Is There a Test for Mold Toxicity?
No, there is currently no validated method to test humans for toxigenic mold exposure, and mycotoxin testing in blood or urine should be avoided as these tests are not validated for clinical use. 1, 2, 3
Why Standard "Mold Toxicity" Testing Is Not Recommended
The American Academy of Pediatrics explicitly states that:
- No standardized serologic tests exist to reliably assess exposures to mold and other agents associated with damp indoor environments 1, 3
- Assays to detect mycotoxins and microbial volatile organic compounds in blood or urine have been developed for research purposes only and have not been standardized for clinical use 2, 3
- It remains unclear what levels of these substances are associated with actual health effects 2
- There are no accepted valid airborne levels of mold that predict adverse health effects 1, 3
What Testing May Actually Be Appropriate
For Allergic/Atopic Patients
- Skin prick testing or mold-specific IgE testing can identify allergic sensitization to molds, which is relevant for allergic rhinitis, asthma exacerbations, and allergic bronchopulmonary aspergillosis 2, 4
- Note that mold sensitization prevalence is only 3-10% in the European population, indicating relatively low sensitizing potential 4
For Immunocompromised Patients
When invasive fungal infection is suspected, appropriate testing includes:
- Radiological imaging (chest CT) 2
- Microbiological cultures 2
- Serum galactomannan antigen testing for Aspergillus 2
- Immunological evaluation of immune function 2
For Suspected Hypersensitivity Pneumonitis
- High-resolution CT findings integrated with clinical findings (not used in isolation) 2, 3
- Serum antigen-specific IgG or IgA testing should NOT be relied upon solely to confirm or rule out the diagnosis 2, 3
- Antigen-specific inhalation challenge testing and lymphocyte proliferation testing are NOT recommended 3
The Clinical Approach That Actually Works
Instead of laboratory testing, focus on:
History Elements to Document
- Visible mold growth in home or workplace (discolored patches, cottony growth on walls/furniture) 1, 2
- Water damage or flooding history 1, 2
- Musty odors in specific areas 1, 2
- Timing of symptoms relative to being in the moldy environment 2
- Immune status and atopic history 2
Physical Examination Findings
- Pale nasal mucosa, pharyngeal "cobblestoning," and rhinorrhea in allergic presentations 5
- Respiratory signs including wheezing, cough, and sinus tenderness 1, 6
Critical Pitfalls to Avoid
Do not order or rely on:
- Urine mycotoxin testing - not validated for clinical use 1, 2, 3
- Blood mycotoxin testing - not validated for clinical use 1, 2, 3
- IgG antibody testing to molds - has no validated clinical relevance 7
- Environmental mold testing as part of medical evaluation - usually not necessary for visible mold growth 1, 3
The concept of "toxic mold syndrome" has been disproven, and laboratories offering these unvalidated tests propagate misinformation while inflicting unnecessary costs on patients 7
When Environmental Testing May Be Useful
Environmental sampling may be considered only when:
- There is suspicion of mold (musty odor) but no visible mold growth 3
- Testing should be performed by professionals with expertise (industrial hygienists or indoor environmental quality consultants) 3
- Air sampling requires specialized equipment and simultaneous outdoor air sample for comparison 3
- Higher indoor concentrations, predominance of one type, or differences from outdoor samples suggest an indoor problem 3
Bottom Line for Clinical Practice
The diagnosis of mold-related illness relies on clinical history and physical examination, not laboratory testing for "mold toxicity." Focus on identifying and remediating the moisture source rather than pursuing unvalidated testing. For patients with respiratory symptoms and mold exposure, treat the specific clinical condition (asthma, allergic rhinitis, hypersensitivity pneumonitis) based on established diagnostic criteria, not on mycotoxin levels. 1, 2, 4