INSPECTION    REMEDIATION

ANALYSIS   ABATEMENT

Children and especially infants are most susceptible to mold and fungal diseases because their immune systems are not fully developed. Recent research emphasizes this.

Reactive airways disease in children is increasing in many countries around the world. The clinical diagnosis of asthma or reactive airways disease includes a variable airflow and an increased sensitivity in the airways. This condition can develop after an augmented reaction to a specific agent (allergen) and may cause a life-threatening situation within a very short period of exposure. It can also develop after a long-term exposure to irritating agents that cause an inflammation in the airways in the absence of an allergen.

Several environmental agents have been shown to be associated with the increased incidence of childhood asthma. They include allergens, cat dander, outdoor as well as indoor air pollution, cooking fumes, and infections. There is, however, increasing evidence that mold growth indoors in damp buildings is an important risk factor. About 30 investigations from various countries around the world have demonstrated a close relationship between living in damp homes or homes with mold growth, and the extent of adverse respiratory symptoms in children. Some studies show a relation between dampness/mold and objective measures of lung function. Apart from airways symptoms, some studies demonstrate the presence of general symptoms that include fatigue and headache and symptoms from the central nervous system. At excessive exposures, an increased risk for hemorrhagic pneumonia and death among infants has been reported.

The described effects may have important consequences for children in the early years of life. A child's immune system is developing from birth to adolescence and requires a natural, physiologic stimulation with antigens as well as inflammatory agents. Any disturbances of this normal maturing process will increase the risk for abnormal reactions to inhaled antigens and inflammagenic agents in the environment.

The knowledge about health risks due to mold exposure is not widespread and health authorities in some countries may not be aware of the serious reactions mold exposure can provoke in some children. Individual physicians may have difficulty handling the patients because of the lack of recognition of the relationship between the often complex symptoms and the indoor environment

The workshop was organized to develop a basis for risk assessment and formulation of recommendations, particularly for diagnostic purposes and prevention, and to formulate priorities for future research. The participants were all active researchers with current experience in child health, molds, and respiratory disease. They were engaged in free and intensive discussions on a scientific basis throughout the duration of the 3-day workshop

This monograph contains peer-reviewed papers based on individual presentations at the workshop as well as the workshop conclusions. They are offered to the public health community, administrators, research agencies, physicians, particularly pediatricians, nurses and health workers as information and encouragement to engage themselves in this health problem of importance for the next generation in our population.

Acknowledgments: The workshop received financial support from the U.S. Environmental Protection Agency, the National Center for Environmental Assessment at the U.S. EPA, the Vårdal Foundation (Sweden), Astra Corp (Sweden), the Committee on Organic Dusts, International Commission on Occupational Health. The printing of this document was made possible by a grant from the Center for Indoor Air Research (U.S.). Yvonne Peterson, research secretary, provided excellent and invaluable assistance in the organization and publication efforts.

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New Findings and Unique Aspects in Pediactric Aspergillosis 2005

W. J. STEI NB A C H , Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA

Childhood Asthma

Noreen M. Clark,¹ Randall W. Brown,² Edith Parker,¹ Thomas G. Robins,³ Daniel G. Remick Jr,² Martin A. Philbert,³ Gerald J. Keeler,³ and Barbara A. Israel¹

¹University of Michigan School of Public Health Department of Health, Behavior and Health Education, ²University of Michigan Medical School, ³University of Michigan School of Public Health, Department of Environmental and Industrial Health, Ann Arbor, Michigan USA

http://ehpnet1.niehs.nih.gov/docs/1999/suppl-3/421-429clark/abstract.html

Introduction and Summary: Workshop on Children's Health and Indoor Mold Exposure

Ragnar Rylander¹ and Ruth Etzel²

¹Department of Environmental Medicine, University of Gothenburg, Gothenburg, Sweden; ²Division of Epidemiology and Risk Assessment, Food Safety and Inspection Service, Washington, DC USA

Abstract
To evaluate the health consequences for children of indoor exposure to molds, an international workshop was organized with 15 scientists from eight countries. The participants agreed that exposure to molds may constitute a health threat to children resulting in respiratory symptoms in both the upper and lower airways, an increased incidence of infections, and skin symptoms. Allergy, either to molds or to other indoor agents, also presents a health risk. At very high exposure levels to specific molds, nose bleeding, hemoptysis, and pulmonary hemorrhage have been documented. Pediatricians and allergists need to obtain information about mold and dampness in the home environment when examining children with chronic respiratory symptoms, recurrent infections, or persistent fatigue and headache. Measurement techniques are available to determine exposure. Most important, the source of dampness must be eliminated and the indoor environment must be thoroughly cleaned of molds. Key words: asthma, inflammation, molds, prevention, sampling. -- Environ Health Perspect 107(suppl 3):465-468 (1999).

http://ehpnet1.niehs.nih.gov/docs/1999/suppl-3/465-468rylander/abstract.html

This article is based on a presentation at the International Conference on Indoor Mold and Children held 21-24 April 1998 in Alexandria, Virginia.

Address correspondence to R. Rylander, Department of Environmental Medicine, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden. Telephone: 46 31 773 3601. Fax: 46 31 82 5004. E-mail: ragnar.rylander@envmed.gu.se

Received 3 September 1998; accepted 4 November 1998.

 

Overview of Investigations into Pulmonary Hemorrhage among Infants in Cleveland, Ohio

Dorr G. Dearborn,¹ Iwona Yike,¹ W.G. Sorenson,² Martha J. Miller,¹ and Ruth A. Etzel³

¹Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio USA; ²Division for Respiratory Disease Studies, National Institute of Occupational Safety and Health, Morgantown, West Virginia USA; ³Centers for Disease Control and Prevention, Atlanta, Georgia USA

---

Abstract
Idiopathic pulmonary hemorrhage was diagnosed in 37 infants in the Cleveland, Ohio, area between 1993 and 1998. This rare disorder has been related to 12 deaths, including 7 originally thought to be sudden infant death syndrome. Thirty of the infants were African American, all of whom lived in a limited geographic area of eastern metropolitan Cleveland, an area of older housing stock. An investigation led by the Centers for Disease Control and Prevention has found an association with household exposure to a toxigenic mold, Stachybotrys chartarum, and other fungi. The rapidly growing lungs of young infants appear to be especially vulnerable to the toxins made by toxigenic molds. Environmental tobacco smoke was frequently present in the infants' homes and may be a trigger precipitating the acute bleeding. Stachybotrys, although not thought to be a common mold, is known to have a wide geographic distribution. An additional 101 cases of acute, idiopathic pulmonary hemorrhage have been reported in infants in the United States over the past 5 years. In this overview, the investigations are summarized, the clinical profile is described, the toxicity of S. chartarum is discussed, and pathophysiologic concepts are presented. Key words: environmental tobacco smoke, idiopathic pulmonary hemosiderosis, indoor mold, pulmonary hemorrhage, satratoxins, Stachybotrys chartarum, sudden infant death syndrome, toxigenic fungi, trichothecenes. -- Environ Health Perspect 107(suppl 3):495-499 (1999).

http://ehpnet1.niehs.nih.gov/docs/1999/suppl-3/495-499dearborn/abstract.html