Protocols for subClinical investigations by clinical industrial hygienists within human habitations that may be beneficial to physicians in the diagnosis of allergy and asthma

November 11, 2009. PAAM, Venice, Italy. Clinicians at the annual meeting of Pediatric Allergy and Asthma Conference review studies of environmental factors that may be causative or contribute to allergies and asthma.

Dumanov J 1,2 , Rudenko M 1,2 , Badali H 2,5 , Hooper D 2,3 , Gray M 4 , Jones T 2

1 Mycological Institute, New Jersey, USA, 2 subClinical Research Group, EU, UK, US, 3 Real Time Labs, Dallas, Texas USA,4 Arizona Health Care, USA , 5 CBS, Utrecht, Netherlands

Keywords: allergy, asthma, diagnosis of fungal allergy, Immunoglobulin E sensitivity, IgE, mold, rhinitis, Aspergillus, Alternaria, Cladosporium, indoor allergens, contact dermatitis,indoor environmental investigations,clinical, cC, subClincal investigations, CCIH

ABSTRACT

Allergy to molds (IgE-mediated hypersensitivity to fungi) from genera such as Aspergillus, Alternaria and Cladosporium is commonly recognized. In cases where mold fungi are suspect as agents within human habitations a system for the detection, measurement and identification has eluded the acceptance by clinicians due to the lack of a protocol that could be widely accepted. Such a protocol has been tested and been generally accepted by an increasing number of doctors and clinicians aware that a system of sample collection and reporting by medically trained investigators for a range of health conditions in the form of subclinical investigatory protocols. Subclinical investigations are studies of indoor environmental factors that may include air gas composition, particulates, vapor levels, temperature, sound, light and electromagnetic radiation. For the doctor such factors present may be of interest to complement the diagnosis. Institute researchers have developed a series of three investigate protocols for related indoor environmental investigations, sC-1, sC-2 and sC-3 in order of most requested studies for allergy, toxicity and infection. These when indicated may be prescribed for patients with a diagnosis of allergy, anaphylaxis, neurological disorder or conditions relating to the presence of fungi, related disease and mycosis. Such investigations may prove to be of benefit in cases where the possibility of repeated exposure has or may have reoccurred. The subclinical investigative protocols when employed by medical mycologists with a high level of clinical training and awareness under prescription or order by a doctor can provide a definitive environmental diagnostic with all appropriate differentials considered in cases where respiratory pathogens, airborne fungal spores and fragments of fungal dermatophytes that may be present.

These protocols may answer many of the questions that may be important to the doctor in identifying the genera and levels of airborne fungi and particulates present, animal dander, arthropods, irritants such as fiberglass, silica, asbestos and synthetic and natural fibers, existence of polyaromatic and polycyclic hydrocarbons, electromagnetic fields and non-ionizing radiation. In general clinically trained industrial hygienists have the ability to apply common differential diagnostic practices of inclusion and exclusion relevant to the point of inquiry for the prescribed subclinical study.

MATERIALS AND METHODS

Subclinical investigation and inspection of human habitations when performed with the aim to identify relevancy for the health condition of a patient and current indoor environment. Specific methods employed for fungal mold identification include: visual, sampling and microscopy, culture methods, PCR, enzyme and molecular assay for mycotoxins. Following equipment is used for the purpose of investigation: air pump for air same collection, air gas composition analytical meter, humidity meter for level of moisture measurement, tape lift sample and microscope slides for sample collection, staining of samples with standard commercially available stains including GMS, LPCB, and PAS. Molecular methods for serum assay for select mycotoxins. Tesla/Gauss meters and RF detection instruments for electromagnetic and non-ionizing radiation.

CONCLUSION

Subclinical investigation methods are now available for indicated condtions may provide the doctor with a clinical lead in diagnosis.