What is the treatment for mold allergy?

Treatment for Mold Allergy

The treatment of mold allergy consists of three pillars: environmental avoidance/remediation, pharmacotherapy for symptom control, and allergen immunotherapy for select patients with confirmed IgE-mediated sensitization. 1

Environmental Control and Remediation

Environmental control is the foundation of mold allergy management and must be addressed before other interventions can be effective. 2

Immediate Remediation Steps

• Water-damaged materials must be cleaned within 24 hours to prevent mold amplification. 2
• For areas less than 10 ft², patients can perform cleanup themselves using soap and water or bleach solution on nonporous surfaces. 2
• For areas greater than 10 ft² or HVAC system involvement, professional remediators should be hired. 2
• Porous materials (carpet, drywall, wood) must be discarded rather than cleaned, as mold cannot be adequately removed from these substrates. 2

Moisture Control Strategies

• Maintain indoor humidity below 50% using dehumidifiers, as moisture control is the cornerstone of mold prevention. 2
• Vent moisture-producing appliances (clothes dryers, stoves) to the outside. 1
• Use bathroom fans or open windows during showering; wipe shower walls with towels after use. 1
• Avoid carpeting in bathrooms and basements. 1, 2
• Insulate cold water pipes to prevent condensation. 1

Air Filtration

• HEPA filters can reduce airborne spore concentrations in single rooms. 1, 2
• Medium-efficiency filters (20-50% efficiency for 0.3-10 μm particles) should be used for central HVAC systems. 1
• Avoid ozone generators marketed as "air purifiers," as they produce harmful ozone levels without proven benefit. 1, 2
• Close doors and windows during high outdoor mold seasons; use air conditioning. 1

Pharmacotherapy

First-Line Medications

Intranasal corticosteroids are the primary pharmacologic treatment for mold-induced allergic rhinitis. 3

• Fluticasone propionate nasal spray: 2 sprays per nostril once daily for adults; 1 spray per nostril once daily for children ≥4 years. 3
• Effects may begin within 12 hours but take several days of regular use to reach maximum efficacy. 3
• Should be used on a regular basis, not as-needed. 3

Leukotriene Receptor Antagonists

• Montelukast 10 mg once daily is effective for perennial allergic rhinitis, which includes mold allergy. 4
• Particularly useful for patients with concomitant asthma. 4
• Can be used as monotherapy or in combination with intranasal corticosteroids. 4

Additional Considerations

• Antihistamines may be added for ocular symptoms or breakthrough symptoms. 3
• For asthma exacerbations triggered by mold, standard asthma controller medications should be optimized. 1

Allergen Immunotherapy

Allergen immunotherapy should be considered for patients with demonstrable IgE antibodies to clinically relevant molds when symptoms cannot be adequately controlled by avoidance and pharmacotherapy. 1

Patient Selection Criteria

• Patients must have specific IgE antibodies to mold allergens confirmed by skin testing or in vitro testing. 1
• Clinical symptoms must correlate with mold exposure and positive testing. 1
• If the patient has asthma, it must be stable with pharmacotherapy before initiating immunotherapy. 1
• Patients must be cooperative and compliant. 1

Evidence for Mold Immunotherapy

• Immunotherapy is effective for Alternaria and Cladosporium species, though the evidence is of low strength. 1, 5
• Studies show higher benefit with longer follow-up periods and in well-designed trials. 5
• The allergen content of most commercially available mold extracts is variable and generally low, which limits efficacy. 1
• Extracts for many clinically important fungi (ascospores, basidiospores) are not commercially available. 1

Critical Mixing Considerations

Mold extracts contain proteolytic enzymes that can digest other allergens (pollens, dust mites) and must be separated when preparing immunotherapy mixtures. 1

• Mold extracts should be kept in separate vials from pollen and dust mite extracts. 1
• This separation prevents enzymatic degradation of other allergen components. 1

Safety Profile

• Subcutaneous immunotherapy: 37.2% of participants experienced generalized adverse reactions. 5
• Sublingual immunotherapy: 12.5% of participants experienced generalized adverse reactions. 5
• Immunotherapy should only be administered where equipment and personnel for treating anaphylaxis are immediately available. 1

Special Populations

Infants with Acute Idiopathic Pulmonary Hemorrhage

• Inquire about home water damage and mold exposure in infants with AIPH. 1, 2
• Moisture sources and mold growth must be eliminated before the infant returns home. 1, 2

Immunocompromised Patients

• Require HEPA-filtered rooms with positive pressure for inpatient care. 2
• Should avoid gardening, mulch spreading, and proximity to construction/renovation. 2
• No plants or cut flowers should be allowed in patient rooms. 2

Common Pitfalls to Avoid

• Do not rely on environmental testing to guide treatment decisions; clinical correlation with symptoms and IgE testing is essential. 1
• Do not use single-component allergen mitigation strategies (e.g., mattress covers alone); they are rarely effective. 1
• Do not mix mold extracts with other allergens in immunotherapy preparations due to proteolytic enzyme activity. 1
• Do not initiate immunotherapy in patients with unstable asthma. 1
• Distinguish between indoor molds (Penicillium, Aspergillus) and outdoor molds (Alternaria, Cladosporium) when assessing clinical relevance. 1