Mycotoxins and building-related illness
Page E, Journal of Occupational and Environmental Medicine. September,
1998; 40(9):761-764. (Review)
Purpose: Critique of the 1998 article published by Hodgson and
colleagues and the authors' reply.
Design: Letter to the Editor and Authors' Reply.
Outcome: Two scientists from the Center for Disease Control used
the Letter to the Editor format to review the limitations of the
courthouse-related study conducted by Hodgson and colleagues. Page and
Trout did not agree with Hodgson et al., who concluded that mycotoxins
from fungi growing on water-damaged building material were the most
likely cause of individual complaints in the Florida buildings that were
evaluated. Page and Trout opined that there was a lack of objective
evidence documenting pulmonary illness in the building occupants, a lack
of information demonstrating actual exposure to mycotoxins, and limited
evidence from the literature suggesting that mycotoxins are related to
illness caused by the indoor environment. Page and Trout stated that the
studies cited by Hodgson and colleagues failed to make up for these
shortcomings. Hodgson et al., responded to Page and Trout by explaining
their approach to assessing whether or not mycotoxins were the culprit.
Hodgson et al., believed that they had ruled out the possibility that
the cases had either type I allergy or hypersensitivity pneumonitis
induced by an allergen from fungi. They claimed that a reaction to
allergens could not explain the lung function abnormalities because
there was not sufficient evidence that the appropriate antibodies were
correlated with the observed symptoms. They also attempted to rule out
airborne endotoxins from sources other than fungi because they felt
there wasn't enough evidence of a water reservoir from which endotoxins
might derive. Hodgson and colleagues reiterated their original view that
mycotoxins were the most likely candidate that they could identify.
Significant Quotes: "Most scientists recognize that case reports
and outbreak investigations cannot provide generalizable knowledge, as
the population to which they may be extrapolated is controversial. The
purpose of such reports is generally to make the medical and scientific
community aware of discussions, theories, and concerns they should be
aware of, could keep their eyes open for, and perhaps recognize again if
encountered elsewhere." (p. 763).
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