Buildings used to breathe. It was inevitable and somewhat helpful, but it can make it more expensive to heat and cool those spaces with common central heating and cooling systems. When the oil embargo of the 1970s came along, building practices shifted to focus on more hermetically sealed buildings as a means to save energy.
And just as our wooden furniture and cotton clothes gave way to cheaper particle board, plastics, and polymers, building materials also shifted from stone, brick, and post-and-beam framing to stick framing, and OSB board (pressed plywood), and drywall. We sealed these spaces with sheets of plastic inside the walls or thicker membranes under the exterior finish.
Many multi-use buildings, such as office buildings, are built with fixed windows that can’t be opened. Central HVAC systems that move air through an entire house or building are situated in basements, attics, or roofs where changes in temperature in ductwork can cause condensation. Such changes in building practices and heating/cooling methods have resulted in significant health problems because they create environments conducive to toxic indoor mold. Beyond condensation that forms inside, any kind of water intrusion from a roof leak, basement leak, or burst pipe will contribute to a moist environment where toxic mold species and bacteria can flourish.
Mycotoxins
Much of the scientific literature describing the health effects of mold toxins (mycotoxins) has focused on the ingestion of foodstuffs contaminated with mold toxins, yet also note that exposure to mycotoxins also occurs by inhalation or through intact skin. Effects can be either acute or chronic. Chronic toxicity results from low-dose exposure over prolonged periods of time that may lead to health effects such as cancer, liver failure, kidney failure, chronic fatigue, and neuropsychiatric symptoms attributed to other causes.Mycotoxins are known to cause: cancer; inhibition of protein synthesis, which interferes with growth and bodily repair; immunosuppression, which makes fighting infections more difficult; rashes and skin irritation; asthma; chronic respiratory infections; and damage to metabolic processes.
What Is Sick-Building Syndrome?
Sick building syndrome (SBS), also known as biotoxin illness or chronic inflammatory response syndrome (CIRS), is the constellation of symptoms that occur in those exposed to either growing or dead mold found in water-damaged buildings or vehicles. Building practices and materials in use over the past several decades have unfortunately made buildings more susceptible to mold growth.A full 25 percent of the world’s population has the genetic predisposition to develop chronic illness when exposed to indoor toxic molds that grow in water-damaged buildings. This means that fully one-quarter of the employees, students, and families who spend time in these buildings may develop chronic illnesses of varying degrees that affect their respiratory systems, immune systems, and central nervous systems.
Biotoxin illness or CIRS can manifest as any combination of flu-like syndromes, chronic headaches, nasal congestion, sinusitis, pharyngitis, bronchitis, pneumonitis, pneumonia, asthma, fatigue, brain fog, profound fatigue, cognitive dysfunction, focus and concentration problems, memory abnormalities, emotional lability, irritability, anxiety, paranoia, anger and rage, hormonal dysfunction, gastrointestinal distress, leaky gut, inadequate digestive function, peripheral vascular disease, autoimmune disease, muscle pain and weakness, aerobic exercise intolerance, and more.
Short-term exposure is associated with many of the symptoms listed above, whereas long-term exposure causes ongoing up-regulation of systemic inflammation with resultant damage to the body that may or may not be reversible. Patients can develop chronic restrictive lung disease or asthma from long-term inflammation of the airways. The central nervous system’s control of the neuro-immune and neuro-endocrine systems is damaged with resultant deficiencies in crucial central regulatory hormones such as melanocyte-stimulating hormone, vasoactive intestinal peptide, and antidiuretic hormone.
The entire hypothalamic-pituitary-adrenal axis and thyroid gland can be affected. Alterations in leptin metabolism affect the body’s entire energy metabolism of fats, carbohydrates, and proteins. Salt and water balance, blood osmolality, and blood pressure control are disrupted. Immune system confusion and dysfunction result in chronic polymicrobial infections. Needless to say, the clinical ramifications are diverse and highly significant.
Many aspects of indoor toxic molds cause adverse reactions in genetically susceptible individuals. The toxins on the mold spores, any portion of cell wall fragments or any microparticles of the mold cells or cell contents, as well as mold gases released from actively growing molds, can all stimulate an inflammatory innate immune response.
Variability in response from individual to individual has to do with prior lifetime exposure as well as other comorbidities. Patients who have had prior mold exposure will react more strongly to new exposures. This inflammatory innate immune response can occur even at mold levels that might be considered “within normal limits” on air quality testing or at levels that might not affect other people.
Often people are confused and think that the sick-building syndrome is just a mold allergy. It’s not. This is a different branch of the immune system that’s not involved with true IgE medicated allergic reactivity. Yet the adverse inflammatory response does occur as quickly as an anaphylaxis type reaction when sensitized individuals are exposed to mold.
Treating Biotoxin Illness
The first and most crucial thing to do in treating biotoxin patients is to remove them from any ongoing mold exposure. Unless ongoing exposure to the mold that is causing the illness is stopped, there is little hope for improvement.Due to chronic inflammation and dysregulated immune systems in these patients, a complete medical workup is required. Many will be suffering from significant systemic inflammation, leaky guts with markedly abnormal gastrointestinal microbiomes and poor digestive function, nutritional deficiencies, inadequate liver detoxification pathways, damaged mitochondrial energy production, abnormalities of coagulation, and chronic vector-borne and community-acquired infections. Laboratory testing to elucidate comorbidities helps to guide treatment. Both inflammatory markers in the blood and mycotoxins measurable in the urine provide useful means for following treatment progress.
Treatment begins with reducing inflammation, healing the gastrointestinal tract, normalizing liver detoxification, optimizing organ drainage and regulation, and binding toxins for elimination via the stool. If the patient has enough vitality to exercise or sauna, sweating is another good way to eliminate toxins. Active infections also need to be addressed. As treatment progresses, patients recover gastrointestinal integrity, physical and psychic energy, aerobic exercise tolerance, and cognitive function.
Addressing Mold in Buildings
Patients need to be guided on how to safely eradicate mold from water-damaged buildings. If the patient owns the home or building, this will be easier to accomplish. It’s more challenging to deal with situations when the patient is a tenant in an apartment or house, or employee in a business or work vehicle, or a student in a moldy school. In these cases, the owners may not adequately address the water damage and mold growth. The best action for health is to leave the home, apartment, business, or school immediately and not return.The source of water intrusion into a building must be found. Heating and air-conditioning systems and all ducting must be closely evaluated. Plumbing conduits, basement, crawl spaces, roof and soffits, flashing and stucco need thorough examination for signs of moisture or microbial growth.
The contents of a water-damaged building may also be contaminated with mold particulates and toxins and need special attention. Anything that is nonporous, such as most dishes, utensils, pots and pans, metal, glass, porcelain, or stone objects, can be cleaned with a nontoxic moldicide. Simple household cleaners such as borax, bleach, and vinegar may be useful. Porous materials such as rugs, drapes, bedding, furniture, and clothing may or may not be salvageable. Wool and leather clothing, drapes, and area rugs can be dry cleaned. Other bedding, clothes, and towels can be washed in a hot wash load with moldicide soaps. Be sure to check washing machines for mold. Many front load washers become moldy if the unit is not allowed to dry completely between loads. In severely contaminated homes, mattresses, washing machines, and vacuum cleaners may need replacing.
When the water intrusion is fixed and all the mold remediated by a reputable company, the building will need deep, deep cleaning. All the interior surfaces, including ceilings, walls, and floors should be both dry and wet mopped. Remove all dust with a HEPA-rated vacuum cleaner. It’s also advised to do a whole house fogging to remove all microparticulates of mold and then vacuum again. Some remediation companies routinely do this for clients.
Now the home is ready for all the cleaned belongings to be replaced and true healing can begin in a clean and healthy environment.
- Sick building syndrome (SBS) and exposure to water-damaged buildings: Time series study clinical trial and mechanisms, Neurotoxicology and Teratology, 2006
- Research Committee Report on Diagnosis and Treatment of Chronic Inflammatory Response Syndrome Caused by Exposure to the Interior Environment of Water-Damaged Buildings, Policy Holders of America, 2010
- Detection of mycotoxins in patients with chronic fatigue syndrome. Toxins, 2013
- A Review of the Mechanism of Injury and Treatment Approaches for Illness Resulting from Exposure to Water-Damaged Buildings, Mold, and Mycotoxins. Scientific World Journal, 2013
- Review of Health Hazards and Prevention Measures for Response and Recovery Workers and Volunteers After Natural Disasters, Flooding, and Water Damage: Mold and Dampness Health Environmental health and preventive medicine, 2014
- Environmental Mold and Mycotoxin Exposures Elicit Specific Cytokine and Chemokine Responses PLoS One. 2015