From the Guidelines
There are blood and urine tests available for detecting mold exposure, though they have significant limitations and should be interpreted with caution. According to the most recent study 1, timely and accurate diagnosis of pulmonary invasive fungal infections (pIFI) is critical, but standard of care diagnostics are insensitive and have many inherent challenges. The study highlights the limitations of fungal detection in culture and histopathology, as well as the variability in clinical test sensitivity and specificity of fungal biomarkers such as Aspergillus galactomannan (GM) and 1,3-b-D-glucan (BDG) 1.
Some of the available tests include:
- Blood tests that measure antibodies (IgG, IgM, IgE) produced in response to mold exposure
- Inflammatory markers like C4a and TGF-beta
- Mycotoxin testing in urine to detect the presence of toxins produced by certain molds However, these tests are not universally accepted in mainstream medicine and may not be covered by insurance. Their reliability is debated because they cannot definitively prove that symptoms are caused by mold exposure rather than other conditions. Additionally, the presence of mold antibodies might simply indicate past exposure without current illness.
It is essential to consult with an environmental medicine specialist or immunologist who can interpret these tests within the complete clinical picture and environmental exposure history, as recommended by the American Thoracic Society clinical practice guideline 1. The guideline suggests using more than one diagnostic test, including direct visualization and culture of sputum, BAL, or other biopsy material; urine and serum antigen testing; and serology (serum antibody testing) for patients with suspected coccidioidomycosis. The most effective approach is to use a combination of tests and clinical evaluation to establish a diagnosis, as no single test can provide a definitive diagnosis of mold exposure.
From the Research
Blood and Urine Tests for Mold Exposure
- There are limited blood and urine tests available for detecting mold exposure, and their use is not widely recommended 2.
- Some studies have used serum anti-mold immunoglobulin G antibodies and trichothecene toxin breakdown products in urine to confirm patient sensitivities and exposures 3.
- However, indoor measurements of mold fungi, microbial volatile organic compounds (MVOC), and/or mycotoxins are generally not indicated as part of the medical evaluation, nor are blood or urine tests for particular mold components or metabolites 2.
Diagnostic Approaches
- A rational diagnostic work-up for mold exposure typically begins with history-taking and physical examination, with attention to risk factors such as immune compromise and atopy 2.
- Targeted allergy diagnostics, including skin prick tests and measurement of specific IgE antibodies, may be performed if there is evidence of atopy 2.
- Serological tests, such as immunodiffusion, complement fixation, and ELISA, can be used to detect antibodies against mold infections, but their performance characteristics vary 4.
Treatment and Management
- Early diagnosis and appropriate treatment of mold exposure can be very successful, with approximately 85% of patients clearing completely and 14% having partial improvement 3.
- Treatment approaches may include mold avoidance, antigen injections, desensitization to mold antigens, and additional therapies such as sauna, oxygen therapy, and nutrients 3.