Autoimmune Disease and the Built Environment

Craig Whittaker founded Environmental Solutions Group in 2002 to provide impartial evaluation of properties relative to environmental health. A doctoral member of the American Academy of Environmental Medicine, he is frequently asked to speak on the topic of unsuspected toxins in the home, he has conducted hundreds of assessments in a wide variety of building types.

Environmental professionals should be taking note of a relatively new area of medical science – autoimmune disease. This condition occurs when the body’s immune system responds against substances and tissues that are normally present as if they were a pathogen or invader. The treatment of the wide variety of autoimmune diseases is typically through immunosuppression, or medication that decreases immune response.

Readers who have been diagnosed with autoimmune disease and their medical practitioners may also be interested in environmental testing that is becoming more widely available. We have found that our office gets more calls each year from individuals whose physicians have suggested getting their house assessed for an environmental pathogen or toxin. Perhaps it’s due to the popularity of television’s ‘House’ series, or maybe environmental illness is being taught in medical school and at conferences. The reason is not what’s important – it’s the resulting thought and action that could lead to a clue that may help someone who struggles with a debilitating disease.

I have been encouraged by others who practice environmental science and have noticed a similar trend – physicians and environmental practitioners working together to help people who suffer from often-unexplained illness. Carl Grimes has written about this in Indoor Environment Connections a few times, and I pay close attention to Carl as he has a keen understanding of the relationship between buildings and health. On one hand, the environmental investigator is not a medical professional and cannot diagnose. On the other hand, the medical professional is not trained to assess buildings for microbial and chemical pathogens or toxins. Both sides need to understand the capabilities of the other and communicate their findings in a way that can assist the patient.

Autoimmune disease is extremely complex, but so is the relationship between the thousands of chemicals we (often unknowingly) bring into our homes. Add moisture from a water leak or high humidity and the chemicals change. Your home and bodies living in it become a chemistry experiment that sometimes goes wrong.

I am not suggesting that autoimmune disease can be eradicated through environmental assessments and improvements. I do believe, however, that some people can be helped through the knowledge that can come from a basic health hazards screen of the home and/or workplace.

In Support of Sampling for Mold

Craig Whittaker founded Environmental Solutions Group in 2002 to provide impartial evaluation of properties relative to environmental health. As a Certified Indoor Environmentalist, he has conducted hundreds of environmental assessments in buildings ranging from apartment units to medical buildings to military installations. 

I frequently read that it is not necessary to collect surface or air samples for analysis of mold spores when conducting an air quality assessment. The justification seems reasonable: if mold is visible, just clean it up or replace the item on which it’s growing. If mold is not visible, it’s probably not present and testing with lab analysis of samples is a waste of resources.

Consider argument #1- “if mold is visible, just clean it up”. The problem is that many property owners have paid hundreds, thousands and even 10s of thousands of dollars cleaning up something that was not mold. One of our investigators was in a house this week where a contractor calling himself a mold remediator quoted the female owner $1300 to remove the ‘toxic mold’ from her crawl space. This fee did not include the cost to replace all the floor insulation. It turns out that the staining on the wood wasn’t mold at all, but insect feces. Even if the homeowner decided to have the stuff cleaned up, it would have cost a fraction of the fee quoted and she would not have to replace the insulation. Here’s the interesting part of the story – the contractor told the homeowner that he knew mold when he saw it and testing was a waste of money. Wrong. Believing nonsense from a contractor who is about to charge a fortune is a waste of money. Thankfully, the homeowner called for a 2^nd opinion from a reputable firm that did not perform remediation.

How about argument #2 – “I don’t see anything, so there’s no need to do testing”. I wish I had a nickel for every time an insurance adjustor, landlord, builder, or family friend told one of our clients that testing was not necessary. This argument is even easier to dismiss than the first one. Fact: mold spores are too small to be seen without a microscope. When you see green, white or dark fuzzy stuff growing inside your house or office, you are seeing the mold colony, which contains millions of sprouted spores. Another reason you may not see the mold is simply because it’s not growing where you can see it! Mold likes dark, damp places  - places like wall cavities, crawl spaces, and underneath furniture, carpet and hardwood flooring. Testing air quality in a suspicious area can often identify an issue that needs to be tested in a lab, especially if someone’s health is being affected.

I want to be clear that taking samples to a lab for analysis is not always necessary, especially if the investigator knows how to properly assess a building for moisture damage. There are tools the experienced professional can use to measure moisture levels and air quality to help determine if a mold issue is likely. Collecting samples for a lab to analyze may prove that a mold issue does not exist or show that mold is present at an abnormal level. Either way, the result is very important information that could have a significant bearing on the next step.

Mold in Medical Buildings

While most of us probably know of someone who has had an infection following an operation, you may not realize the significance of airborne mold spores. Fungal growth actually presents a difficult and often expensive dilemma for medical facilities. Perhaps more important than the structural damage caused by mold is the danger of health care-associated infections (HAIs).

The CDC estimates that HAIs are a rapidly growing concern that affect two million Americans and cause about 100,000 deaths each year. This number is expected to increase over the next several years due to four main factors: 1) hospitals are building additions onto their existing structure to accommodate more patients and dust from demolition activities contains high levels of mold spores; 2) doctors and patient families are willing to try keeping the patient alive longer through risky organ transplants and other medical procedures that require deactivating the immune system; 3) the number of small, privately-owned surgical centers is rising. Many of these facilities do not have the resources to properly manage airborne contaminants, and 4) in an effort to keep costs down, insurance companies require shorter hospital stays, placing the patient at risk for an infection that may not become apparent until it is too late to treat with success.

The resulting disease resulting from exposure to mold in a health facility is largely dependent on the individual response. Healthy hospital staff may become sensitized to mold, but there is only a small risk of infection in healthy people. Mold exposure can be life-threatening, however, for patients who are immunosuppressed. The crude mortality rate from fungal infections exceeds 50 percent in the latter group, which is comprised of a large percentage of hospital patients.

What Can Hospitals Do?

As fungal infections can be difficult to diagnose, prevention is key in reducing exposure to pathogenic fungi such as Aspergillus. Keeping construction areas tightly sealed-off from patient areas, preventing the transfer of unfiltered air through ventilation systems, and properly maintaining HEPA filters and other HVCA components will help keep fungal spores from dust & soil from entering areas not under construction. It is important to note that common areas such as cafeterias, break rooms and hallways need to be sealed to the same level as patient rooms as mold spores can be blown or carried from common areas into patient areas.

Since fungal spores and fine dust can remain suspended in air for hours, it is important to assess the air quality before, during and at the end of a renovation project. In a hospital-like setting, baseline data are very important should an outbreak occur during or after a project.

What Can Patients Do?

Larger hospitals tend to understand the risk and are more prepared to deal with prevention and treating an HAI. The smaller the hospital, the greater the risk, therefore, check out all your options prior to choosing a hospital for your surgery. It is best to avoid using a surgical center that is not located in a hospital.

No matter which hospital you choose, ask for the administration to provide and discuss their policies for preventing HAIs. Even if you do not see a construction site at the building, everyday activities and common water leaks generate mold-containing dust particles that cause infection.

Health-care associated infections are a major health issue that result in nearly 100,000 unnecessary deaths each year and add considerable cost to health care. Making prevention a priority is sure to make a difference.

How Often Should I Check the Health of My Home?

Craig Whittaker founded Environmental Solutions Group in 2002 to provide impartial evaluation of properties relative to environmental health. As a Certified Indoor Environmentalist, he has conducted hundreds of environmental assessments in buildings ranging from apartment units to military installations.

Homeowners contact us several times a day to inquire about testing the air quality in their home. We try to help the caller understand that checking a home for common indoor pollutants is similar to getting an annual medical check-up. Common indoor pollutants can aggravate existing health conditions & cause new ones to develop, even in healthy adults. Pollutants can also cause damage to building products and can cause problems when you go to sell or refinance your home.

Many people are unaware that the indoor air is typically five to ten times more polluted than the outdoor air. Since the 70s, tighter buildings and the introduction of tens of thousands of chemicals into the home environment have led to measurements of airborne gases and particulate in suburban homes that used to be exclusive to outdoor air in urban areas.

We know homeowners are concerned due to the popularity of home environmental test kits. These kits that prompt the homeowner to collect their own samples and send them to a lab for analysis. Usually the lab sells the kit for low cost and charges a high fee for the testing.  Aside from the cost and the fact that the lab report will not be meaningful to someone who doesn’t read lab documents every day, sending air samples to a lab is often unnecessary.  The testing can produce false negatives if the samples were not collected properly and did not follow a scientific method.

So is it really necessary to have a home health check-up? You be the judge. A few of the environmental conditions our firm has identified during a routine home check-up include:

• Pipe leak in a wall cavity behind the shower (leak identified before structural damage occurred)
• Leaking toilet dripping sewage into the crawl space under the house (found before it became a major issue)
• An unhealthy level of carbon monoxide in the master bedroom from a faulty propane heater (finding this probably saved a life as the homeowner’s CO detector was not working)
• Elevated level of airborne formaldehyde from new kitchen cabinets (explained why the entire family had terrible headaches)
• Mold on the back of an antique mirror in an elderly woman’s bedroom (the woman had the mirror removed and her sinus issues improved)
• Disconnected flue vent pipe in an attic next to a child’s bedroom (sewer gas odor could have eventually become overpowering and even dangerous)
• Birds living in the dryer vent (additional testing found that pathogens in the bird nest were being pulled into the house through the dryer when the A/C came on)
• Dead rat inside a wall at a house for sale (the rat was missed by the pest control company and home inspector)

If you are like many homeowners who realize the importance of an annual home health check-up, look for an environmental consultant who does not sell remediation services. Also locate someone who has equipment that can be used to check measurements of airborne gases and particles before collecting samples for lab analysis. This type of service is often called a home health assessment, and the investigator should be able to show you the live readings on test equipment before recommending additional samples.

How Often Should an Air Conditioning Filter Be Replaced?

One of the most common questions posed to our indoor air quality team is “how often should I replace my HVAC filter?” Our response is usually something like, “How often do you think it should be changed?” The replies vary tremendously, and include “whenever I happen to remember to change it” to “every month or so, depending on how dirty it looks”.

It may come as no surprise that many people we encounter do not even realize that they have an air filter on their system, especially young adults living on their own for the first time. Unless their landlord or a loved one changes the filter, it is probably not getting replaced. One elderly client had forgotten to change her filter for several years – it was covered in about an inch of dust and the paper frame was covered in fuzzy mold.

If you live alone, have no furry pets or carpet, don’t smoke and stay relatively still, it’s possible to get 90 days of service from a filter. Most of us have a dog (or at least a toddler) that jumps around, plays outdoors, and creates some dust. This is the stuff that fills up a paper filter very quickly, starving the system of air and reducing the effectiveness of the filter. Contrary to what some homeowners believe, a dirty filter does not capture more dirt.

We have had many opportunities to demonstrate how important filtration is to a property owner or tenant. As all of our air quality investigators measure airborne particle load almost immediately upon entering a building, we know right away when the level of invisible dust, known as ‘respirable particles’, is not acceptable.

As an example, the living room of a home with three medium-sized dogs was found to have an elevated particle load that totaled more than 300 micrograms per cubic meter of air (mcg/m3). This is more than twice the EPA’s recommended level for respirable particles in a home if measured over a 24-hour period, and much higher than normal. The homeowner had replaced their high quality filter 30 days prior to our measurement, however, it was no longer doing the job. The homeowner immediately put in a new filter of the same quality, and an air quality measurement at the living room 10 minutes later found the total particle load had dropped to a very respectable 8mcg/m3. You can see for yourself in the pictures below that the particle readings are much lower after the filter change.

There you have it – our best advice is to change your HVAC filters every 30 days. Otherwise, you risk having the lungs of everyone in the building work overtime.

Particle measurement prior to filter changeAfter filter change

 

 

 

Mold in Schools – Why Parents Should Be Concerned

A recent investigative report on CNN focused on a sensitive topic – could schools be making our kids sick? One of the children in the report, a third grader from Connecticut named Matthew, developed a series of worsening respiratory symptoms through the 2010-11 school year. What started with lethargy, headaches, a persistent cough and respiratory infections progressed into pneumonia and a sinus infection so severe that it required hospitalization.

Matthew missed 53 days of school that year, but he seemed to miraculously recover when summer vacation started. Within three weeks of starting school later that year, Matthew missed 10 days of school with a respiratory infection. Matthew is now being home-schooled by his mother and is doing fine. Testing at the school found elevated levels of mold in the gym/cafeteria and two other areas. The school board spent $16,000 cleaning the school and is considering whether to close the school temporarily to replace a leaking roof.

CNN states that figures are hard to come by, but studies estimate that a third or more of U.S. schools have mold or other indoor air quality issues serious enough to cause respiratory issues like asthma in students and teachers. Doctors who treat children with asthma say that the medications students take for asthma, allergies and sinus infections, can make it harder for them to do their best work.

Just how bad is the air in our schools? Research published in Pediatric Allergy and Immunology in late 2011 found that the level of living mold in the air of over 200 classrooms exceeded an established standard in 33% of classrooms tested. Children in the rooms with abnormal mold counts experienced more stuffy noses,  coughs and infections than children in rooms with normal mold counts. The scientists who conducted the study recommended that schools be routinely tested and evaluated for airborne mold.

I used to teach in a state-owned school building that had a roof leak for years. There was no money to repair the roof, so facilities placed a dish pan with a garden hose leading to a bucket on the floor that faculty were expected to empty out when full. I remember the musty smell in that room and have often wondered what was growing above the ceiling – it certainly could not have been good.

So what is going on here? Our firm has been engaged to test the air in numerous schools, and it is unfair to imply that all schools are poorly maintained, with mold growing everywhere. In fact, we have run to the defense of many administrators, who make every effort to fix the leaks and other environmental issues in their buildings using the scant resources that are available.

Since I have doubts that there will never be enough money to rid our schools of mold hazards, my advice to parents is to be observant. Does your child stay sick while school is in session, and get better during breaks? Are other parents experiencing the same problem with their children? Have you observed moisture problems in the school? If you are quite certain there is an issue that is going unnoticed, let the administration know about your concerns for the health of the children and teachers. The decision to remove your child from the school may become an easy one if nothing can be done to fix the problem and your child continues to be unhealthy.

Taking Lead Contamination Seriously

Our office received a call a few days ago from a homeowner who had us conduct a lead risk assessment at her home a few years ago. At the time, her infant’s blood levels for lead were found to be elevated and since their home was built in the 1920s, the pediatrician suggested having the home checked for lead hazards.

The homeowner called to let us know that she had decided to stay in the house even though some lead hazards were identified during the risk assessment. Although they took care of the known hazards, unfortunately, their child now has permanent brain damage. In retrospect, she feels the disability may have been avoided if they moved out of that house and eliminated any additional lead exposure.

This woman’s reason for calling was to let us know that homeowners need to fully understand the risks of lead contamination. Even if they love their house and do not want to move, it’s more important to keep their children safe and find a house without lead hazards.