Purpose: The author investigated the clinical presentation of exposure to toxic fungi such as Stachybotrys chartarum.

Design: Retrospective case series. Medical records were reviewed for adults and children from an ambulatory occupational and environmental health clinic. Cases were included if there was a verifiable history of indoor exposure to fungal air contaminants. Patients filled out a survey listing discomforts that they were experiencing and underwent laboratory testing to determine blood cell count and antibody presence. The authors also examined a single "sentinel" family living in an apartment with a history of moisture problems and widespread fungal growth on interior surfaces.

Outcome: The authors reported that there was a high prevalence of reported symptoms of the upper and lower airways, eyes, and central nervous system. Johanning and colleagues reported that only five percent of the children had evidence of specific IgE antibodies to the five fungal allergens tested. From this low percentage, the authors discounted the possibility of allergies as the major cause of illness. The authors described that after leaving the apartment, the sentinel cases reported marked improvements and partial resolutions of their health problems. Inside the apartment, the authors identified very high levels of fungi, with a predominance of Cladosporium and Stachybotrys chartarum. Cockroach antigen was high, according to the standards established by the National Cooperative Inner-City Asthma Study, although none of the sentinel case children had antibodies specific for cockroach antigen.

Significant Quote: "On the basis of available data and the observed health improvement with exposure cessation, we concluded that indoor fungal exposure was the probable contributing cause of the health problems associated with living in this apartment. Some other unidentified agents or conditions may have also contributed to the improved outcome, although we think this is very unlikely under the circumstances." (p. 493).

Defendants' Perspective: The authors were not able to establish a direct link between fungal exposure and the symptoms in this case series.

Plaintiffs' Perspective: The authors determined that allergies were not a possible explanation for the symptoms because of the lack of antibody correlation, leaving the fungal exposure as the most likely cause.

Peer Review: Yes.

Relevance to Ongoing Cases: The plaintiffs will likely cite this study in order to connect reported health problems with indoor fungal exposure.

How to Obtain the Article: http://ehpnet1.niehs.nih.gov/docs/allpubs.html