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## Complete Summary

#### GUIDELINE TITLE

Spectrum of noninfectious health effects from molds.

#### BIBLIOGRAPHIC SOURCE(S)

Committee on Environmental Health, American Academy of Pediatrics, Kim
JJ, Mazur LJ. Spectrum of noninfectious health effects from molds.
Pediatrics 2006 Dec;118(6):2582-6. \[25 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17142549)

#### GUIDELINE STATUS

This is the current release of the guideline.

All clinical reports and policy statements from the American Academy of
Pediatrics automatically expire 5 years after publication unless
reaffirmed, revised, or retired at or before that time.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Noninfectious health effects from exposure to molds, including:

-   Immune mediated (allergic rhinitis/conjunctivitis, asthma,
    hypersensitivity pneumonitis, allergic bronchopulmonary
    aspergillosis \[ABPA\], allergic fungal sinusitis \[AFS\])

-   Nonimmune mediated (irritant symptoms, inhalation fever, acute
    idiopathic pulmonary hemorrhage \[AIPH\] in infants, toxin-mediated
    diseases)

#### GUIDELINE CATEGORY

Evaluation\
Management\
Prevention

#### CLINICAL SPECIALTY

Allergy and Immunology\
Family Practice\
Pediatrics

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

To describe the pediatrician\'s role in the education of families about
mold, its adverse health effects, exposure prevention, and remediation
procedures

#### TARGET POPULATION

Children with environmental exposure or potential exposure to molds

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Inquiring about presence of mold or water damage in patient\'s home

2.  Providing guidance for families on:

    -   Health issues associated with mold exposure

    -   Prevention/reduction of mold exposure

3.  Education of families on mold remediation

#### MAJOR OUTCOMES CONSIDERED

Adverse health effects associated with exposure to mold

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Not stated

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not applicable

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

1.  Because there are established health hazards, inquire about the
    presence of mold as part of a \"healthy home\" inventory. Questions
    about a child\'s environment are basic to a comprehensive pediatric
    health history (American Academy of Pediatrics, 2003). Questions can
    be incorporated during visits for health supervision or sick visits.
    Asking about a child\'s environment should be routine for children
    with common illnesses, such as allergic rhinitis/conjunctivitis and
    asthma, as well as for those with less common illnesses, such as
    hypersensitivity pneumonitis.

2.  Provide guidance to parents of all children about:

    -   The adverse health effects of mold exposure, especially the
        causal relationship between mold and allergic illness and
        respiratory symptoms; and

    -   Preventing and reducing mold exposure in the immediate indoor
        and outdoor environments.

3.  Educate families on mold remediation. Visible signs of mold growth
    (e.g., discolored patches or cottony or speckled growth on walls or
    furniture, evidence of dampness or water damage or an earthy musty
    odor in a particular area) suggest a damp environment and mold
    growth. In areas where flooding has occurred, prompt cleaning
    (within 24 hours) of walls and other flood-damaged items is
    necessary to prevent mold growth. Testing the environment for
    specific molds is usually not necessary. In general, individuals can
    perform mold cleanup for areas less than 10 ft (Centers for Disease
    Control and Prevention, 1997).

4.  When treating an infant with acute idiopathic pulmonary hemorrhage
    (AIPH), inquire about mold and water damage in the home. Report
    cases of AIPH to state health departments. Although a causal
    relationship between AIPH and damp, moldy indoor environments has
    not been firmly established, the knowledge is incomplete at this
    time. Therefore, it is prudent to recommend that parents of infants
    with AIPH try to find and eliminate sources of chronic moisture and
    mold growth before the child returns to the home. Avoidance of
    exposure to secondhand cigarette smoke is always recommended, but
    especially in cases of AIPH.

5.  Be aware that there are no uniformly accepted, valid, quantitative
    environmental sampling methods or serologic tests to assess
    exposures to mold and other agents associated with damp indoor
    environments. There are also no accepted valid airborne levels of
    mold that predict adverse health effects.

6.  Be aware that there is currently no method to test humans for
    toxigenic mold exposure (California Department of Health Services,
    2005).

7.  Be aware that mold-contaminated foods (especially grains) can
    contain harmful amounts of mycotoxins. The US Department of
    Agriculture has set allowable limits in certain food items and has
    some routine monitoring in place to prevent harmful ingestion of
    mycotoxin-contaminated foods. Inquire about dietary history if a
    mycotoxin-induced illness is suspected.

See the original guideline document for recommendations to government.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### REFERENCES SUPPORTING THE RECOMMENDATIONS

[References open in a new
window](http://www.guideline.gov/summary/select_ref.aspx?doc_id=10394)

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting the recommendations is not specifically
stated.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Prevention of mold-related clinical illness in children and improvements
in environmental quality

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

The guidance in this report does not indicate an exclusive course of
treatment or serve as a standard of medical care. Variations, taking
into account individual circumstances, may be appropriate.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Staying Healthy

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Committee on Environmental Health, American Academy of Pediatrics, Kim
JJ, Mazur LJ. Spectrum of noninfectious health effects from molds.
Pediatrics 2006 Dec;118(6):2582-6. \[25 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17142549)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2006 Dec

#### GUIDELINE DEVELOPER(S)

American Academy of Pediatrics - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American Academy of Pediatrics

#### GUIDELINE COMMITTEE

Committee on Environmental Health

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Committee on Environmental Health, 2005-2006*: Michael W. Shannon, MD,
MPH, *Chairperson*; Dana Best, MD, MPH; Helen J. Binns, MD, MPH; Joel A.
Forman, MD; Christine L. Johnson, MD; Catherine J. Karr, MD, PhD;
\*Janice J. Kim, MD, PhD, MPH; \*Lynnette J. Mazur, MD, MPH; James R.
Roberts, MD, MPH

*Liaisons*: Elizabeth Blackburn, RN, US Environmental Protection Agency;
Mark Anderson, MD, Centers for Disease Control and Prevention/National
Center for Environmental Health; Martha Linet, MD, National Cancer
Institute; Walter Rogan, MD, National Institute of Environmental Health
Sciences

*Staff*: Paul Spire

*\*Lead authors*

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

All clinical reports and policy statements from the American Academy of
Pediatrics automatically expire 5 years after publication unless
reaffirmed, revised, or retired at or before that time.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Academy of Pediatrics
(AAP) Policy Web
site](http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/6/2582).

Print copies: Available from American Academy of Pediatrics, 141
Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following is available:

-   Mazur LJ, Kim J; American Academy of Pediatrics, Committee on
    Environmental Health. Spectrum of noninfectious health effects from
    molds \[technical report\]. Pediatrics. 2006;118(6). Electronic
    copies: Available from the [American Academy of Pediatrics (AAP) Web
    site](http://pediatrics.aappublications.org/cgi/content/full/118/6/e1909).

Print copies: Available from American Academy of Pediatrics, 141
Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927.

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on April 2, 2007. The information
was verified by the guideline developer on April 9, 2007.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions. Please contact the
Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest
Point Blvd, Elk Grove Village, IL 60007.

### DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008