Purpose: The authors reviewed the published scientific literature to determine whether or not there is sufficient evidence to conclude that mycotoxins from indoor molds are causally associated with health problems.

Design: Review.

Outcome: Using MEDLINE and a literature database maintained by the National Institute for Occupational Safety and Health, the authors identified 13 articles addressing the presence of fungi and mycotoxins in buildings that purportedly had moisture problems. The authors focused on articles published by Croft et al., Hodgson et al., and Johanning et al., as part of their review. Page and Trout observed that all of these case studies suffered from methodological flaws. For example, the Croft case series was a descriptive report of five individuals with a variety of nonspecific symptoms. Page and Trout pointed out that the cases were poorly defined and the procedure for medical evaluations was not well described. The study by Hodgson and colleagues used undefined clinical diagnoses and epidemiological case definitions, making it difficult to interpret the reported symptoms and pulmonary function test results. Page and Trout also noted that Johanning and colleagues did not define cases; instead, a comparison was made of complaints from employees of a problem building with complaints from workers in a building with no known problems. Using this type of qualitative comparison, Johanning and colleagues found an excess of nonspecific symptoms in the problem building. Page and Trout opined that all of these studies were inconclusive and that research involving the identification and isolation of specific fungal toxins in the environment is needed before a more definitive link between health outcomes and mycotoxins can be made.

Significant Quote: "This review of the literature indicates that there is inadequate evidence to support the conclusion that exposure to mycotoxins in the indoor (nonindustrial) environment is causally related to symptoms or illness among building occupants." (p. 647).

Defendants' Perspective: The report concludes that the case studies done so far in the area of building-related mycotoxins are inconclusive because of methodological limitations and incomplete data sets.

Plaintiffs' Perspective: The authors cite literature that supports the connection between mycotoxins and illness. These statements might be used to support a plaintiff's claim if taken out of context.

Peer Review: Yes.

Relevance to Ongoing Cases: The defense might use this article to cross examine experts relying on the studies by Croft, Hodgson, or Johanning and their respective colleagues.

How to Obtain the Article: http://aiha.allenpress.com/aihaonline/?request=index-html