The weather has been beautiful the past few weeks: crisp fall days with lots of foliage on the trees. Then it falls to the ground, giving many homeowners the added weekend job of raking up leaves. From an allergy perspective, the problem with those leaves is that they decompose and become a perfect breeding ground for mold spores. The mold spores become airborne and trigger numerous types of allergy symptoms from sinus pressure, swelling around the eyes, and asthma in many patients. Mold counts don’t get the same press as high pollen counts, but with climate change and with super storms increasing in frequency, we are seeing mold counts climbing and staying around longer. Autumn has been well recognized as the time when rising mold counts trigger asthma. The New England Journal of Medicine documented this precise connection several years ago involving the mold Alternaria.
The Allervision panel of skin testing includes the key molds you should be knowledgeable about: Alternaria , Cladysporium, Aspergillus and Penicillium.
Alternaria is one of the best understood and most important molds that causes allergic diseases. Patients with mold allergy will commonly complain of sneezing or shortness of breath after raking leaves. I’ll never forget one patient I took care of who suffered from mold allergy with severe sinus pressure for years. His job was with the Parks Department and guess what his duty was… he operated the machine that collected the leaves off the ground at the parks in town. Fortunately, I treated him with allergy immunotherapy and he was able to continue his job.
Aspergillus is another mold that frequently causes allergic sinus disease and asthma exacerbation. There is a disease called Allergic BronchoPulmonary Aspergillosis; these patients tend to have steroid-dependent asthma. You typically find a high total IgE (over 2,000) and elevated eosinophil counts. Keep an eye out for your patients who test positive to this mold and have the above lab findings. They also typically have bronchiectasis on a chest x-ray.
Cladysporium and Penicillium are the other common molds. Please explain to the patients that testing positive to Penicillium doesn’t mean you are allergic to Penicillin the antibiotic — that’s a different test.
Avoiding mold is difficult, but there are some ways to decrease exposure in the home. If patients smell mold, or mildew as they call, it in their home, I would advise they hire a professional to eradicate it. Also, they should be aware of the humidity in their home; mold loves humidity over 50%. Your patients can purchase a $15 dollar Hygrometer which gives a simple reading.
I would also consider the option of allergy immunotherapy for patients with mold allergy. I have treated many patients just for this specific allergy problem with excellent results and the patients were very grateful.
– Dr. Dean Mitchell