Curr Allergy Asthma Rep (2012) 12:590–598 of a patient’s medical illness or condition. As a practis- ing allergist/clinical immunologist (H.M.W.), physician/ toxicologist (R.E.G.), and an experienced civil litigation attorney (R.P.H.), the authors have provided insights into the challenges of rendering a diagnosis, determining medical causal assessment, and offering a legal causa- tion analysis. The primary focus was to help elucidate the unfamiliar idiosyncrasies of a legal proceeding. As a patient advocate or medical expert, participation in the legal system is an opportunity to place state-of-the-art science into case law. Disclosure No potential conflicts of interest relevant to this article were reported. Open Access This article is distributed under the terms of the Crea- tive Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited. References Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance 1. Evans AS. Causation and disease: the Henle-Koch postulates revisited. Yale J Biol Med. 1976;49(2):175–95. 2. Hackney JD, Linn WS. Koch's postulates updated: a potentially useful application to laboratory research and policy analysis in environmental toxicology. Am Rev Respir Dis. 1979;119:849–52. 3. Irey NS. Diagnostic problems in drug-induced diseases. Ann Clin Lab Sci. 1976;6:272–7. 4. Irey NS, Mullick FG. Syllabus: environmental pathology. Washington, DC: Armed Forces Institute of Pathology; 1984. p. 1–50. 5. Gots RE, Gots BA, Spencer J. Proving causes of illness in environmental toxicology: 'Sick buildings' as an example. Fresenius Environ Bull. 1992;1:135–42. 6. Gots RE. Medical causation and expert testimony. Regul Toxicol Pharmacol. 1986;6:95–102. 7. Gots RE. Scientific and legal approaches to proof of causation in tort cases. 3rd Chemical Congress of North Am: the book of abstracts ACS. 1988;#16 CHAL. 8. Gots RE. Toxic risks: science, regulation, and perception. Boca Raton: Lewis Publishers; 1993. 9. Guzelian PS, et al. Evidence-based toxicology: a comprehensive framework for causation. Hum Exp Toxicol. 2005;24(4):161–201. 10. Hill AB. The environment and disease: association or causation? Proc R Soc Med. 1965;58:295–300. 11. Schwartz SL. An overall conceptual approach to the problem of causation. Shepard's Expert Sci Evid Q. 1995;3(1):1–24. 12. Klaassen CD. Toxicology: the basic science of poisons. 7th ed. New York: McGraw Hill Medical; 2008. 13. Black B, Warshaw MS, Hollander DH. Unraveling causation: back to the basics. Toxics Law Reporter. 1993;1061-1070. 597 14. Muscat JE, Huncharek MS. Causation and disease: biomedical science in toxic tort litigation. J Occup Med. 1989;31:997–1002. 15. Ruth JH. Odor Thresholds and Irritation Levels of several chem- ical substances: a review. Am Ind Hyg Assn J. 1986;47(3):A 142–51. 16. Documentation of Threshold Limit Values and Biological Exposure Indices, American Council of Governmental Industrial Hygienists (ACGIH), 1999. 17. Agency for Toxic Substances and Disease Registry (ATSDR), Toxicological Profiles (Sic. Various chemicals and years). 18. Richie IM, Lehnen RG. Formaldehyde-Related complaints of residents living in mobile and conventional homes. Am J Public Health. 1987;77:323–8. 19. Nielson GD, Alarie Y. Sensory irritation, pulmonary irritation, and respiratory stimulation by airborne benzene and alkylbenzenes: Prediction of safe inhdustrial exposure levels and correlation with their thermodynamic properties. Toxicol Appl Pharmacol. 1982;65 (3):459–77. 20. American College of Medical Toxicology Practice Committee, Sudakin DL and Kurt T American College of Medical Toxicology Position Statement on the Institute of Medicine Report on Damp Indoor Spaces and Health. 2006; October:1-4. 21. American College of Occupational and Environmental Medicine Adverse human health effects associated with mold in the indoor environment. ACOEM Evidence-based statement: Position Statement/Guidelines:2002; 1-10. Web address: www.acoem.org 22. American College of Occupational and Environmental Medicine, ACOEM Council on Scientific Affairs, Hardin BD, Kelman BJ, Saxon A. Adverse human health effects associated with mold in the indoor environment Revised position statement. ACOEM. 2011; 1-7. 2-14. 23. Bush RK, et al. The medical effects of mold exposure: AAAAI Position Paper. J Allergy Clin Immunol. 2006;117(2):326–33. 24. Fung F, Hughson WG. Health effects of indoor fungal bioaerosol exposure. Appl Occup Environ Hyg. 2003;18(7):535–44. 25. Institute of Medicine (U.S.), Committee on Damp Indoor Spaces and Health, Board on Health Promotion and Disease Prevention of the Institutes of Medicine. Damp indoor spaces and health. Washington, DC: National Academies Press; 2004. 26. World Health Organization Guidelines for Indoor Air: Dampness and Mould. (2009) World Health Organization. Copenhagen, Denmark. 27. Kellner R. Somatization. Theories and research. J Nerv Ment Dis. 1990;178:150–60. 28. Health Survey of the Population Living Near the Price Landfill, Egg Harbor Township, Atlantic County. (1983) Environmental Health Hazard Evaluation Program, New Jersey Department of Health, and DHEHHEP. 29. Kaye WE, Hall HI, Lybarger JA. Recall bias in disease status associated with perceived exposure to hazardous substances. Ann Epidemiol. 1994;4:393–7. 30. Lees-Haley PR, Brown RS. Biases in perception and reporting following a perceived toxic exposure. Percept Mot Skills. 1992;75:531–44. 31. Lipscomb JA, Goldman LR, Satin KP, Smith DF, Vance WA, Neutra RR. A follow-up study of the community near the McColl waste disposal site. Environ Health Perspect. 1991;94:15–24. 32. Lipscomb JA, Satin KP, Neutra RR. Reported symptom prevalence rates from comparison populations in community-based environmental studies. Arch Environ Health. 1947;1002:263–9. 33. Logue JN, Fox JM. Residential health study of families living near the Drake Chemical Superfund site in Lock Haven, Pennsylvania. Arch Environ Health. 1096;41:222–8. 34. Roht LH, Vernon SW, Weir FW, Pier SM, Sullivan P, Reed LJ. Community exposure to hazardous waste disposal sites: assessing reporting bias. Am J Epidemiol. 1985;122:418–33.