Toxic Events Were Insufficiently Considered

The article, labeled as a review (1), claims to assess the “pertinent” publications and research results on indoor mold as a basis for rational counseling of patients. In our view, the article is flawed and does not adequately represent the relevant literature and research results regarding indoor mold. As clinicians and researchers who have worked in this area for more than 30 years, we think that the focus on infections and allergies as well as the selective literature search fall short and hamper an unbiased evaluation and care of such patients. The often-present indoor exposure to microbial toxins and associated harmful toxic health outcomes—which we have observed over the years in our patient care and studies, and which have been documented extensively (2–4)—were described inadequately. We observed health problems that should be clearly categorized as non-allergic symptom complexes—for example, non-allergic asthma, sinusitis, dry irritating cough, skin and mucous membrane problems, immune dysregulation, cognitive impairments, and excessive fatigue (2–3).

The inhalation risks and exposures related to mycotoxins and other metabolites in indoor environments damaged by mold were either ignored or insufficiently considered. Instead, a controversial study (Kelman et al., 2004 in [4]) was cited as proof that mycotoxins in indoor spaces represent a negligible risk. Clinicians may disagree with the presented focus (1), as they did with the old position paper of the American Academy of Allergy, Asthma and Immunology (PMID: 16514772; 2006). In our opinion, the incomplete representation of the indoor air science will be disadvantageous to affected patients.