Mold and Mycotoxins

Overview

Understanding Mold Allergy and Its Management

Mold allergy occurs when the immune system overreacts to mold spores in the environment. This leads to a range of uncomfortable symptoms similar to other respiratory allergies. Managing mold exposure is crucial to minimizing allergic reactions for those with this condition.

Symptoms of Mold Allergy

Mold allergies can cause various symptoms that affect the respiratory system and skin, including:

• Sneezing. Frequent sneezing triggered by the inhalation of mold spores.
• Runny or Stuffy Nose. Nasal congestion or a continuous nasal discharge.
• Cough and Postnasal Drip. Irritation in the throat from mucus dripping down from the back of the nose.
• Itchy Eyes, Nose, and Throat. Sensation of itchiness, which can be bothersome and persistent.
• Watery Eyes. Excessive tearing can blur vision and cause discomfort.
• Dry, Scaly Skin. Dermatological reactions to mold exposure include dryness and flaky skin patches.

These symptoms can be persistent throughout the year or worsen during damp weather conditions or in environments with high mold concentrations.

Mold Allergy and Asthma

Exposure to mold spores can trigger severe asthma symptoms for individuals with both a mold allergy and asthma. Mold-related asthma symptoms can include:

• Coughing. Often worsens at night or early in the morning, affecting sleep.
• Wheezing. A whistling sound when breathing indicates obstruction or narrowing of the airways.
• Shortness of Breath. Difficulty breathing, which can be distressing and may limit activity.
• Chest Tightness. A feeling of pressure or discomfort in the chest, especially when breathing in.

Managing Mold Allergies

The most effective strategy to manage a mold allergy involves reducing mold exposure. Here are several measures that can help:

• Control Humidity. Maintain indoor humidity below 50% to inhibit mold growth.
• Fix Leaks. Repair any leaks in your home’s roof, walls, or plumbing so mold does not have moisture to grow.
• Clean Damp Areas. Regularly clean and dry areas where mold accumulates, especially basements, bathrooms, and kitchens.
• Ventilation. Ensure adequate ventilation in moist areas, such as using exhaust fans in bathrooms and kitchens.

Medications for Mold Allergy

Various medications can help manage and control the symptoms of a mold allergy:

• Antihistamines. Help relieve sneezing, itching, and runny nose.
• Nasal Corticosteroids. Sprays are designed to reduce inflammation and treat nasal symptoms, including congestion, sneezing, and runny nose.
• Decongestants. Available as pills or nasal sprays, they can relieve stuffiness and congestion.
• Allergy Shots (Immunotherapy). It may be recommended for severe allergies. This treatment involves regular injections of small amounts of allergens to build tolerance over time.

For those with asthma and mold allergy, additional asthma medications, including inhaled corticosteroids and bronchodilators, may be necessary to manage asthma symptoms effectively.

‍

Diagnosis

Besides considering your signs and symptoms, your doctor might conduct a physical examination to identify or exclude other medical problems. Tests used to identify an allergy include:

• Skin prick test. This test uses diluted amounts of common or suspected allergens, such as molds found in the local area. During the test, these substances are applied to the skin of your arm or back with tiny punctures. If you're allergic, you develop a raised bump (hive) at the test location on your skin.
• Blood test. A blood test, sometimes called the radioallergosorbent test, can measure your immune system's response to mold by measuring the amount of certain antibodies in your bloodstream known as immunoglobulin E (IgE) antibodies. A blood sample is sent to a medical laboratory, where it can be tested for evidence of sensitivity to specific types of mold.

Positive reaction to allergy test

A small area of swelling with surrounding redness (arrow) is typical of a positive skin prick test for allergy.

Treatment

Managing Mold Allergy: Treatment Options

Mold allergies are challenging to manage because mold spores are ubiquitous. While it's impossible to avoid exposure altogether, several effective treatments can alleviate the symptoms of allergic rhinitis caused by mold.

Medications for Mold Allergy

Managing a mold allergy typically involves using medications to control symptoms:

• Nasal Corticosteroids. These sprays are often the first line of treatment for mold allergy. They reduce inflammation in the nasal passages, helping to alleviate congestion, sneezing, and itching. Standard options include ciclesonide (Omnaris, Zetonna), fluticasone (Flonase, Xhance), mometasone (Nasonex), triamcinolone, and budesonide (Rhinocort). While highly effective, potential side effects include nosebleeds and nasal dryness.
• Antihistamines. These drugs counteract the histamine released during allergic reactions, addressing symptoms like itching and runny nose. Options include loratadine (Claritin), fexofenadine (Allegra), and cetirizine (Zyrtec), which generally do not cause drowsiness. Prescription nasal sprays such as azelastine and olopatadine can also be used, though they may taste bitter or cause nasal dryness.
• Oral Decongestants. Useful for reducing nasal stuffiness, oral decongestants like pseudoephedrine (Sudafed) should be used cautiously, especially by those with hypertension, due to potential side effects like increased blood pressure, insomnia, and palpitations.
• Decongestant Nasal Sprays. Products like oxymetazoline (Afrin) provide quick relief but should not be used for more than three to four days to avoid rebound congestion. Possible side effects include headaches and nervousness.
• Montelukast (Singulair). This medication blocks leukotrienes, chemicals in the immune system contributing to allergy symptoms. Due to concerns about psychological side effects, its use is accompanied by caution and is typically considered when nasal sprays are unsuitable or when mild asthma coexists.

Additional Treatments

Beyond medications, other strategies can help manage mold allergy symptoms:

• Immunotherapy. Allergy shots may be an option for certain types of mold allergies. This long-term treatment can decrease sensitivity to allergens and provide lasting relief.
• Nasal Lavage. Rinsing the nasal passages with saline can help remove mucus and allergens. Devices like squeeze bottles, bulb syringes, or neti pots are used to perform nasal irrigation. Using distilled, sterile, or properly filtered water is crucial to prevent infections. After each use, the irrigation device should be thoroughly rinsed with clean water and left to air-dry.