What lab tests can determine if a patient has mold exposure symptoms?

Laboratory Testing for Mold Exposure Symptoms

There are currently no validated or standardized laboratory tests to determine if a patient has symptoms due to mold exposure. 1

Current State of Diagnostic Testing

• There are no uniformly accepted, valid quantitative environmental sampling methods or serologic tests to assess exposures to mold and other agents associated with damp indoor environments 1
• There is currently no method to test humans specifically for toxigenic mold exposure 1
• Immunoassays for mold have not been standardized for clinical use, and it is not clear what levels are associated with health effects 1
• Major limitations to serum antigen-specific IgG/IgA testing include lack of standardized antigen preparations, lack of standardized immunoassay techniques, variable diagnostic cutoff thresholds, and limited validation in population settings 1

Diagnostic Approach for Suspected Mold Exposure

History and Environmental Assessment

• Focus on identifying visible signs of mold growth (discolored patches, cottony growth on walls/furniture, evidence of dampness/water damage, musty odor) 1
• Environmental sampling may be useful to identify the source if there is suspicion of mold (musty odor) but no visible growth 1
• If environmental sampling is performed, it should be done by professionals such as industrial hygienists or indoor environmental quality consultants 1
• Consultation with a certified environmental hygienist for visual inspection of an indoor environment may help identify an antigenic source 1

Clinical Evaluation

• Symptoms commonly associated with mold exposure include:
  • Respiratory symptoms (rhinitis, cough, asthma-like symptoms) 2
  • Headache and fatigue 2
  • Central nervous system symptoms 2
  • Increased morbidity due to respiratory tract infections 3

Limited Role of Laboratory Testing

• Serum antigen-specific IgG/IgA testing has poor diagnostic utility and should not be relied upon to confirm or rule out mold-related symptoms 1
• When there is questionable exposure based on history, detection of serum antigen-specific IgG/IgA may suggest a putative exposure, but lacks consistent support as a reproducible and accurate diagnostic tool 1
• Antigen-specific inhalation challenge testing is not recommended due to lack of standardized preparations and techniques 1

Management Considerations

• The key to mold control is moisture control - identify and eliminate sources of chronic moisture 1
• Remediation of water-damaged items should be performed promptly (within 24 hours) 1
• For patients with suspected hypersensitivity pneumonitis related to mold, classification based on likelihood of occupational or environmental inciting antigen exposure is suggested 1
• Mold-related symptoms may improve with avoidance of exposure 4, though evidence for specific treatments is limited

Common Pitfalls to Avoid

• Relying solely on laboratory tests to diagnose mold-related illness 1
• Assuming that all non-specific symptoms are caused by mold exposure when other conditions may be responsible 5
• Failing to address the underlying moisture problem that allows mold growth 1
• Overlooking the potential for allergic reactions to mold, which are more common than toxic effects 2, 5

Despite claims by some practitioners, there is insufficient evidence supporting the use of specialized laboratory tests for diagnosing "toxic mold syndrome" or similar conditions 5, 6. The focus should be on identifying and remediating sources of mold exposure rather than pursuing unvalidated testing.