Author: Gilles Pesant, Mech Eng. written with his expertise while observing the expertise of his wife, "Dr.Kim." The article is written in "the doctor voice" for those used to reading Dr. Crawford's blogs.
Mold and mycotoxin illness

What do you do when you suspect mold toxicity?

By Kim Crawford, M.D. Last updated: March 24, 2023
What do you do when you suspect mold toxicity?

The Two “Sick Patients” with Mold Toxicity

Mold toxicity means you’re sick and your home is sick. Plain and simple. Or is it? Unfortunately not. I always spend a considerable amount of time reviewing the list of symptoms of each one of my patients during our visit. Sometimes, it is evident that someone’s illness results from exposure to mold toxins; sometimes, it’s far from it.

When I have any doubt, I always ask patients to take a quick and simple test available online called a VCS test. False positives occur in up to 5% of cases and false negatives in about 8%, but it is nevertheless beneficial for screening purposes. More details on this later.

However, it is only after reviewing their lab work that I can tell for sure whether or not mold is playing a role in their condition. This rules-out any guesswork and provides the scientific basis that allows me to make a definitive diagnosis.

When I have a diagnosis of mold toxicity, I now find myself dealing with two distinct patients: the 1st one is a human, and the 2nd one is a building. In other words, I am now facing a medical issue but also an environmental one.

The importance of this is that no matter how effective my medical treatment is, this patient will never become ultimately better unless their environmental issues are dealt with and remediated properly.

Treating health conditions caused by exposure to mold toxins is undoubtedly not easy. Unfortunately, resolving the environmental issues proves to be even more challenging in many instances. If someone doesn’t know where the problem is, it’s often necessary to obtain a professional inspection to ascertain if there is mold toxicity or not.

Why Perform a Mold Inspection?

A mold inspection is the first step in addressing issues related to a building’s contamination with mold because it provides the assessment of the condition of the building.

Just as physicians need a diagnosis before determining the appropriate medical treatment, the mold inspection will determine the mold remediation plan.

Understandably, there is some psychological trauma resulting from the realization that your home is what is making you sick.

Some patients simply cannot come to grips with the fact that their house, which they built so carefully in some cases, is the culprit.

They, unfortunately, remain in total denial and categorically refuse even to get a proper mold inspection.

When this happens, all I can do is treat their other ailments, but I know that exposure to mold toxins will continue its ravaging effects over the long term.

They usually feel better after a short time due to the treatment of their symptoms, but, ironically, they invariably misinterpret this as evidence that their environment is just fine.

Sadly, feeling better reinforces their conviction, and they become defensive or downright combative when I bring up the mold issue. Luckily, this is not my typical experience with patients. But, let’s circle back a moment regarding mold inspection. Just as many doctors are not “CIRS-literate,” such is the case with many mold inspectors.

Why is it So Important to Find a Good Mold Inspector?

When a patient is diagnosed with CIRS (often called “mold illness”), they need to hire a professional to inspect their dwelling. Still, if they unluckily find someone not adequately qualified, the inspection is usually done improperly and will often fail to identify the full scope of the mold issues.

If an inspector erroneously concludes that nothing is wrong or that a quick clean-up will suffice, CIRS patients get confused since they receive contradictory opinions.

Their physician tells them that their environment is causing their symptoms, but the inspector tells them that this is not possible because their place is just fine.

What we then have is a nightmare scenario for the physician. Why? This patient will be much less likely to take the appropriate steps to get their dwelling more thoroughly decontaminated to the acceptable level.

Why does this happen? Because, in large part, the mold inspection/remediation industry does not yet recognize CIRS as an actual problem.

Until recently, it was impossible to map an individual’s gene sequences quickly and affordably.

But genomic sequencing technology combined with advancements in computer processing power and laboratory equipment has progressed at such an astonishing pace that it is now possible for physicians to order routine tests designed to look for and identify specific genes.

This technology proved to be a potent tool for microbiologists and researchers. It is now well established in the scientific literature that an individual’s specific set of genes often determines the level of mycotoxins that will cause them harm.

In other words, acceptable conditions for some people are not suitable for others.

Several genes have been identified as so-called “mold genes” because they impede the ability of the immune system to detect and eliminate mycotoxins absorbed in an individual’s body during exposure.

Someone can have only one or two “mold genes,” or none. While it is not unheard of for someone without any “mold genes” to develop CIRS, the more “mold genes” one has (meaning two), the higher the likelihood of developing CIRS, and usually, the worse the symptoms are.

Unfortunately, this knowledge has not yet made its way into any state’s mold inspection or remediation training certification programs.

Many mold inspectors and remediators believe that a building is safe for everyone once remediated to current standards. Consequently, these inspectors are skeptical that some individuals require an environment meeting a higher level of decontamination than is taught in their program.

Nothing is perfect, and it is impossible to remove every trace of mold spore dust after remediation of a contaminated building. As a result, the industry has settled on a level of contaminants considered normal (basically “good enough”). The problem is that “normal” is only acceptable for someone who does not have any “mold genes.”

For these reasons, finding a good mold inspector (one who understands that CIRS is a real thing and that everyone is not equal-genetically speaking) is essential.

Without some appropriate extra remediation measures, patients suffering from CIRS will continue having exposure to an unsafe environment. As a physician, treating their conditions is fighting a losing battle. They will get considerably better but will never achieve the results we should expect, which is a full recovery.

Since you can’t necessarily trust mold inspectors or remediators, let me give you a quick course in mycology.

Mold, what is it, and how does it harm us?

Mold is not an animal nor a plant; it is part of the “Fungi Kingdom.” Therefore, it is a living organism that requires food and specific environmental conditions to grow and spread.

While mold is an essential part of the ecosystem and a beneficial one, some species (but not all of them) have developed the nasty ability to produce dangerous toxins called “mycotoxins.”

Mycology is the branch of biology specializing in the systematic study of fungi, including their genetic and biochemical properties. The term “mycotoxins” comes from this branch of biology.

Mold spores are everywhere, outside as well as inside. Therefore, it is customary to find mold spores around your house. However, a “normal fungal ecology,” a term you will find in every mold inspection report, means that the spores captured in your home, despite being alive, have not “set up shop,” representing: established growing colonies.

Spores considered part of a normal fungal ecology should not be producing toxins, the process that certain mold species use to kill other mold species and take over. Instead, it is a fight for food and a matter of survival, one of the pillars of the evolutionary process.

Outside in nature, there is plenty of food for every species. Once inside a building, however, nutrition becomes more limited (we’re talking about organic materials such as drywall, wood, fabric, etc.).

Most toxin-producing species very rarely do so outside in nature. However, they will coincidentally become toxic if they start growing inside a building where they will invariably come in contact with other species.

This phenomenon can be observed under a microscope in a laboratory when growing cultures in a petri dish. Some toxin-producing varieties will not do so if there are no other mold species in the same petri dish. However, the moment you add another species to the mix, you will quickly see mycotoxins appear.

As you might expect, when mold starts growing inside a building, there is always a variety of species. Therefore, it is just a matter of time until some begin producing mycotoxins.

Molds are complex structures, and they come in many different forms. They grow in “colonies,” which we can see on moldy surfaces. On the other hand, spores are too small to see with our eyes, but they are visible under a microscope. Mycotoxins, for their part, are so small that they are invisible under any microscope.

It is essential to understand the distinction between mold, spores, and mycotoxins: mold is a living organism made of cells; a spore is just a component of the mold structure (also made of living cells); a mycotoxin is an organic compound, in other words, a chemical.

As the name implies, mycotoxins are toxic to humans and animals alike. Moreover, they include a particularly dangerous family of toxins called “neurotoxins.”

Neurotoxins are toxins that are destructive to nerve tissue. In other words, they affect and damage the nervous system, including the brain. Other toxins cause symptoms in different tissues such as the liver, the kidneys, and the cells of respiration called mitochondria.

The variety of mycotoxins, in part, explains why symptoms from CIRS can vary wildly from one patient to another. As a result, it is a condition that is not easy to diagnose for the uninitiated physician and is thus so often misdiagnosed.

Speaking of diagnosis, you might be wondering why it seems that more and more buildings are moldy; are they, or are we “spotting it” more? It’s a bit of both, quite frankly.

Mold Contamination: a very old issue, a very modern problem

More and more physicians (particularly in functional medicine) claim that some previously unexplained symptoms could have resulted from toxic mold exposure.

This whole mold toxicity problem might sometimes sound like a new hype. How come we rarely heard about this in the past? Our ancestors were exposed to moldy houses, too (remember those “musty” basements)?

The answer is: yes, indeed, they were. However, a lot of things have changed dramatically since then.

For one, many ailments they were suffering from were not known to be caused by mold toxin exposure. And the field of mycology, along with advancements in mold toxicity, has grown in leaps and bounds.

Maybe this explains, at least in part, why some of the mysterious symptoms our ancestors were experiencing for real were actually “unexplained.”

“Idiopathic” is the medical term used to describe a symptom that has no diagnosis. In other words: unexplained symptoms have no known cause or remedy. How often have you heard someone say: “I was told it’s all in my head”?

As technology (along with new scientific tools) evolve, so does the medical body of knowledge. For example, while it was nearly impossible 30 years ago to map the genetic sequence of some organic tissue, now everyone can quickly get their genetic code identified and analyzed through commercial or medical services.

In this context, it only makes sense that some former “idiopathic” symptoms are just now revealing their long-hidden causes. Therefore, the medical community is just beginning to understand the effects of toxic mold exposure on the human body. This understanding is evolving, and it is slowly making its way into the mainstream medical establishment.

In addition, our homes have changed dramatically.

We use different construction methods and materials when building our modern dwellings. For example, we impregnate them with chemicals and use glue, sealants, paints, coatings, etc.

Depending on your age, you may not realize that air conditioning was very rare until the ’70s and practically nonexistent in residential buildings before the ’60s.

Here are some critical factors that might help explain our “modern mold problem”:

  1. Not all mold species are toxic:

Mold spores are plentiful outdoors: the dirt in your backyard garden is full of them, but they are not toxic. The reason some mold spores become toxic in certain conditions is simply a matter of survival and evolution.

Most mold from the “toxic species” begin producing toxins only if “food” is in short supply. These toxins (called “mycotoxins”) are made within the spores but spread to the dense mass bathing the colony (viewed under a microscope; to the naked eye, colonies often look more like a powdery substance).

As the colony grows, anything that comes into contact with it becomes contaminated. So you can picture colonies as tiny blobs of slime that continuously expand to the point where they eventually cover a large area of the material upon which they grow.

Some mold species also expel their spores in the air, which allows them to travel over long distances and seed new colonies wherever they land.

So, what’s the takeaway?

It is essential to understand that mold colonies need three things: Moisture, Heat, and Food (organic matter) to proliferate.

Unless you live in an Igloo, there is enough heat and “food” in your house. However, the amount is limited (compared to a forest). Hopefully, however, there is not enough moisture.

In your garden outdoors, there is plenty of food and moisture (and heat in summertime) for everyone. So there is not a lot of competition. Bring those spores inside your house, though, and that’s a different story altogether.

In a nutshell, mold spores (only certain species) produce toxins to kill other mold species in an attempt to take over. You know, “survival of the fittest.”

The problem for us humans (and animals alike) is that, unfortunately, many of these toxins are “neurotoxins,” meaning they cause damage to our nervous system. The focus on potential neurological issues is why mold growth inside a building is often considered a severe problem. There is simply not the same abundance of organic matter (“food”) indoors as outdoors, and there’s typically not enough moisture.

As a result, if mold is allowed to grow inside a building (due to a water spill or water leakage, for instance), you can be sure that some species of the toxic category will eventually settle in and produce toxins.

Remember that mold spores are plentiful outdoors, and many are airborne. Each time you open a door or a window or go in and out, some of these spores are invariably being brought in with you. However, as long as the conditions for growth are not present in the building, these spores will simply remain dormant and will cause no harm (just like when you are stirring dirt in your garden).

However, this flow of mold spores is also why water leaks or spills, resulting in moist areas in a building quickly becoming a fertile breeding ground for mold even if the house looks otherwise clean. The leak is often limited to a cramped space or semi-enclosed areas, such as behind a bathroom cabinet. This type of space is called a “micro-climate.”

  1. Modern houses “cannot breathe”:

How often have you heard that newer houses “cannot breathe” while older homes were very “leaky”?

To reduce energy waste, we build our houses as airtight and insulated as possible to prevent hot or cold air infiltration. While this is a good thing from an energy conservation standpoint, it also means that there is practically no air circulation from the outside and, in turn, less air circulation in-between walls or wall cavities.

Walls in modern construction are never “solid” and contain therefore empty spaces or “cavities.” These enclosed spaces communicate throughout your house, allowing air to migrate from one cavity to another. Still, the volume of air circulation is relatively small and certainly cannot be described as air “flow.” Consequently, the materials will not dry very quickly or easily if a water leak occurs.

Being “leaky,” older constructions allowed some outside air to infiltrate these cavities, promoting air circulation between these enclosed spaces. This air leakage is what some builders or construction workers refer to as “breathing.” One consequence is that water spills were allowed to dry faster than in modern-day construction.

In other words, in a modern “airtight” house, wet materials will take longer to dry unless you control the humidity by dehumidifiers or air conditioning. If a water leak occurs in a modern building and is not quickly addressed, the immediate surrounding area will remain humid, creating a perfect breeding ground for mold. Remember what mold spores need to proliferate: food, heat, and moisture.

So, are older houses better? No, not really. As described in this article, other factors have changed, but an older house is more likely to have experienced water damage at one point or another since it has been around longer. On top of that, unless they have been thoughtfully remodeled, they are typically wasting a lot more energy than newer ones.

  1. Mold species are evolving to adapt to their new environment:

As mentioned previously, building materials have also changed significantly. Many modern materials are now impregnated with fungicidals (chemicals that impede fungus growth). Almost every material can be treated this way: paint, drywall, wood, even concrete.

You will be hard-pressed to find any air conditioning duct material in the U.S. not impregnated with one such chemical.

While this seems like a good idea at first glance, scientists now see that many fungi species are becoming more resistant to these fungicidal agents (much like bacteria are becoming more resistant to antibiotics).

This is the paramount principle of evolution.

  1. Air conditioning is exacerbating the problem (sometimes causing it):

The advent of residential air conditioning has made our dwellings more comfortable but also more susceptible to mold growth if not designed and installed correctly.

To understand this, let’s first talk about humidity:

“Humidity” is the % of the maximum amount of water molecules held in the ambient air at a given temperature and pressure.

We can ignore the atmospheric pressure variation here for all practical purposes.

It might help to picture air as being just like a glass. 50% humidity simply means that the ambient air is holding ½ of the water it can support at the current temperature (the glass is ½ full.). 100% corresponds to the “saturation point” or “the glass is full” point.

You might remember from your physics class that the higher the air temperature is, the more considerable the amount of water the air can hold (the glass becomes larger as the temperature increases). So keep this thought- this is important because that explains why condensation occurs on cold surfaces.

Picture that glass of iced tea that you bring outside on a hot summer day. All those droplets of water that form on the surface of the glass seem to appear out of thin air because…wait for it- they do.

The air temperature very close to the surface of the glass is cold, much more so than the ambient air. Because of that sudden temperature drop, the air in contact with the glass can no longer hold the water in it, hence the water droplets appearing out of the blue. That’s condensation.

The humidity of the air in contact with the glass has rapidly gone from, let’s say, 60% to above 100%, meaning the glass has overflowed.

What does this have to do with air conditioning? In a nutshell: condensation over cold surfaces.

When your A/C system is running, the air inside the network of ducts is much colder than the ambient air. Therefore, if any outer surface of this ductwork (or any other system component) gets too cold, condensation will occur just as it does on your glass of ice tea in the summer.

All ductwork is insulated for this precise reason. Unfortunately, it is all too easy to compress or damage this insulation during handling and installation unless the installers use a lot of care.

To make matters worse, in a conventional vented attic, it is not possible to avoid having some portions of ducts and register boxes covered by the insulation installed on top of the ceilings.

Since air can migrate through the insulation (no matter whether it is the loose, blown type, or fiberglass batts), the amount of moisture in the air is the same everywhere. However, the temperature is not. The surfaces of the buried duct or boxes are colder than ambient air, a situation worsened by the insulation. The cooler the surface is, the higher the likelihood of condensation.

Therefore, it is critical to look under the insulation by physically displacing it when inspecting the attic to look for condensation and mold. Also, the ducts connected directly to the HVAC air handler cabinet are always the coldest components since the air they carry has just passed the system’s cooling coils. Therefore, you must meticulously inspect these components if you are looking for moisture.

As you can imagine, condensation over any ducts will lead to wet materials (wood, drywall, etc.), perfect organic food for mold.

Since air conditioning was nonexistent in the days of our grandparents, their houses had no or fewer cold surfaces indoors that could cause condensation. But, of course, that also affected their lifestyle as they left windows open in the summertime, and used ceiling fans liberally, all of which promoted more ventilation. We can therefore conclude the following.

What can we conclude about how we build houses?

Mold in houses was not as much of a problem “back in the days” for several reasons:

  • We built houses differently, and building materials have changed significantly since then.
  • Mold spores that made their way into houses did not necessarily become toxic.
  • Some mold species are becoming more resistant to fungicides and becoming more difficult to avoid or eradicate.
  • The advent of central air conditioning systems can create conditions favorable to mold growth in modern houses if not installed correctly.

What steps should I take if I suspect that my house is toxic?

  1. Don’t ignore it! I have encountered many people who just cannot get past the psychological barrier and are incapable of coming to grips with the idea that their house might be moldy. Somehow, they remain in denial, and their health continues to degrade.
  2. If you are a patient of mine, I will ask you to perform an ERMI test as a preliminary confirmation of whether or not our suspicions are confirmed. This also gives me an overall picture of the condition of your house by looking at two things: what species of spores can be found in your home and what kind of concentration levels are present (a lot or just a little). If the ERMI is suspicious for “active mold growth,” I’ll ask you to do #3; below.
  3. Hire a professional inspector. They have tools to measure the level of moisture in materials (and even behind them). They also have the instrumentation to detect the presence of mold spores, species, and concentrations. They are trained and know where to look and what to look for. They also follow protocols to perform inspections safely. A good inspector will also guide you and present you with the best plan of action for your situation.

Performing an inspection yourself is unlikely to reveal hidden problems (otherwise, you would already have found them). In addition, this will expose you to dangerous mycotoxins if you were indeed to see mold growth. Finally, realize that stirring up objects or materials contaminated by mold will spread the spores all over and worsen the problem. You don’t want to do this.

  1. If the inspection reveals mold contamination, hire a professional mold remediator. Mold growth is a serious matter because your health is at risk. However, there is more to mold remediation than what popular belief would have it. A competent professional remediator will follow strict protocols to do it thoroughly while preventing you and your loved ones from exposure.


References :

History of air-conditioning:

Anti-fungal in building materials:

What does it mean when you learn mold is why you feel sick?

Chances are you have been suffering from all sorts of medical issues for a long time, you have seen numerous physicians, have received all kinds of diagnoses, but no treatment turned out to be effective. Unfortunately, this is a story I hear all too often. How do you know mold is making you sick? If you’re not sure after reading this article, please read the one I just linked for you.

Suppose you are coming to me with symptoms that I suspect might result from mold exposure. In that case, I will assess to look for typical symptoms such as gastrointestinal problems, cognitive or mood issues, pain issues, sleep problems, and much more. 

These symptoms result from mold toxicity from exposure to a mold-contaminated environment. People with exposure to live mold or dead mold containing mycotoxins (more on this distinction to come) can develop a condition called CIRS, short for Chronic Inflammatory Response Syndrome.

CIRS, called “Mold Illness” or “Biotoxin Illness,” is a condition caused by other types of biotoxin exposures, such as Lyme bacteria or blue-green algae.

Symptoms are not trivial and can vary substantially from one patient to another. They also often overlap or even mimic symptoms associated with other medical conditions. For example, Lyme Disease, Ehrlichiosis, and even some autoimmune disorders come to mind. As a result, exposure to toxic mold and CIRS are often misdiagnosed or simply not diagnosed.

Since it is one of the easiest and quickest tests for preliminary assessment for CIRS, I will likely ask you to take a Visual Contrast Sensitivity Test or, in short, a VCS test. You will take this test online. Again, it is quick and inexpensive, with results immediately available.

This online test might sound like witchcraft, but it is a genuine scientific assessment. The U.S. Military Medical Services initially developed this test as a visual assessment for jet fighter pilots.

However, this test does not assess visual acuity but rather the ability to distinguish contrast at various levels and shades of black, white, and grey. This capability is part of the brain’s functions using sensory information provided by the optic nerve, which is often affected by mycotoxins. Always try to remember that while live mold produces mycotoxins, there is still a danger from dead mold, as dead mold spores contain active mycotoxins. Mold and mycotoxins are the issue.

Even though VCS is a nonspecific test of neurological function integrity, it provides a high degree of accuracy and sensitivity for biotoxin exposure, such as mycotoxins.

Over 90% of people suffering from CIRS fail a simple VCS test. It is not enough to provide a definitive diagnosis, but it gives an initial indication that CIRS might be a likely diagnosis. Therefore, we need to investigate further to determine the cause (which can potentially be a mold-contaminated environment).

In practice, if you fail the test, you are probably suffering from CIRS. However, if you pass, there is still a possibility that you do have CIRS.

Now What?

If you have failed the VCS test, I will order the appropriate bloodwork panels. I will usually ask you to perform an ERMI test of your environment (home, office, workplace, depending on your specific situation). This easy-to-do swab is another relatively quick and easy test that, once interpreted correctly, allows me to get a very good picture of the following:

  1. Were mold spores present at one point or another in this building?
  2. What species of mold were present?
  3. How bad is the contamination level?

The ERMI test does not tell me whether or not these mold spores are still active (alive). Other tests are required for that (but they are more expensive).

Once I have the results of your lab tests and the ERMI test, I will know a lot more about your situation from a physiological standpoint. In addition, I will learn more about your genetic makeup, and I will also have some suggestions vis-à-vis your environment’s conditions.

At that point, if everything is pointing towards mold contamination, we need to get answers to the following questions:

  1. Is mold actively growing in your house (or workplace)?
  2. What is the root cause for the presence of mold, and what is the source?
  3. What is the best strategy to remove the source, repair the damage, and finally, decontaminate it?

There is only one way to do this right, and it is to hire mold assessment experts.

How do I find Mold Assessment Experts, and How do I check their qualifications?

Great question. I get asked all the time.

The mold assessment & remediation industry is a very crowded space. Therefore, individuals and companies are required to hold State-issued licenses to be considered qualified to perform these services.

Many different combinations of education and experience are accepted, but everyone must pass a written examination to obtain a license (renewable usually every two years). Some states even accept certifications from other states to issue a license (as long as the candidate submits an application and pays the fees).

Despite these legal requirements, unfortunately, quite a few individuals or companies are not following strict protocols or are making unfounded claims, sometimes based on misconceptions, ignorance, or simply “anecdotal evidence.”

Some unscrupulous individuals pretending to be qualified are not even properly licensed. Despite being illegal and subject to fines and penalties, these individuals can be operating for quite some time before any complaints are filed.

As a result, finding a qualified, honest, and thorough mold inspector or remediation company may be challenging. In other words, you need to do your homework.

We have an entire handout dedicated to this topic alone which we give to patients who need us to help them find an inspector, examine a remediation proposal, and so on.

Remember that there are “two patients” when we deal with CIRS, and without environmental clean-up, the human patient will not recover.

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Li, De-Wei, and Chin S. Yang. “Fungal contamination as a major contributor to sick building syndrome.” Advances in Applied Microbiology 55 (2004): 31-112. 


Malir, F., Ostry, V., Pfohl‐Leszkowicz, A., & Novotna, E. (2013). Ochratoxin A: Developmental and reproductive toxicity—An overview. Birth Defects Research Part B: Developmental and Reproductive Toxicology, 98(6), 493-502. 


Marin, D. E., & Taranu, I. (2015). Ochratoxin A and its effects on immunity. Toxin Reviews, 34(1), 11-20. 


Mousavi, B., Hedayati, M. T., Hedayati, N., Ilkit, M., & Syedmousavi, S. (2016). Aspergillus species in indoor environments and their possible occupational and public health hazards. Current medical mycology, 2(1), 36. 


Müller, G., Kielstein, P., Rosner, H., Berndt, A., Heller, M., & Köhler, H. (1999). Studies of the influence of ochratoxin A on immune and defence reactions in weaners. Mycoses, 42(7‐8), 495-505. 


Nagayoshi, M., Tada, Y., West, J., Ochiai, E., Watanabe, A., Toyotome, T., … & Tatsumi, K. (2011). Inhalation of Stachybotrys chartarum evokes pulmonary arterial remodeling in mice, attenuated by Rho-kinase inhibitor. Mycopathologia, 172(1), 5-15. 


Ochiai, E., Kamei, K., Watanabe, A., Nagayoshi, M., Tada, Y., Nagaoka, T., … & Shibuya, K. (2008). Inhalation of Stachybotrys chartarum causes pulmonary arterial hypertension in mice. International journal of experimental pathology, 89(3), 201-208. 


Odhav, B., Adam, J. K., & Bhoola, K. D. (2008). Modulating effects of fumonisin B1 and ochratoxin A on leukocytes and messenger cytokines of the human immune system. International immunopharmacology, 8(6), 799-809. 


Park, S., Lim, W., You, S., & Song, G. (2019). Ochratoxin A exerts neurotoxicity in human astrocytes through mitochondria-dependent apoptosis and intracellular calcium overload. Toxicology letters, 313, 42-49. 


Pestka, J. J., Yike, I., Dearborn, D. G., Ward, M. D., & Harkema, J. R. (2008). Stachybotrys chartarum, trichothecene mycotoxins, and damp building–related Illness: new insights into a public health enigma. Toxicological sciences, 104(1), 4-26. 


Pfohl‐Leszkowicz, A., & Manderville, R. A. (2007). Ochratoxin A: An overview on toxicity and carcinogenicity in animals and humans. Molecular nutrition & food research, 51(1), 61-99. 


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Rosenblum Lichtenstein, J. H., Molina, R. M., Donaghey, T. C., Hsu, Y. H. H., Mathews, J. A., Kasahara, D. I., … & Brain, J. D. (2016). Repeated mouse lung exposures to Stachybotrys chartarum shift immune response from type 1 to type 2. American journal of respiratory cell and molecular biology, 55(4), 521-531. 


Sahin, O. A., Kececioglu, N., Serdar, M., & Ozpinar, A. (2016). The association of residential mold exposure and adenotonsillar hypertrophy in children living in damp environments. International journal of pediatric otorhinolaryngology, 88, 233-238. 


Steinemann, A. (2018). National prevalence and effects of multiple chemical sensitivities. Journal of occupational and environmental medicine, 60(3), e152. 


Stoev, S. D. (2008). Complex etiology, prophylaxis and hygiene control in mycotoxic nephropathies in farm animals and humans. International journal of molecular sciences, 9(4), 578-605. 


Suojalehto, H., Ndika, J., Lindström, I., Airaksinen, L., Karvala, K., Kauppi, P., … & Alenius, H. (2021). Transcriptomic Profiling of Adult-Onset Asthma Related to Damp and Moldy Buildings and Idiopathic Environmental Intolerance. International Journal of Molecular Sciences, 22(19), 10679. 


Tuuminen, T., & Lohi, J. (2018). Immunological and toxicological effects of bad indoor air to cause Dampness and Mold Hypersensitivity Syndrome. AIMS allergy and immunology. 


Viana, M. E., Coates, N. H., Gavett, S. H., Selgrade, M. K., Vesper, S. J., & Ward, M. D. (2002). An extract of Stachybotrys chartarum causes allergic asthma-like responses in a BALB/c mouse model. Toxicological Sciences, 70(1), 98-109.  


Von Tobel, J. S., Antinori, P., Zurich, M. G., Rosset, R., Aschner, M., Glück, F., … & Monnet-Tschudi, F. (2014). Repeated exposure to Ochratoxin A generates a neuroinflammatory response, characterized by neurodegenerative M1 microglial phenotype. Neurotoxicology, 44, 61-70. 


Wang, J., Janson, C., Lindberg, E., Holm, M., Gislason, T., Benediktsdóttir, B., … & Norbäck, D. (2020). Dampness and mold at home and at work and onset of insomnia symptoms, snoring and excessive daytime sleepiness. Environment international, 139, 105691. 


Wu, Q., Wu, W., Franca, T. C., Jacevic, V., Wang, X., & Kuca, K. (2018). Immune evasion, a potential mechanism of trichothecenes: new insights into negative immune regulations. 


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