There is increasing evidence that mold antigens are implicated in contributing to adverse health effects in indoor environments. Specifically, mold antigens are associated with allergic reaction, asthma and hypersensitivity pneumonitis. We present two case reports that illustrate the contribution of mold antigens to the exacerbation of asthma in one case and development of hypersensitivity pneumonitis in the other. The exposure scenarios were investigated and medical evaluation/treatment were provided. Industrial hygiene studies were conducted and bioaerosol testing revealed that several mold antigens were present. Based on the industrial hygiene survey, medical evaluation and test results (immunology testing, pulmonary function, computerized Tomography (CT) scan and lung biopsy), it was concluded that molds were most likely responsible for inducing the respiratory illness. Post-remedial bioaerosol sampling results revealed background fungal levels. Both individuals returned to the indoor areas without recurrence of symptoms. Practically, several factors should be considered prior to concluding an association between exposure and illness. First, the symptoms and signs should be consistent with a specific medical diagnosis. Second, there should be either in vitro or in vivo evidence of exposure. Third, environmental assessment should reveal evidence of plausible biological exposure. Fourth, there should be substantial improvement or even resolution of the illness after appropriate treatment and remediation of the health hazard. These two case reports illustrate the importance of close collaboration between industrial hygienist and occupational medicine physician in managing and preventing potential health hazards including bioaerosol exposures.

• fungi: health effects : respiratory

1. Health effects of indoor fungal bioaerosol exposure