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Source: Indoor Environment Connections

A coalition of physicians, scientists and others is calling for a comprehensive approach to various illnesses that have one thing in common: they are caused in large part by hazards found in the indoor environment.

“A method of disseminating current, on-going and accurate information to medical teaching facilities regarding these illnesses and appropriate treatments must be established as a matter of public health policy,” the group said in a recent policy statement.

One of the most urgent needs, the advocates say, is the creation of a national database of patients identified by practitioners that can be accessed by collaborating researchers in the private sector and government agencies.

Advocates for individuals whose health has been adversely affected by their indoor environments are increasingly using a new term to describe the problem: Chronic Inflammatory Response Syndrome Caused by Exposure to the Interior Environment of Water-Damaged Buildings (CIRS-WDB).

Earlier this year, a new group was formed called the Action Committee on the Health Effects of Mold, Microbes and Indoor Contaminants. It is composed of physicians, scientists, researchers, indoor air quality experts, industrial hygienists, building engineers, teachers, advocates and others who are working together to promote the truth about the health effects of mold, microbes and indoor contaminants.

“We note in recent years a dramatic increase in published studies from the private sector, US governmental agencies and international health agencies with a focus on various and diverse human health effects acquired following exposure to the interior environment of water damaged buildings,” the group said.

In addition to a new national database, also needed are the development of a standard protocol for therapy based on the results of collaboration of actual practicing physicians, and an accelerated search for newer therapies based on genomics testing.

A new research paper has been released that discusses “the current state of the science regarding human health effects acquired following exposure to the multiple microbes and microbial contaminants and their metabolites found in the interior environment of water damaged buildings (WDB).”

These contaminants include fungi, bacteria, actinomycetes, and mycobacteria and their toxins; as well as inflammagens from fragments of fungal structures; and beta glucans, mannans, hemolysins, proteinases, spirocyclic drimanes and microbial volatile organic compounds (VOCs).

Several similar consensus statements have been composed in the past decade. Yet none have included assessments made by physicians involved with diagnosis and treatment of these adverse health effects; academic papers written by physicians reporting both baseline and treatment data on the human illness, reporting of results from published studies using treatment protocols or studies on prospective human or animal experimentation, and reporting based on objective parameters found in affected patients.

Despite these substantial shortcomings of pertinent information, these prior consensus statements are being used in legal matters to report the state of human health effects from exposure in water damaged buildings and to serve as the basis for public health policy, the advocates say.

As identified by the Government Accountability Office and the World Health Organization report, there are many compounds, both toxigens and inflammagens, present in the indoor air of a water damaged building that have been identified within the complex mixture found in the air and in the dust of the interior environments of a water damaged building.

Further, there is clear data showing that each of these compounds can initiate an inflammatory host response such that no single compound can be identified as the sole cause of the inflammatory responses seen in affected patients.

Since many sources of inflammatory stimulus exist, some of which are synergistic, and no single causative agent within the water damaged building can be deemed to be solely responsible for the symptoms exhibited, the sole causative agent becomes the interior environment of the water damaged building itself.

“It is our consensus opinion that this syndrome acquired after exposure to water damaged buildings with evidence of amplification of microbial growth shall be referred to as, ‘Chronic Inflammatory Response Syndrome (CIRS) acquired following exposure to the interior environment of Water-Damaged Buildings,” the group concludes.

CIRS-WDB is a multisystem, multisymptom illness acquired following exposure to the interior environment of a water damaged building and it exists as a recognizable syndrome. When defined by exposure, symptom evaluation and epidemiologic similarities between studies of similar hosts and similar exposures, CIRS-WDB is both identifiable and treatable. A proven and consistent pattern of symptoms is demonstrated among published research findings involving both animal and human studies.

CIRS-WDB is identified as immunologic in origin, with differential inflammatory responses seen according to (a) genetic susceptibility and (b) unique aspects of host innate immune responses. Direct effects of microbial toxins, particularly mycotoxins, in pathogenesis are recognized to act synergistically with those toxins made by actinomycetes, gram negative bacteria, and possibly mycobacteria causing the effects shown in CIRS-WDB.

Cellular immunity affecting T-cells and Th-17 plays a role in CIRS-WDB, as do immunologic changes activated by both toxins and inflammagens that are found in the interior environment of a water damaged building.

“Given the current scientific information and readily available physiologic abnormalities that patients with CIRS-WDB experience, we must expand our assessment beyond the known effects of simple, individual toxins when establishing public health policy and private sector physician treatment protocols,” members of the committee said.

Treatment of human illness that is acquired following exposure to the interior environment of a WDB is necessarily sequential. No single intervention is likely to correct all the underlying abnormalities in the inflammatory responses. Many approaches to treatment of CIRS-WDB are in current use. “To date there has been a paucity of academic papers published on the entire selection of therapies used with success by individual practitioners,” the position paper said.