Testing for Mold Exposure in a 6-Year-Old Child
Routine laboratory or environmental testing is not recommended for this child, as there are no validated methods to test humans for mold exposure and no accepted airborne mold levels that predict adverse health effects. 1
What NOT to Test
The American Academy of Pediatrics explicitly states the following tests should be avoided:
- No blood or urine mycotoxin testing – These assays are not standardized for clinical use and it is unclear what levels correlate with health effects 1, 2
- No serologic tests for mold exposure – There are no uniformly accepted, valid serologic tests to assess exposures to mold 1
- No environmental mold testing as part of medical evaluation – Testing the environment for specific molds is usually not necessary 1
- No method exists to test humans for toxigenic mold exposure 1, 3
Clinical Assessment Instead of Testing
Focus on symptom-based evaluation rather than laboratory testing:
History to Obtain
- Respiratory symptoms: Allergic rhinitis, cough, wheezing, asthma exacerbations 1, 3
- Mucous membrane irritation: Eyes, nose, throat symptoms 3
- Timing: Whether symptoms occur specifically at school and improve away from school 2
- Atopic history: Personal or family history of allergies or asthma 2
Physical Examination Findings
- Nasal mucosa: Look for pale, boggy appearance 4
- Pharynx: Check for "cobblestoning" 4
- Respiratory: Auscultate for wheezing 1
When Allergy Testing May Be Appropriate
If the child has documented respiratory symptoms (rhinitis, asthma, cough), consider allergy evaluation:
- Skin prick testing to mold allergens – Only if allergic symptoms are present 2, 3
- Mold-specific IgE testing – Alternative to skin testing for atopic patients with symptoms 2, 3
This testing evaluates whether the child has developed IgE-mediated allergic sensitization to molds, which occurs in approximately 5% of individuals and can cause rhinitis or asthma 5. However, this tests for allergy, not toxicity 4.
Management Priority: Environmental Remediation
The school environment must be addressed regardless of testing results, as this is the primary intervention:
- Water damage must be cleaned within 24 hours to prevent mold amplification 1, 6
- Visible mold growth requires remediation – Look for discolored patches, cottony growth, musty odors 1
- Professional remediation needed if area >10 ft² or HVAC system involved 1, 6
- Humidity should be maintained <50% to prevent growth 6, 3
Critical Pitfalls to Avoid
- Do not order mycotoxin panels – These are marketed but not validated for clinical diagnosis 1, 2
- Do not delay environmental remediation while waiting for test results that don't exist 6
- Do not attribute all symptoms to mold without evaluating for established allergic conditions first 3
- Outdoor molds are more important allergens than indoor ones – Most allergic reactions are to outdoor molds 5
Special Consideration
If this child is immunocompromised (chemotherapy, transplant, HIV/AIDS, chronic granulomatous disease), a different approach is needed with imaging, cultures, and galactomannan testing for invasive fungal disease 2. However, this is not indicated for healthy children with environmental exposure 5.