The Journal of Allergy and Clinical Immunology
Volume 118, Issue 3 , Pages 767-768, September 2006

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  • Robert A. Wood, MD

      Affiliations

    • From the Department of Pediatrics, Johns Hopkins Medical Center, Baltimore, Md
    • ,
  • Robert K. Bush, MD

      Affiliations

    • Department of Medicine, University of Wisconsin, Madison, Wis

Article Outline

 

To the Editor:

We appreciate the thoughtful responses regarding the position statement on mold allergy published in the February 2006 issue of the Journal.1 Because many of these letters contain similar sentiments,2, 3, 4, 5, 6, 7, 8 we will respond to them as a group but make every effort to address the major points from each.

Our approach to developing the position statement was to require definitive evidence for all conclusions and recommendations. For example, although it is recognized from clinical observation that molds can cause allergic rhinitis, the rigor of scientific studies and the resulting body of evidence on this association to date were considered to be insufficient to permit definitive conclusions about this relationship. As was well stated by Dr Marinkovich,9 lack of evidence is not necessarily evidence against.

The issue of mycotoxins was a major concern in most of the letters. We struggled with this topic and concluded that the weight of the evidence does not support a clear relationship between mycotoxin exposure and adverse health effects. We did an exhaustive literature search in the preparation of this statement and clearly did not overlook the many citations provided in the above letters. We also made it clear in the statement's introduction that space constraints limited the number of references that could be included. In our final analysis, we believed that the purported adverse health effects of mycotoxins are still not definitive. Many of these citations, in fact, do support the adverse health effects of mold exposure but not necessarily the specific contribution of mycotoxins to these health effects. We fully admit that this might be another example of an overly conservative approach.

Several of the letters expressed concern about our conclusions regarding the utility of IgG antibody assays. We respect the opinions expressed in these letters and have carefully reviewed the citations provided. We continue to believe, however, that these assays have only a limited role in the assessment of mold-related illness and should not be widely recommended.

It is clear that this is an area of great controversy. It is also clear that this is a rapidly evolving science and that much of the controversy will be settled with ongoing evidence-based research. To that end, we are confident that the Academy and the Journal will continue to lead the way in analyzing and disseminating this information. This position statement was intended to provide an up-to-date review of this topic but was never intended to be the final word. Further research is needed on many of these mold-related topics before definitive conclusions can be reached.

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References 

  1. Bush RK, Portnoy JM, Saxon A, Terr AI, Wood RA. The medical effects of mold exposure. J Allergy Clin Immunol. 2006;117:326–333
  2. Goldstein GB. Adverse reactions to fungal metabolic products in mold-contaminated areas. J Allergy Clin Immunol. 2006;118:760–761
  3. Straus DC, Wilson SC. Respirable trichothecene mycotoxins can be demonstrated in the air of Stachybotrys chartarum–contaminated buildings. J Allergy Clin Immunol. 2006;118:760
  4. Kilburn KH, Gray M, Kramer S. Nondisclosure of conflicts of interest is perilous to the advancement of science. J Allergy Clin Immunol. 2006;118:766–767
  5. Lieberman A, Rea W, Curtis L. Adverse health effects of indoor mold exposure. J Allergy Clin Immunol. 2006;118:763
  6. Shoemaker RC, Ammann H, Lipsey R, Montz E. Rigor, transparency, and disclosure needed in mold position paper. J Allergy Clin Immunol. 2006;118:764–766
  7. Ponikau JU, Sherris DA. The role of airborne mold in chronic rhinosinusitis. J Allergy Clin Immunol. 2006;118:762–763
  8. Strickland MHV. How solid is the Academy position paper on mold exposure?. J Allergy Clin Immunol. 2006;118:763–764
  9. Marinkovich VA. Position paper on molds is seriously flawed. J Allergy Clin Immunol. 2006;118:761–762

 Disclosure of potential conflict of interest: R. K. Bush has consultant arrangements with Ventria Science, Central Biosciences, and Broadata Communications and research support from the US Department of Veteran Sciences, National Institutes of Health, and Cooper Laboratories; R. A. Wood has declared no conflict of interest.

PII: S0091-6749(06)01385-6

doi:10.1016/j.jaci.2006.06.032

The Journal of Allergy and Clinical Immunology
Volume 118, Issue 3 , Pages 767-768, September 2006

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