Revising the Criteria for Occupational Mould-Related Disease: Arguments, Misconceptions, and Facts

Occupational exposure to indoor air moulds and the consequent development of dampness and mould hypersensitivity syndrome (DMHS) may cause lung damage; in most cases, this is not allergic asthma mediated by specific immunoglobulin E-class antibodies. Instead, it is often a hypersensitivity pneumonitis or bronchopneumonitis. In Finland, the current diagnostic criteria for occupational DMHS have been adapted from knowledge of immunoglobulin E-mediated asthma; however, the safety of the methods used in occupational medicine have been insufficiently addressed in the literature. Accordingly, the aim of this paper is to raise awareness about the safety of current methods: specific inhalation challenge, workplace peak expiratory flow monitoring, and histamine provocation tests, by illustrating four cases. The medical records of these four cases with documented occupational DMHS were reviewed. The presented evidence suggests that the methods applied to study the occupational nature of lung damage are not suitable and the current ethics are questionable. The authors claim that, in particular, serial inhalation challenge with extracts from moulds, workplace serial peak expiratory flow leading to continuous exposure to mycotoxins, and histamine provocation tests may irreversibly damage the health of DMHS patients. Therefore, there is a prompt need to revise current practice guidelines to assess occupational DMHS. The guidelines should not be based on old dogmas, nor should they be influenced by insurance considerations. Instead, they should be based solely on medical evidence and, crucially, they should be safe for the patient and, therefore, should be implemented with caution.