Edmondson David A, Nordness Mark E, Zacharisen Michael C, Kurup Viswanath P, Fink Jordan N
Division of Allergy/Immunology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 53201, USA.
Ann Allergy Asthma Immunol. 2005 Feb;94(2):234-9. doi: 10.1016/S1081-1206(10)61301-4.
"Toxic mold syndrome" is a controversial diagnosis associated with exposure to mold-contaminated environments. Molds are known to induce asthma and allergic rhinitis through IgE-mediated mechanisms, to cause hypersensitivity pneumonitis through other immune mechanisms, and to cause life-threatening primary and secondary infections in immunocompromised patients. Mold metabolites may be irritants and may be involved in "sick building syndrome." Patients with environmental mold exposure have presented with atypical constitutional and systemic symptoms, associating those symptoms with the contaminated environment.
To characterize the clinical features and possible etiology of symptoms in patients with chief complaints related to mold exposure.
Review of patients presenting to an allergy and asthma center with the chief complaint of toxic mold exposure. Symptoms were recorded, and physical examinations, skin prick/puncture tests, and intracutaneous tests were performed.
A total of 65 individuals aged 1 1/2 to 52 years were studied. Symptoms included rhinitis (62%), cough (52%), headache (34%), respiratory symptoms (34%), central nervous system symptoms (25%), and fatigue (23%). Physical examination revealed pale nasal mucosa, pharyngeal "cobblestoning," and rhinorrhea. Fifty-three percent (33/62) of the patients had skin reactions to molds.
Mold-exposed patients can present with a variety of IgE- and non-IgE-mediated symptoms. Mycotoxins, irritation by spores, or metabolites may be culprits in non-IgE presentations; environmental assays have not been perfected. Symptoms attributable to the toxic effects of molds and not attributable to IgE or other immune mechanisms need further evaluation as to pathogenesis. Allergic, rather than toxic, responses seemed to be the major cause of symptoms in the studied group.
“毒性霉菌综合征”是一种与接触受霉菌污染环境相关的存在争议的诊断。已知霉菌通过IgE介导的机制诱发哮喘和变应性鼻炎，通过其他免疫机制引起过敏性肺炎，并在免疫功能低下的患者中导致危及生命的原发性和继发性感染。霉菌代谢产物可能是刺激物，可能与“病态建筑综合征”有关。接触环境霉菌的患者出现了非典型的全身症状，并将这些症状与污染环境联系起来。
描述以接触霉菌为主要诉求的患者的临床特征及可能的病因。
回顾在过敏与哮喘中心就诊、以接触毒性霉菌为主要诉求的患者。记录症状，并进行体格检查、皮肤点刺/皮内试验。
共研究了65名年龄在1.5岁至52岁之间的个体。症状包括鼻炎（62%）、咳嗽（52%）、头痛（34%）、呼吸道症状（34%）、中枢神经系统症状（25%）和疲劳（23%）。体格检查发现鼻黏膜苍白、咽部“鹅卵石样改变”和鼻漏。53%（33/62）的患者对霉菌有皮肤反应。
接触霉菌的患者可出现多种IgE介导和非IgE介导的症状。霉菌毒素、孢子或代谢产物的刺激可能是导致非IgE表现的原因；环境检测尚未完善。由霉菌毒性作用而非IgE或其他免疫机制引起的症状在发病机制方面需要进一步评估。在所研究的群体中，过敏反应而非毒性反应似乎是症状的主要原因。
