Eckardt Johanning M.D., M.Sc., Paul Landsbergis Ph.D. johanni2@crisny.org

Objective: Review of symptoms, clinical abnormalities and laboratory findings of building occupants with abnormal indoor fungal exposure, primarily allergenic and toxigenic fungi (Stachybotrys atra, Penicillium, Aspergillus).

Design: Descriptive review of 151 cases evaluated at a specialty clinic. Analyses of a standardized health symptom questionnaire and immunological laboratory data.

Subjects: Pediatric and adult specialty clinic population with verified abnormal indoor fungal exposure.

Main outcome measures: Self-reported symptom-complexes, Immunoglobulin E and G, T- lymphocyte enumeration and function.

Results: Widespread contamination of water-damaged building materials primarily with toxin producing fungi were identified in the patients exposure history, who are reporting from a variety of nonspecific"sick building"-like complaints to a history of more serious morbidity of the respiratory system, skin, eye, chronic fatigue-like symptoms (CFIDS) and central nervous system dysfunctions (vertigo, memory, irritability, concentration, verbal dysfunctions). In some cases abnormalities of enumeration and functional laboratory tests (flow-cytology), mainly of the white blood cell system were identified. IgE or IgG antibodies used as exposure markers, were positive in about less than 25% of all cases. Removal from exposure typically resulted in improvement in the majority of cases.

Conclusion: Indoor air exposure to mycotoxin and allergen producing fungi results in a high frequency of health complaints, variant multi-organ and laboratory abnormalities requiring a detailed exposure assessment and clinical evaluation. Removal from fungal exposure and symptomatic treatment generally results in noticeable improvement of most patients. I propose to name these presentations and clinical findings-if certain criteria are met: "fungal syndrome".