Photo Credit: Department of Labor; US Department of Labor
Sandy, Toxic Mold, and (at last) a theory potentially
explaining 'Sick Building Syndrome'
Introduction by Ritt Goldstein
Theory by Dr. Bernt Danielsson and Ritt Goldstein
As many still struggle to address the devastation of Superstorm Sandy, another facet of this epic battle is underway, though many remain unaware of it. In the aftermath of Hurricane Katrina, many of the people of New Orleans found themselves faced with unusual health symptoms, respiratory problems being the most common and obvious among these. They coined a name for such airways issues - Katrina Cough.
According to Wikipedia, "Katrina cough is a putative respiratory illness thought to be linked to exposure to mold and dust". And a new 'illness' has emerged in New York, Fox NY (and I never thought I'd cite Fox News) headlining "Far Rockaway Cough", mold thought to play a role in it as well. But beyond coughing there are other symptoms that mold can cause, the US Centers for Disease Control (CDC) even having an advisory site for storm victims.
The CDC warns those affected by flooding that mold can be hazardous, so when deciding what belongings can be salvaged, they urge, "When in doubt, take it out!" As to how hazardous mold can be, the US Environmental Protection Agency (EPA) warns that some molds can produce mycotoxins, the EPA observing: "Many symptoms and human health effects attributed to inhalation of mycotoxins have been reported including: mucous membrane irritation, skin rash, nausea, immune-system suppression, acute or chronic liver damage, acute or chronic central nervous-system damage, endocrine effects, and cancer. More studies are needed to get a clear picture of the health effects related to most mycotoxins. However, it is clearly prudent to avoid exposure to molds and mycotoxins."
Severe mold exposure can have significant and long-lasting health effects, some terming these effects 'Sick Building Syndrome'. Several years ago, I and a colleague developed a theory on the physical mechanism through which such sufferers were affected, a theory we were invited to present at a Mold Symposium in Sweden's parliament organized by the Swedish Green Party. The following is an article on the theory Dr. Bernt Danielsson and I developed, the below piece approximating the one we distributed at our Parliamentary presentation.
The theory is one that leans heavily upon Professor Beatrice Golomb's work on Gulf War Illness, my readings of Golomb -- done quite by coincidence in combination with readings on the natural occurrence of chemical compounds called acetylcholinesterase inhibitors in some varieties of mold -- leading me to contact Danielsson, spawning the work we did. However, Golomb's theory provoked considerable controversy and debate, and today the actual causes of Gulf War Illnesses are yet debated. As for the mold theory Danielsson and I derived, while some medical scientists applauded it, it was never published in any journal, it remains untested. There is one certainty, however, and that is the severity of illness that some of those having significant mold exposures are known to have endured.
In view of Superstorm Sandy's impact, it seemed time for the following to be made public.
SICK BUILDING SYNDROME AND GULF WAR ILLNESS -- A COMMON CAUSE?
By Bernt Danielsson, MD, and Ritt Goldstein, UJ
study linking the multisymptom problems of so-called Gulf War Illness
(GWI) to acetylcholinesterase inhibitors (AChEis) was recently
published: Professor Beatrice Golomb's 'Acetylcholinesterase inhibitors
and Gulf War illnesses'. In our following paper we hypothesize that
AChEis are also connected to another, strikingly similar malady, but one
vastly more widespread and affecting far larger numbers globally,
particularly in The West - Sick Building Syndrome (SBS).
Since the 1970s, debate has existed regarding the nature of so-called Sick Building Syndrome (SBS). More recently, similarities between SBS and GWI have fueled speculation as to the basis for such a commonality, a commonality that may now well be explained.
Spring 2008 saw the publication of Acetylcholinesterase inhibitors and Gulf War illnesses, Gulf War Illness (GWI) being the condition termed to describe the chronic symptoms endured by many veterans of the Gulf War (1990-91). Expanding upon the study's conclusions of AChEi linkage to GWI, one might theorize that exposures to comparable levels of AChEis, in non-Gulf War settings, could potentially yield symptoms resembling those of GWI. Indeed, the study specifically states that its findings "may be relevant to a subset of civilians with chronic multisymptom complaints",(1) opening a passageway to argue that AChEi-rich mycotoxins, emanating from particular strains of indoor molds, may well be an unrealized cause of SBS. Having said this, we also believe AChEi linkage suggests that non-biological, chemical contaminants containing sufficient AChEi levels, could also yield SBS symptoms; though, we focus our attention upon mold.
Soma or Psyche?
Again, since the 1970s debate has existed regarding the nature of SBS. As the pathophysiologic mechanism of SBS's puzzling combination of symptoms has been hard to understand, the question of psychosomatic reaction has often been raised.
Paralleling the SBS experience, findings have shown that about 25 to 30 percent of Gulf War veterans suffer a set of chronic and equally puzzling symptoms.(1) As a result of these veteran's symptoms, a very substantive amount of epidemiological, toxicological, and psychological research has sought both GWI's cause and best treatment. Posttraumatic stress, burning oil wells, burnt-out uranium, nerve agents, and more have all been proposed as explanations of GWI's cause.(1)
Given the lengthy GWI debate, the conclusions presented by Professor Golomb -- that GWI resulted from AChEi exposure generally, and the use of pyridostigmine bromide as a nerve-agent pretreatment particularly(1) - may be termed 'somewhat unexpected' by some. However, beyond her study's publication in one of America's most respected scientific journals,(1) Golomb's findings were confirmed by the US Department of Veterans Affairs' Research Advisory Committee on Gulf War Veteran's Illnesses - a body in which the vast majority of members hold substantive scientific stature.
In a particularly telling observation, an observation upon what might be termed as a further similarity between GWI and SBS, the Committee pointedly observed that GWI had been "poorly understood and, for too long, denied or trivialized".(2)
However, regardless as to one's position upon the relation of GWI to AChEis, Golomb's study does note that there is a history of illness among agricultural workers -- suffering AChEi exposure -- whose symptoms "mirror those" of GWI (1), implying a similar 'mirroring' with those of SBS.(3,4)
As quite potent AChEis are known to naturally occur in mold species associated with SBS,(5,6,7) there indeed appears to be a common denominator to explain the stated similarities of the symptoms/maladies in question. Of course, beyond the fact of such similarities, a question is highlighted as to what the full public health impact of AChEi exposures may be, what maladies such exposures -- in fact -- may be the cause of.
GWI, AChEis, and SBS
"Each of the major types of AChEi exposure that GWV (Gulf War Veterans) experienced... is linked epidemiologically to illness with remarkable consistency. A dose-response relationship is present", (1) read the Spring 2008 findings published in the Proceedings of the National Academy of Sciences of the United States of America. Notably, the study emphasized that criteria widely accepted for the determination of causality based upon observational data, Hill's causality criteria, had been "arguably satisfied".(1)
Golomb noted that only Hill's final criterion, that of specificity, was somewhat in question, Golomb highlighting that causal relationships -- by their nature -- "routinely violated" this demand that an "exposure be linked only to the outcome examined", citing alcohol's generation of multiple problematic outcomes (accidents, liver problems, neuropathy, cancer) to illustrate her argument.(1) Then, assuming the linkage between GWI and AChEis as firm, an extraordinary similarity between symptoms of GWI and those of SBS would seem to suggest the possibility of common biochemical processes in play within both complaints.
Examining this GWI/SBS similarity, according to the so-called Kansas definition of GWI, there must be "multiple or at least moderately severe symptoms in three or more of six symptom groups, focused on fatigue/sleep, pain, neurological/cognitive/mood, gastrointestinal, respiratory, and skin problems."(1) Providing a virtual 'mirror image', according to a 1997 study by Redlich, Sparer, and Cullen, symptoms of SBS include: "mucus-membrane irritation -- eye irritation, throat irritation, cough; neurotoxic effects -- headaches, fatigue, lack of concentration; respiratory symptoms -- shortness of breath, cough, wheeze; skin symptoms -- rash, pruritus, dryness; chemosensory changes -- enhanced or abnormal odour perception, visual disturbances".(3) In 1988, the World Health Organization listed similar symptoms, but also included "gastrointestinal complaints".(4)