybotrys atra and Other Fungi.” On page 81 of the WHO 2009 Guidelines for Indoor Air Quality, it states that this 1998 report by Etzel et al had been retracted. That statement is incorrect. Per Dr. Etzel, this report has not been retracted.
3. There are certain stakeholders who try to confuse this issue by claiming that molds and mycotoxins are only harmful if ingested (not inhaled or touched). This is simply a marketing ploy and is not valid. Molds and mycotoxins are harmful to humans whether exposure is by “ingestion, inhalation, skin and mucosal exposure, or by a combination of two or more of these routes.” The following items represent a few examples where this issue is addressed.
a. From page 96 of the “U.S. Army Medical Management of Biological Casualties.”
“Exposure causes skin pain, pruritis, redness, vesiculation, necrosis, and sloughing of the epidermis. Effects on the airway include nose and throat pain, nasal discharge, itching and sneezing, cough, dyspnea, wheezing, chest pain, and hemoptysis. Toxin also produces similar effects after ingestion or eye contact. Severe intoxication results in prostration, weakness, ataxia, collapse, shock, and death.”
b. The following quote is from page 284 of the 2006 paper titled, “What the Primary Care Pediatrician Should Know about Syndromes Associated with Exposures to Mycotoxins” (by Etzel RA).
“Mycotoxins can have protean manifestations; the symptoms depend on the specific toxin or mixture of toxins, the age, sex, and diet of the child, the dose, and whether exposure is by ingestion, inhalation, skin and mucosal exposure, or a combination of two or more of these routes. The most well-characterized presentations among infants and children are summarized in Table 2 under four headings: vomiting illness, bone marrow failure, acute pulmonary hemorrhage, and recurrent episodes of apnea and/or pneumonia.”
c. Another good source is the ACGIH book (published in 1999) titled “Bioaerosols: Assessment and Control.” This book has a lot of information about the health effects of mycotoxins including the chart of health effects from “ingestion, dermal, or inhalation exposure” on page 24-3.
d. The following statements are from Dr. Harriet Amman’s 2002 report titled “Is Indoor Mold Contamination a Threat to Health?”
“Because molds grow in moist or wet indoor environments, it is possible for people to become exposed to molds and their products, either by direct contact on surfaces, or through the air, if mold spores, fragments, or mold products are aerosolized.”
“Health effects from exposures to molds in indoor environments can result from allergy, infection, mucous membrane and sensory irritation and toxicity alone, or in combination.”
e. On page 6 of the 2008 report by the U.S. Government Accountability Office, they state:
“Mold may affect human health through a number of routes and mechanisms. While inhalation is generally the most common route of exposure for mold in indoor environments, exposure can also occur through ingestion (for example, hand-to-mouth contact) and contact with the skin. The roles of these routes of exposure in causing illness are unclear. Once exposure occurs, health effects may arise through several potential mechanisms, including allergic (or immune-mediated), infectious, and toxic. It is not always possible to determine which of these mechanisms is associated with a specific health outcome.”
Thank you again for your invitation to submit additional literature items. I look forward to hearing from you after you have had an opportunity to review this information.