The horror stories and success stories about mold sensitized individuals flow into Wonder Makers in about equal measure. Time after time consultation clients tell us how bad remediation of fungal contamination in their home or workplace made their health situation substantially worse. In many of these cases the descriptions make it clear that the remediation contractor either did not know, or did not care, about following the current standard of care for mold remediation. Removal of fungal contaminated materials without isolation barriers, personal protective equipment, negative air machines, HEPA vacuums – as well as visible debris in the work area and dust all over after sampling results which purport to show success – are common themes of these descriptions of truly scary restoration efforts. These circumstances make it easy to make a causal connection between environmental exposures and ill health effects. 

In contrast to the horror stories, we also learn about many very sick individuals who were helped by caring contractors. The common themes in those instances are that the contractors understood the standard of care and were rigorous in following it; they appreciated the value of whole-house cleaning; and they reinforced that the control of the environment was only a part of the issue. For mold-sensitized individuals, getting proper medical treatment must precede hand-in-hand with detailed mold remediation.

The Market for Helping Mold-Sensitized People  

From a business perspective, many mold remediation contractors have found that assisting sensitized occupants provides financial rewards in addition to the appreciation from the people that are able to begin healing. Indeed, a small but growing segment of mold remediation contractors are targeting sensitized individuals as their primary client base. These contractors typically have built a reputation for excellence and take pride in completing a thorough project. Since mold-sensitized individuals typically need to have residual contamination, as well is areas of visible fungal growth addressed, the work scope generally allows restoration professionals to match standard mold remediation with detailed structure cleaning. Oftentimes, those contractors cross train their smoke contamination cleaning crews to adapt their existing skill sets so that they are successful in moving from soot and odor removal to eliminating mold spores and other fungal byproducts. 

An interesting byproduct of targeting sensitized individuals as a target market is the fact that after the initial investment in understanding and reaching mold-sensitized individuals, the cost of marketing rapidly drops off. This is due in large part to a strong word-of-mouth referral system and Internet discussion groups focused on mold-sensitized individuals.  

Another important factor is that contractors who specialize in assisting mold-sensitized individuals quickly learn that they need to have a team of support professionals. From the restoration standpoint, if the contractor does not have duct cleaning or content cleaning capabilities, those are critical pieces where subcontractors need to be identified. If rebuilding is not part of the existing mix for the restoration contractor, finding a partner firm that will make improvements to the structure that minimizes future mold growth is another important addition. Doctors and other medical professionals who take the time to learn about mold contamination are also crucial to support the efforts of restoration contractors. In a similar fashion, counselors, attorneys and even bankers can be added to the team to provide necessary support to the sensitized client. Taking the time to build such a team of supporting professionals also opens the doors to return referrals when members of the team identify a sensitized individual.

A Better Understanding of The Science  

Despite the fact that there is a general perception for decades that some individuals reacted more significantly to mold exposures than most people, it is only the last few years where a real understanding of the reasons for this phenomenon have been explained. In contrast to individuals who suffer allergic reactions to mold (generally short-term and dose related), there are individuals who have a genetic susceptibility to mold exposure (often long-term and unrelated to the amount of fungus they are exposed to). Although there still is some discussion and serious debate between health professionals regarding the specifics, the concept that many mold-sensitized individuals suffer from Chronic Inflammatory Response Syndrome (CIRS) is rapidly reaching the point of general medical consensus. 

A key factor in dealing with CIRS is the understanding that it has both a personal and environmental component. Just as it took health agencies time to appreciate the connection between deteriorating lead paint in homes and schools and blood lead levels in children; it has taken time to match mold exposure in homes and workplaces with individuals suffering a bewildering list of maladies.  

For years any symptoms people tried to connect with mold exposure that are the classic allergic responses of eye irritation, runny nose, cough, sinus pressure and headache are often dismissed as a person being hypochondriac. Today, a growing number of medical personnel understand that for people with genetic sensitivities toward mold, multisystem complaints can indeed be a reaction to fungal exposure. Though the list of symptoms is extensive, some of the more unusual reactions of mold-sensitized individuals include over activation of the immune system and subsequent inflammation of the central nervous system. These conditions result in inflammation of the central nervous system with specific symptoms such as headaches, nervousness, difficulty concentrating, dizziness and excessive fatigue.  

A key breakthrough in a more thorough understanding of the challenges faced by mold-sensitized individuals came when additional attention was paid to the impact that mycotoxin exposure has on some individuals. For many years it was believed that if mycotoxins were not present on foodstuffs being consumed, there would not be enough exposure to the mold produced poisons to lead to serious illness. In fact, the idea that inhalation of mold residues such as mycotoxins, beta glucans and other toxic pieces could be enough to cause symptoms was summarily dismissed because it was not in keeping with the standard dose/response approach where more serious symptoms arise in close correlation with the level of exposure. The more recent information confirms that certain people who are not able to naturally break down and remove the mycotoxins and other molds contaminants from their system can suffer significant illness from relatively low levels of exposure.

Translating Science into Action  

Restoration contractors who have successfully catered to mold-sensitized individuals use all of this information to their benefit. The practical impact of all of this knowledge is that mold-sensitized individuals need to have a living/working environment that is better than the normal understanding of clean. Standard mold remediation techniques for source removal have to be completed with an acute attention to detail. More importantly, for mold sensitized individuals the job is not done when the source material has been removed. Extensive cleaning to remove the mold residue from surfaces, contents and HVAC systems, even when there is no visible fungal growth present, is commonplace. Another additional step that experience has shown makes a big difference is the treatment of the entire structure after the detailed cleaning has been done. However, an extra step may be necessary to break down any residual mycotoxins sticking to the surfaces. Extensive experience, and at least one well-designed/documented case study, has shown that proper application of hydrogen peroxide is very effective in removing mycotoxins that other types of cleaning might leave behind.

The Importance of Mycotoxin Sampling  

Just as important as the remediation, is the documentation of the effectiveness of those efforts. Because of the outsize importance that fungal residue in the environment has on the mold-sensitized individual, standard testing for post-remediation and post cleaning needs to be supplemented. Specifically, testing for mycotoxins in the environment helps to ensure that the restoration procedures were successful in creating an environmental situation where mold sensitized individuals can heal. On that front, science has also stepped in to help. 

While several laboratories have the ability to identify mycotoxins from various samples, Real-Time Labs in Texas developed a specific test process where a single sample allows the identification of both mold spores and fragments as well as mycotoxins. The Environmental Mold and Mycotoxins Assessment¹ (EMMA) sampling system combines the best aspects of identifying mold with the ability to check for residual mycotoxins.  

A white paper produced by Real-Time labs entitled Mycotoxins: Critical Information for Mold Remediation Contractors and Occupants² provides extensive information on mycotoxins. One of the most interesting sections is a comparison of sampling procedures typically used for mold-sensitized individuals. The comparisons between spore trap, ERMI, HERTSMI-2 and EMMA samples objectively shows the pros and cons of each method. 

For contractors dealing with mold-sensitized individuals, the ability of the EMMA sample to check for both mold residue and mycotoxins is a big step forward. The primary reason is because other sample types collected from the environment cannot be directly compared to some of the medical markers utilized by mold-sensitized individuals to track the progress of their health. However, the use of EMMA samples gives the contractor and the sensitized clients credible information to really determine whether the environment continues to have a negative impact on their health. As the white paper notes: 

“Because specific mycotoxins recovered from the built environment can be compared to the types of fungal poisons obtained from biological samples collected directly from people, both building remediation efforts and individual medical treatments to be targeted much more precisely.” 

Another important feature of incorporating mycotoxin testing in the post remediation verification of cleaning and remediation effectiveness is that the mycotoxin testing of surfaces generally represents deposition from a longer period of time than what is possible with the standard air sample. Typical spore trap sampling of five to 10 minutes represents a snapshot in time, whereas surface sampling necessary for mycotoxin testing evaluates what has happened in the environment over hours or days.

Quality Control Is Key for Sensitized Individuals 

No mold remediation project should be conducted outside the current standard of care. That approach includes a thorough evaluation of the situation; development of a comprehensive work scope; and work activities which deal with source removal, content decontamination, HVAC cleaning and removal of secondary contamination from the entire structure. For much of the content cleaning and removal of secondary contamination, evaluating the effectiveness of the remediation efforts requires sampling beyond the standard spore trap air sampling, which works well for documenting source removal and HVAC cleaning. 

Mycotoxin sampling, particularly when the environmental samples from the remediated work areas are generated in such a way that they can be compared to levels of mycotoxins recovered from the sensitized individual, are a significant step forward from existing procedures now being used on many projects. Such sampling provides more specificity than what is currently available from the two most common approaches to evaluating overall remediation effectiveness for sensitized individuals; ERMI samples and HERTSMI-2 samples. 

Given the consequences for remediation on the health of sensitized individuals, contractors should take a stair-step approach to documenting the effectiveness of their work. Samples collected by restoration personnel as each phase of the work effort is close to being finished allows the contractor to move from post-remediation evaluation to post remediation verification with a good sense that they are ready for sampling by a third-party consultant. Using different types of sampling methods for each part of the remediation process, ending with some type of highly sensitive mold and mycotoxins sampling such as an EMMA test, will help to ensure that the work done to create an environment for sensitized individual can heal becomes a reality.

Endnotes

1. Learn more about the EMMA test at: https://realtimelab.com/emma/ 
2. Available for review on the Wonder Makers website at: https://www.wondermakers.com/Education/Wonder-Makers-News-and-Updates