OBJECTIVES: Indoor air toxicity is of major public health concern due to the increase in humidity-induced indoor mould exposure and associated health changes. The objective is to present evidence for the causality of health threats and indoor mould exposure. METHODS: PubMed search on the following keywords: dampness, mould, indoor air quality, public health, dampness, and mould hypersensitivity syndrome, sick building syndrome, and building-related illness as well as information from the health authorities of Bavaria and North Rhine-Westphalia, the Center of Disease Control (CDC), World Health Organisation (WHO), and guidelines of professional societies. RESULTS: The guidelines of professional societies published in 2017 are decisive for the assessment of the impact of mould pollution caused by moisture damage on human health and for official regulations in Germany. Until 2017, a causal connection between moisture damage and mould exposure could usually only be established for pulmonary diseases. The health risk of fungal components is apparent as documented in the fungal priority pathogens list (FPPL) of the WHO. Since 2017, studies, especially in Scandinavia, have proved causality between moisture and mould exposure not only for pulmonary diseases but also for extrapulmonary diseases and symptoms. This was made possible by new test methods for determining the toxicity of fungal components in indoor air. Environmental medical syndromes, e.g., dampness and mould hypersensitivity syndrome (DMHS), sick building syndrome (SBS), building-related symptoms (BRS), and building-related illness (BRI), and fungal pathogens, e.g., Aspergillus fumigatus, pose a major threat to public health. CONCLUSION: There is evidence for the causality of moisture-induced indoor moulds and severe health threats in these buildings. According to these findings, it is no longer justifiable to ignore or trivialize the mould contamination induced by moisture damage and its effects on pulmonary and extrapulmonary diseases. The health and economic implications of these attitudes are clear.

Ludwig Maximilian University Munich Germany

Zobrazit více v PubMed

Daschner A, González Fernández J. Allergy in an evolutionary framework. J Mol Evol. 2020 Jan;88(1):66-76. DOI

Inamdar AA, Morath S, Bennett JW. Fungal volatile organic compounds: more than just a funky smell? Annu Rev Microbiol. 2020 Sep 8;74:101-16. DOI

Appolloni L, Dettori M, Petronio MG, Raffo M, Settimo G, Rebecchi A, et al. A proposal of hygienic and sanitary standards for the new Building Code in Italy. Ann Ig. 2020 Sep-Oct;32(5 Suppl 1):85-109.

Sabino R, Veríssimo C, Viegas C, Viegas S, Brandão J, Alves-Correia M, et al. The role of occupational Aspergillus exposure in the development of diseases. Med Mycol. 2019 Apr 1;57 Suppl 2:S196-S205. DOI

Rollins SM, Su FC, Liang X, Humann MJ, Stefaniak AB, LeBouf RF, et al. Workplace indoor environmental quality and asthma-related outcomes in healthcare workers. Am J Ind Med. 2020 May;63(5):417-28. DOI

Sakellaris I, Saraga D, Mandin C, de Kluizenaar Y, Fossati S, Spinazzè A, et al. Association of subjective health symptoms with indoor air quality in European office buildings: The OFFICAIR project. Indoor Air. 2021 Mar;31(2):426-39. DOI

Tran VV, Park D, Lee YC. Indoor air pollution, related human diseases, and recent trends in the control and improvement of indoor air quality. Int J Environ Res Public Health. 2020 Apr 23;17(8):2927. doi: 10.3390/ijerph17082927. PubMed DOI

Coulburn L, Miller W. Prevalence, risk factors and impacts related to mould-affected housing: an Australian integrative review. Int J Environ Res Public Health. 2022 Feb 7;19(3):1854. doi: 10.3390/ijerph19031854. PubMed DOI

Kokkonen A, Väänänen M, Säämänen A, Pasanen P. The evaluation of short-term water misting of room air in reducing airborne dust after renovation work. Ann Work Expo Health. 2019 Feb 16;63(2):242-55. DOI

Henneberger PK, Patel JR, de Groene GJ, Beach J, Tarlo SM, Pal TM, et al. The effectiveness of removal from exposure and reduction of exposure for managing occupational asthma: summary of an updated Cochrane systematic review. Am J Ind Med. 2021 Mar;64(3):165-9. DOI

Domínguez-Amarillo S, Fernández-Agüera J, Cesteros-García S, González-Lezcano RA. Bad air can also kill: residential indoor air quality and pollutant exposure risk during the COVID-19 Crisis. Int J Environ Res Public Health. 2020 Sep 30;17(19):7183. doi: 10.3390/ijerph17197183. PubMed DOI

[Mold burden of interior rooms - report of findings, health evaluation and measures. Report of the "Methods and Quality Assurance in Environmental Medicine" Committee]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007 Oct;50(10):1308-23. German.

Moriske HJ, Szewzyk R, Tappler P, Valtanen K, editors. [Guide to the prevention, detection and renovation of mold infestations in buildings]. Dessau-Roßlau: Umweltbundesamt (German Environment Agency); 2017. German.

[Requirements for the prevention of infection in the medical care of immunosuppressed patients: recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2021 Feb;64(2):232-64. German.

Justiz-online. [Public Health Service Act North Rhine-Westphalia (ÖGD NRW)] [Internet]. Düsseldorf: Department of Justice of North Rhine-Westphalia [cited 2022 Apr 24]. Available from: http://www.lexsoft.de/cgi-bin/lexsoft/justizportal_nrw.cgi?xid=146870,1. German.

Centers for Disease Control and Prevention. Basic facts about mold and dampness [Internet]. Atlanta: CDC; 2022 [cited 2023 Feb 19]. Available from: https://www.cdc.gov/mold/faqs.htm.

World Health Organization. WHO releases first-ever list of health-threatening fungi [Internet]. Geneva: WHO; 2022 [cited 2023 Feb 19]. Available from: https://www.who.int/news/item/25-10-2022-who-releases-first-ever-list-of-health-threatening-fungi.

Heseltine E, Rosen J, editors. WHO guidelines for indoor air quality: dampness and mould. Copenhagen: WHO Regional Office for Europe; 2009.

Mudarri D, Fisk WJ. Public health and economic impact of dampness and mold. Indoor Air. 2007 Jun;17(3):226-35. Erratum in: Indoor Air. 2007 Aug;17(4):334. DOI

Norbäck D, Zock JP, Plana E, Heinrich J, Tischer C, Jacobsen Bertelsen R, et al. Building dampness and mold in European homes in relation to climate, building characteristics and socio-economic status: The European Community Respiratory Health Survey ECRHS II. Indoor Air. 2017 Sep;27(5):921-32. DOI

Sylvain IA, Adams RI, Taylor JW. A different suite: the assemblage of distinct fungal communities in water-damaged units of a poorly-maintained public housing building. PLoS One. 2019 Mar 18;14(3):e0213355. doi: 10.1371/journal.pone.0213355. PubMed DOI

Holme JA, Øya E, Afanou AKJ, Øvrevik J, Eduard W. Characterization and pro-inflammatory potential of indoor mold particles. Indoor Air. 2020 Jul;30(4):662-81. DOI

Kespohl S, Liebers V, Maryska S, Meurer U, Litzenberger C, Merget R, et al. What should be tested in patients with suspected mold exposure? Usefulness of serological markers for the diagnosis. Allergol Select. 2022 Mar 29;6:118-32. DOI

Kalayci O, Miligkos M, Pozo Beltrán CF, El-Sayed ZA, Gómez RM, Hossny E, et al. The role of environmental allergen control in the management of asthma. World Allergy Organ J. 2022 Mar 8;15(3):100634. doi: 10.1016/j.waojou.2022.100634. PubMed DOI

Rea WJ. A large case-series of successful treatment of patients exposed to mold and mycotoxin. Clin Ther. 2018 Jun;40(6):889-93.

Hyvönen S, Syrjala H. Asthma case cluster during renovation of a water-damaged and toxic building. Microorganisms. 2019 Dec 3;7(12):642. doi: 10.3390/microorganisms7120642. PubMed DOI

Wiesmüller GA, Heinzow B, Aurbach U, Bergmann KC, Bufe A, Buzina W, et al. Abridged version of the AWMF guideline for the medical clinical diagnostics of indoor mould exposure: S2K Guideline of the German Society of Hygiene, Environmental Medicine and Preventive Medicine (GHUP) in collaboration with the German Association of Allergists (AeDA), the German Society of Dermatology (DDG), the German Society for Allergology and Clinical Immunology (DGAKI), the German Society for Occupational and Environmental Medicine (DGAUM), the German Society for Hospital Hygiene (DGKH), the German Society for Pneumology and Respiratory Medicine (DGP), the German Mycological Society (DMykG), the Society for Pediatric Allergology and Environmental Medicine (GPA), the German Federal Association of Pediatric Pneumology (BAPP), and the Austrian Society for Medical Mycology (ÖGMM). Allergo J Int. 2017;26(5):168-93. DOI

Goh KJ, Yii ACA, Lapperre TS, Chan AK, Chew FT, Chotirmall SH, et al. Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma. J Asthma Allergy. 2017 Apr 21;10:131-140. DOI

Hyvonen SM, Lohi JJ, Rasanen LA, Heinonen T, Mannerstrom M, Vaali K, et al. Association of toxic indoor air with multi-organ symptoms in pupils attending a moisture-damaged school in Finland. Am J Clin Exp Immunol. 2020 Dec 15;9(5):101-13.

Atosuo J, Karhuvaara O, Suominen E, Vilén L, Nuutila J, Putus T. Indoor-related microbe damage induces complement system activation in building users. Innate Immun. 2021 Jan;27(1):15-22. DOI

Vaali K, Tuomela M, Mannerström M, Heinonen T, Tuuminen T. Toxic indoor air is a potential risk of causing immuno suppression and morbidity-a pilot study. J Fungi (Basel). 2022 Jan 21;8(2):104. doi: 10.3390/jof8020104. PubMed DOI

Øya E, Solhaug A, Bølling AK, Øvstebø R, Steensen TB, Afanou AKJ, et al. Pro-inflammatory responses induced by A. fumigatus and A. versicolor in various human macrophage models. J Toxicol Environ Health A. 2019;82(8):483-501. DOI

Salin JT, Salkinoja-Salonen M, Salin PJ, Nelo K, Holma T, Ohtonen P, et al. Building-related symptoms are linked to the in vitro toxicity of indoor dust and airborne microbial propagules in schools: A cross-sectional study. Environ Res. 2017 Apr;154:234-9. DOI

Valtonen V. Clinical diagnosis of the dampness and mold hypersensitivity syndrome: review of the literature and suggested diagnostic criteria. Front Immunol. 2017 Aug 10;8:951. doi: 10.3389/fimmu.2017.00951. PubMed DOI

Tuuminen T. The roles of autoimmunity and biotoxicosis in sick building syndrome as a "starting point" for irreversible dampness and mold hypersensitivity syndrome. Antibodies (Basel). 2020 Jun 22;9(2):26. doi: 10.3390/antib9020026. PubMed DOI

Hyvönen S, Lohi J, Tuuminen T. Moist and mold exposure is associated with high prevalence of neurological symptoms and MCS in a Finnish hospital workers cohort. Saf Health Work. 2020 Jun;11(2):173-7. DOI

Nynäs P, Vilpas S, Kankare E, Karjalainen J, Lehtimäki L, Numminen J, et al. Clinical findings among patients with respiratory Symptoms Related to Moisture Damage Exposure at the Workplace-The SAMDAW Study. Healthcare (Basel). 2021 Aug 27;9(9):1112. doi: 10.3390/healthcare9091112. PubMed DOI

Kumar P, Singh AB, Singh R. Comprehensive health risk assessment of microbial indoor air quality in microenvironments. PLoS One. 2022 Feb 25;17(2):e0264226. doi: 10.1371/journal.pone.0264226. PubMed DOI

Salin J, Ohtonen P, Andersson MA, Syrjälä H. The toxicity of wiped dust and airborne microbes in individual classrooms increase the risk of teachers' work-related symptoms: a cross-sectional study. Pathogens. 2021 Oct 21;10(11):1360. doi: 10.3390/pathogens10111360. PubMed DOI

Kramer A, Wichelhaus TA, Kempf V, Hogardt M, Zacharowski K. Building-related illness (BRI) in all family members caused by mold infestation after dampness damage of the building. GMS Hyg Infect Control. 2021 Dec 7;16:Doc32. doi: 10.3205/dgkh000403. PubMed DOI