Health risk assessment of fungi in home environments.

LEARNING OBJECTIVES Reading this article will enable the readers to recognize the public health importance of fungi in the home environment. In view of the recognized impact of fungi on human health, the large population being exposed to fungi, and the large population risk for developing allergic diseases, there is a need to establish guidelines for allowable exposure to fungi based on a health risk assessment. The aim of this study was to evaluate the status of the data on the relationship between exposure to fungi in the home environment and allergic health effects with respect to the development of such guidelines. DATA SOURCES The past 10 years of peer-reviewed literature focused on the relationships between respiratory disease and exposure to fungi in indoor environments was examined, Indexing terms included mold, fungi, allergy, asthma, and indoor environment, among others. Each study was evaluated on the following criteria: aim and design of the study, methods for assessing exposure and health effects, and data analysis. STUDY SELECTION Nine population based studies were identified that examined the relationship between allergy and the presence of fungi in the home environment. These studies included quantitative measures of fungal presence in either air or dust. RESULTS One or more positive associations were found between fungal levels and health outcomes in seven of the nine cross-sectional studies identified. CONCLUSIONS Despite these positive associations it remains impossible to set guidelines for fungi in home environments based on health risk assessment. This is in part because of the cross-sectional study designs, and inconsistency and inadequate validation of the measures used to evaluate exposure and health effects. Future research designed to generate data that can be used for the development of health risk assessment based guidelines for fungi in home environments should focus on susceptible populations, and use measures that accurately represent exposure and adverse health effects.