21st
Annual International Symposium
on
Man and His Environment in Health and
Disease
Special Focus
Innovative Aspects and
Treatment of Molds, Mycotoxins and Chemical
Sensitivity
Sponsored by
American Environmental
Health Foundation and
American Academy of
Environmental Medicine
This activity has been
planned and implemented in accordance with the Essential Areas and policies of
the Accreditation Council for Continuing Medical Education (ACCME) through the
joint sponsorship of the American Academy of Environmental Medicine (AAEM) and
the American Environmental Health Foundation. The American Academy of Environmental
Medicine is accredited by the ACCME to provide continuing medical education for
physicians.
The American Academy of
Environmental Medicine designates this educational activity for a maximum of
21.5 hours in Category 1 credit toward the AMA Physician=s Recognition Award. Each physician should claim only those
hours of credit that he/she actually spent in the
activity.
Reprints are available from American Environmental Health
Foundation. This volume is not to
be reproduced, all or in part, without the written permission of American
Environmental Health Foundation.
INTRODUCTION
SYMPOSIUM
PURPOSE
Since 1981, the
International Symposium has been recognized as one of the most advanced medical
forums in the world addressing the research and treatment of environmental
effects on health and disease. The
2003 conference will focus on “Innovative Aspects and
Treatment of Molds, Mycotoxins and Chemical Sensitivity”. For this year=s conference, we have
assembled a faculty of top international experts for you. This Conference presents the most
current information available while providing guidelines to identify, diagnose,
treat and to prevent environmentally triggered responses in the
body.
GOALS OF THE
MEETING
!
To provide new insights into
the mechanisms and the environmental causes behind many problems you
see.
!
To present new diagnostic
and treatment modalities to help you improve the quality of care for your
complex patients.
!
To provide concepts, tools
that will enhance your practice.
OBJECTIVES OF THE
MEETING
!
Improve the outcome of
treating patients with chronic disease, nutritional problems and chemical
sensitivity.
!
Use new concepts and
treatments to help better diagnose and manage many patients with chronic
disease, nutritional problems and chemical sensitivity.
!
Apply the concepts of this
conference to your practice by using nutrition and environmental manipulation
for the treatment of chronic disease, nutritional problems and chemical
sensitivity.
!
Use the information
presented to enhance the effectiveness, cost-efficiency, and competitiveness of
your practice in relation to chronic disease, nutritional problems and chemical
sensitivity.
INTENDED AUDIENCE
M.D.=s, D.O.=s, D.D.S.=s, medical students, nurses,
nutritionist, and all other health professionals interested in the concepts and
practice of Environmental Medicine, Occupational Medicine and
Toxicology.
EDUCATIONAL
FORMATS
#
Plenary
#
Panels
Discussions
#
Case
Studies
#
Question & Answer
Sessions.
CONFERENCE
FORMAT
The AEHF Committee has
selected some of the leading experts in the fields of chronic disease, nutrition
and chemical sensitivity.
Each speaker=s presentation will last
approximately 20 minutes and will be followed by a 10 minute question and answer
session. All speakers are
encouraged to use any and all appropriate audio/visual aids. (A brief outline of the speech is
included in this booklet.)
GIVEN IN COOPERATION
William J. Rea, M.D.,
F.A.C.S.
Symposium
Chairman,
American Environmental
Health Foundation,
Environmental Health Center
- Dallas,
Dallas,
Texas
Bertie B. Griffiths,
Ph.D.,
Environmental Health Center
- Dallas
Dallas,
Texas
Kaye H. Kilburn, M.
D.
University of Southern
California Medical Center
Keck School of
Medicine
William J. Meggs, M.D.
Dept. of Emergency
Medicine
E. Carolina Univ. School of
Medicine
Greenville,
NC
Allan D. Lieberman, M.D.
Center for Occupational Environmental Medicine
North Charleston, SC
21st ANNUAL INTERNATIONAL
SYMPOSIUM
SCHEDULE
Thursday, June 19,
2003
7:00 a.m.
REGISTRATION
8:50
WELCOME/MODERATOR: William J.
Rea, M.D.
9:00
Douglas B. Seba, Ph.D., Independent Marine Scientist, Alexandria,
VA: “Environmental Update 2003:
Molds, Dust, Global Warming”
9:20
Q&A
9:30
Tapani Tuomi, Laboratory Chief, Finnish Institute of Occupational
Health, Helsinki, Finland: “Mycotoxins in Indoor
Climates”
9:50
Q & A
10:00
BREAK
10:30
William J. Meggs, M.D., Professor of Toxicology, Dept. of
Emergency Medicine, E. Carolina Univ. School of Medicine, Greenville, NC: “Systemic Anaphylactic Reactions to
Molds and Other Aeroallergens”
10:50
Q & A
11:00
William J. Rea, M.D., Director, Environmental Health Center
B Dallas, Dallas, TX: “Diagnosis of Mold & Mycotoxin
Sensitivity”
11:20
Q & A
11:30
Andrew W. Campbell, M.D., Clinical Immunotoxicologist, Center for
Immune, Environment and Toxic Disorders, Spring, TX: “Immunological and Neurophysiological
Abnormalities in Adults with Exposure to Molds”
11:50
Q & A
12:00 p.m. Lunch
in the Primebird Restaurant
MODERATOR: Wallace Rubin,
M.D.
1:30
Professor Tang G. Lee, AAA, Professor, Faculty of
Environmental Design, University of Calgary, Calgary, Alberta, Canada: “Molds in Native Housing and SIDS
Potential”
1:50
Q & A
2:00
William A. Croft, D.V.M., Ph.D., Private Practice, Mycotoxins,
Environmental Diagnostic Group Inc., Madison, WI: “Pathology of Trichothecene
Mycotoxins in Man”
2:20
Q & A
2:30
Kaye H. Kilburn, M.D., Director of Environmental Sciences Lab,
Ralph Edgington Professor of Medicine, University of S. California Medical
Center, Keck School of Medicine, Los Angeles, CA: “How Molds and Mycotoxins Affect
Human Brains”
2:50
Q & A
3:00
BREAK
3:30
Kalpana D. Patel, M.D., Director of Environmental Health Center
Buffalo, Northwest Center for Allergy & Environmental Medicine, Buffalo, NY:
“What is New and Different in the Diagnosis and Management of Different Skin
Disorders B Itching Eczema and
Urticaria”
3:50
Q & A
4:00
Katherine Warsco, Ph.D., Department of Interior Design, East
Carolina University, Greenville, NC:
“Teaching Design for Good Indoor Air
Quality”
4:20
Q & A
4:30
Michael R. Gray, M.D., M.P.H., Internal Occupational Medicine
Certified Independent Medical Examiner, Progressive Health Care Group, Benson,
AZ: “Molds, Mycotoxins & Public Health: a Clinicians
Perspective”
4:50
Q & A
5:00
Panel Discussion: How to evaluate moldy house? Chris Rea,
William J. Rea, M.D., Geoffrey Hutton, William Croft, D.V.M., Ph.D., and Larry
Foster
6:00
AJOURN
Douglas Seba, Ph.D.
Date of talk:
Thursday, June 19, 2003, 9:00am
P.O. Box 1417, #323
Phone:
703/949-1055
Alexandria, VA 22313
Fax:
N/A
E-mail:
N/A
Major and date of Graduation:
Environmental Oceanography - 1970
Current Job Description:
Independent Marine Scientist
Other Information:
Forty years experience in Ecology and Chemicals
Disclosure Statement:
None
SPEECH TITLE:
“Environmental Update 2003: Molds, Dust, Global
Warming”
The speaker has provided the information
below.
1.) Goals and objectives: To review selected environmental phenomena that
contributes to patient exposure to biochemicals and molds
2.) Outline of talk/abstract: Molds, xenobiotics, genetics, dust, global warming,
fate and transport mechanisms, and wildlife anomalies will all be reviewed for
contemporary aspects.
3.) Conclusion of what is to be learned: That adverse health effects can occur at vast distances
from their environmental origins and put physicians and patients in a constant
state of exposure and challenge.
4.) References:
Taken from a broad spectrum of media, websites and scientific publications
relevant to the moment.
Environmental Update 2003: Molds,
Dust Global Warming
Douglas B. Seba
The world is both a moldy and dusty place. Both may be increasing in the natural
environment perhaps aided by global warming. There also appears to be an increase in
these moieties in indoor environments as we spend increasing amounts of time in
air conditioning. Certainly
structural mold insurance claims have increased greatly in states, like Texas
and Florida, where climate change has increased warmth. Florida is also first among all large
states in both total cancer and increase in pediatric cancers being over double
that of California, for example. Dust from Africa, containing numerous molds,
has also increased in Florida over the last few decades, as well as throughout
the Caribbean and the entire United States as far west as New Mexico and north
to Canada. Additionally, relative
humidity has increase about 10% over the fifty years in the Caribbean and
extending into the southeast U.S.
All of these factors combine to make more nutrients and moisture
available for mold growth. Asthma
cases are also increasing nationally, but the increase in the Southeast is
outpacing the rest of the country and there is a connection between molds/dust
and asthma.
African dust is a quantitative source of hormonally
active environmental agents. Global
assessment of endocrine disrupters show pervasive distribution throughout the
environment including the human body.
Recent work with bisphenyl A at very low levels inducing highly
significant increases in chromosomal aberrations in mouse eggs, frog deformities
caused by interaction between parasites and atrazine, or degradated fluorinated
telomers found in human blood are contemporary examples of these environmental
agents.
These agents profoundly affect the state of your health
as they trigger genes that would not otherwise be expressed. Thus, the nascent field of
toxicogenomics will rapidly expanded as the role of endocrine disruptors as
biomarkers is investigated. These
continuing and emerging sciences will also change the focus of environmental
regulation.
Examples of the items will be personally applied by the
author to ongoing research in wildlife anomalies in the Bitterroot Mountains of
Montana.
Abstract Information & Notes
Tapani Tuomi
Date of talk:
Thursday, June 19, 2003, 9:30am
Finnish Institute of Occupational Health (FIOH)
Phone:
358-9-47472926
Arinatie 3 A
Fax:
358-9-5061087
Helsinki, Finland FIN-00370
E-mail:
tapani.tuomi@occuphealth.fi
School Attended: Helsinki University of
Technology
Major and date of Graduation:
DR, Chemical Engineering (Applied Microbiology),
1995
Current Faculty Appointments:
Docent in Environmental Chemistry and Microbiology, Helsinki Univ. of
Technology
Current Job Description:
Laboratory Chief, Laboratory of Chemistry and Microbiology, Finnish
Inst. Of Occupational Health,
Helsinki, Finland
Disclosure Statement:
None
SPEECH TITLE: “Mycotoxins in Indoor
Climates”
The speaker has provided the information
below.
1.) Goals and objectives: To present current literature on the presence of
mycotoxins in indoor climates and to discuss the possibility for carry-over of
mycotoxins from contaminated indoor surfaces to air.
2.) Outline of talk/abstract: It has been recognized that mycotoxin-producing fungi
can proliferate and produce mycotoxins in damp building materials in
water-damaged building. Mycotoxins
are also frequently found in deposited dust from indoor environments. There is very little evidence, however,
on the presence of mycotoxins in indoor air. This suggests that the air-concentration
of mycotoxins even in buildings hampered by long-standing water-damage and
following mold-damage is below the limit of detection of contemporary methods of
analysis. The talk will examine the
spectra of mycotoxins found on building materials naturally contaminated by
fungi, as well as the evidence on the presence of mycotoxins in inhalable air in
damp buildings.
3.) Conclusion of what is to be learned: A wide range of mycotoxins are potentially present in
indoor climates harboring moldy surfaces.
It has proven difficult, however, that mycotoxins may contribute to the
variety of symptoms experienced by patients exposed to moldy propagules in
indoor climates.
4.) References:
Skaug et al., 2001, Mycopathologia, 151:93-8, Page and Trout, 2001, AIHAJ 2001
Sep-Oct; 62(5):644-8, Peltola et al, 2001, Appl Environ Microbiol. 2001, 67:3269-74, Tuomi et al., 2000,
appl. Environ. Microbiol,
66:1899-1904
Mycotoxins in Indoor
Climates
Tapani
Tuomi
As of present, analyzing for
mycotoxins in indoor environments is difficult, if the goal is to assess the
health consequences of extensive water damage on the occupants of a particular
building. There is accumulating evidence on the presence of mycotoxins in crude
building materials1-7 as well as a body of indirect evidence linking
the presence of mycotoxins in indoor environments to health problems5,
8-15. It is frequently maintained that mycotoxins present in bulk
materials infested with toxigenic fungi are carried to indoor air by fungal
propagules. It follows that the route of exposure to mycotoxins in indoor
environments is inhaling dust particles containing toxigenic fungal
propagules2.
Dose-responses of humans to
airborne mycotoxins are not known and it seems that mycotoxin concentrations in
inhalable dust would have to be some 100-fold higher than what is frequently
encountered in indoor environments for air sampling to be feasible on a general
level. If air sampling is not attempted, deposited dust constitutes one step
closer to the composition of indoor air with respect to mycotoxins. There are
numerous studies from agricultural environments establishing that mycotoxins
present in bulk material are - given the right circumstances - carried into
dust. For instance, trichothecene concentrations of 0,1-1 µg/g dust, aflatoxin
concentrations of 0,02-5 µg/g dust, ochratoxin A concentrations of 0,2-70 ng/g
dust, and zearalenone concentrations of 20-100 ng/g dust have been reported
during grain handling and from other agricultural settings16-21. In
laboratory settings, Sorensen et al.22 found satratoxin
concentrations in the 10 µg/g dust-range, whereas Smoragiewicz et
al.6 detected trichothecenes in deposited dust from a moisture
problem building in amounts exceeding 0.4-4 µg/g and Engelhart et
al.23 found sterigmatocystin (2-4 ng/g) in carpet dust from a damp
indoor environment. It follows that samples of deposited dust should be
considered alongside with bulk samples when assessing the presence of mycotoxins
in indoor environments.
In agricultural settings,
aflatoxin concentrations of 0,01 - 1000 ng/m3 and eoxynivalenol (DON)
concentrations of 3-20 ng/m3 have been reported in air17-18,
20-21, 24-25. In indoor environments, satratoxin in concentrations of
0,1-0,5 ng/m3 and unidentified trichothecenes in concentrations of 1-35
ng/m3 have been found22-23. It seems therefore, that
irrespectively of the environmental setting, whether agricultural or indoor
environments, measurement of airborne mycotoxins generally require use of
high-volume samplers in combination with sensitive chemical or immunological
methods of analysis. Risk-assessment on the inhalation of mycotoxins cannot be
made based on the analysis of bulk samples of construction materials. Neither can mycotoxin contents of
deposited dust serve as basis of risk-assessment. Therefore, with the
development of more efficient methods of sampling and analysis, air sampling
will help us better understand the health consequences of exposure to mycotoxins
in indoor climates and perhaps will at some point enable estimation of
dose-responses of humans to airborne mycotoxins.
In conclusion, a wide range of mycotoxins are potentially present in indoor climates harboring moldy surfaces. It has proven difficult, however, to establish the presence of mycotoxins in indoor air