From the Guidelines
The workup for mold exposure should begin with a thorough medical history and physical examination, focusing on respiratory symptoms, timing of symptom onset relative to exposure, and any pre-existing conditions, and may involve consultation with an occupational medicine specialist and certified environmental hygienist to determine the likelihood of occupational exposure and identify antigenic sources. When evaluating patients with suspected mold exposure, it is essential to consider the potential for hypersensitivity pneumonitis, invasive fungal infections, and other health effects. Initial testing should include:
- A complete blood count with differential to assess for eosinophilia, which may indicate allergic response 1
- Specific IgE antibody testing to common molds (like Aspergillus, Alternaria, Cladosporium, and Penicillium) to identify allergic sensitization
- Skin prick testing to detect immediate hypersensitivity reactions to mold allergens
- Pulmonary function tests, including spirometry and diffusion capacity, to evaluate for obstructive or restrictive patterns in patients with respiratory symptoms
- Chest imaging with X-ray or CT scan to identify infiltrates, nodules, or other abnormalities suggestive of fungal infection or hypersensitivity pneumonitis In cases of suspected invasive fungal disease, bronchoscopy with bronchoalveolar lavage for fungal culture and cytology may be warranted, as recommended by the Infectious Diseases Working Party in Haematology and Oncology of the German Society for Haematology and Oncology 1. Serum precipitins against specific fungi can help diagnose hypersensitivity pneumonitis. This comprehensive approach is necessary because mold exposure can cause various health effects ranging from allergic reactions to invasive infections, depending on the individual's immune status and the type and duration of exposure. The diagnosis and evaluation of hypersensitivity pneumonitis, as outlined in the Chest guideline and expert panel report, emphasize the importance of a multidisciplinary diagnostic workup, including the involvement of occupational medicine specialists and environmental hygienists 1.
From the Research
Workup for Mold Exposure
The workup for mold exposure typically involves a combination of medical history, physical examination, and diagnostic tests. The following are some of the key components of the workup:
- Medical history: A thorough medical history is essential to identify potential exposure to mold and to assess the patient's symptoms and risk factors 2.
- Physical examination: A physical examination is necessary to assess the patient's overall health and to look for signs of mold exposure, such as respiratory problems or skin irritation 2.
- Conventional allergy diagnosis: Conventional allergy diagnosis, including skin prick tests and blood tests, may be used to diagnose allergies to mold 2, 3.
- Provocation tests: Provocation tests, such as challenge tests, may be used to assess the patient's response to mold exposure 2.
- Serological markers: Serological markers, such as specific IgE to mold mixture, may be useful in diagnosing mold-associated respiratory symptoms 3.
Diagnostic Tests
The following diagnostic tests may be used to assess mold exposure:
- Enzyme-linked immunosorbent assay (ELISA): ELISA may be used to measure antibodies against molds and mycotoxins in the blood 4.
- Immunoglobulin (Ig) G, IgM, IgA, and IgE antibodies: Measurements of IgG, IgM, IgA, and IgE antibodies against molds and mycotoxins may be useful in diagnosing mold exposure 4.
- Club cell protein (CC16): Serum concentrations of CC16 may be significantly lower in exposed subjects, especially in asthmatics 3.
Risk Groups
Certain individuals may be at higher risk for mold-related illnesses, including:
- Patients with immunosuppression: Patients with immunosuppression may be at higher risk for infections from indoor molds 2, 5.
- Patients with mucoviscidosis (cystic fibrosis): Patients with mucoviscidosis may be at higher risk for infections and allergies from mold exposure 2.
- Individuals with asthma: Individuals with asthma may be at higher risk for mold-associated respiratory symptoms 3.