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466 Pediatric Allergy and Immunology

Mathematic computation using this method determined that the probability ( P ) of this event occurring by chance was not likely ( P < 0.000004). Where:

The third case illustrates the effect of a mold-contaminated environment on an atopic individual. Her symptoms were typical of allergic reactions. When she was removed from the environment, she began to see significant improve-ments in her symptoms.

Conclusions

Allergists are well suited to help in this area of increasing national concern because they are able to combine expertise in diagnosing and treating the symptoms that accompany mold exposure with expertise in testing and analyzing air quality. This combined experience enables us to set standards for evaluating the air quality in public schools.

Too many of the public school buildings in the United States are in unsatisfactory physical condition. All schools, especially those with carpeting or a history of water dam-age, should be tested annually for fungal contamination. Testing should be performed using volumetric air sampling because semiquantitative culture sampling alone does not give a true reflection of the extent of fungal contamination. However, this testing will not be effective without stan-dards for evaluating the results. Unified standards need to be set: a building must be considered unhealthy if the indoor mold counts exceeds 1000 spores/m 3 of air. Testing for total mold spore counts with the Allergenco MK-3 is an easy and inexpensive way to initially evaluate a mold-contaminated environment. If a problem is found, the next step should be an assessment of the environment using the Anderson Air Sampler. This will allow for more specific mold identification, especially for identifying Aspergilius , Pen-icilium , Stachybotrys, and other relevant molds. Additional

testing, if it becomes necessary, would include bulk sample testing, wall cavity testing, and carpet testing.

There should also be a consistent method for assessing the health impact of mold exposure among students, teachers, and staff, and to what extent these health prob-lems are reversible. The validated Rhinitis Outcomes Ques-tionnaire can effectively and inexpensively gather good data about the health impact of exposure to mold from students, teachers, and faculty.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

1.• Dziadzio L, Bush RK: Assessment and control of fungal aller-gens. Curr Allergy Asthma Rep 2001, 1: 455–460.

This paper helps explain the role of fungi in allergic disease and how to control exposure, specifically for those with mold allergy. 2.•• Environmental Protection Agency: Mold remediation in schools and commercial buildings. http://www.epa.gov/iaq/ molds/index.html. Accessed May 14, 2002.

This web site provides extensive information about the health impact of mold in schools, along with specific instructions for detecting and remediating mold-infected buildings.

3. Occupational Safety and Health Administration, US Depart-ment of Labor: Indoor air quality. http://www.osha.gov/SLTC/ indoorairquality/index.html. Accessed May 14, 2002. 4. National Institute of Allergy and Infectious Diseases: Mold allergy. http://www.niaid.nih.gov/publications/allergens/ mold.htm. Accessed May 14, 2002.

5. Connecticut Education Association: Schoolhouse News.

http://www.cea.org/NewsDesk/SHN/index.html. Accessed May 14, 2002.

6. Connecticut General Assembly: An act concerning indoor air quality in schools. http://www.cga.state.ct.us/asp/cgabillstatus/ cgabillstatus.asp?selBillType=Bill&bill_num=5039. Accessed May 14, 2002.

7. The United States General Accounting Office: Indoor air quality. School facilities: America’s schools report differing conditions. GAO Report #HEHS-96-103. http://www.gao.gov/. Accessed May 14, 2002.

8.• Bush RK, Portnoy JM: The role and abatement of fungal aller-gens in allergic diseases. J Allergy Clin Immunol 2001,

107S: 430–440.

This paper demonstrates the value of quantitative indoor air sampling ( ie , using the Allergenco), and sets the standard for an unhealthy indoor environment as volumetric mold contamination count greater than 1000 spores/m 3 .

9. Downs SH, Mitakakis TZ, Marks GB, et al. : Clinical importance of Alternaria exposure in children. Am J Respir Crit Care Med

2001, 164: 455–459.

10. Dales RE, Cakmak S, Burnett RT, et al. : Influence of ambient fun-gal spores on emergency visits for asthma to a regional chil-dren’s hospital. Am J Respir Crit Care Med 2000, 162: 2087–2090. 11. Savilahti R, Uitti J, Laippala P, et al. : Respiratory morbidity among children following renovation of a water-damaged school. Arch Environ Health 2000, 55: 405–410.

12. Savilahti R, Uitti J, Roto P, et al. : Increased prevalence of atopy among children exposed to mold in a school building. Allergy

2001, 56: 175–179.

13. Taskinen T, Hyvarinen A, Meklin T, et al. : Asthma and respira-tory infections in school children with special reference to moisture and mold problems in the school. Acta Paediatr

1999, 88: 1373–1379.

Table 3. Questionnaire scores for John F. Kennedy Elementary School

Patient Before illness

At height of

symptoms Currently

Teacher #1 8 31 2 Teacher #2 4 88 13 Student #1 4 32 7