Schimmelpilze in Wohngebäuden (German Edition)
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Learn more at Author Central. All Formats Kindle Edition Sort by: Popularity Popularity Featured Price: Low to High Price: High to Low Avg. Korrosion von Beton und Stahlbeton durch chemische Verbindungen und Mikroorganismen: Peter Rauch German Edition Feb 01, Available for download now. Ratgeber zum richtigen Dachgeschossausbau German Edition Aug 17, Einige Pilze enthalten Substanzen, die im menschlichen Alles muss bis ins Kleinste stimmen Je nach der Art der pathogenen Wirkung handelt es sich um eine Mykose, eine Allergose oder auch um eine Mykotoxikose.
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- Meaning of "Holzfußboden" in the German dictionary.
Der Pilz spielt dabei entweder eine aktive oder eine passive Rolle; mitunter kann beides nebeneinander vorkommen. Nach dem Hinweis auf die bisherige Problematik des Allergiebegriffes bezeichnet der Verf. From an allergological perspective, an exposure dose-dependence measured as colony forming units, CFU does not alone determine the clinical reaction in mould-sensitized patients.
Sensitization with the formation of specific IgE antibodies and the triggering of allergic reactions takes place on the protein or peptide-component level. Thus, it is not necessary for whole spores or intact mould mycelium to be present. Allergenicity depends far more on the proteins or peptides which, due to their properties, are allergy-triggering. In the case of rhinosinusitis associated with mould exposure, the risk for developing bronchial asthma doubles Odds ratio [OR]: Young atopic children appear to be at higher risk for developing bronchial asthma in the case of moisture damage or mould exposure in the bedroom or living room [ ].
Only those moulds that are potentially able to form toxins come into consideration as triggers of intoxication. Whether indoor toxin formation takes place in individual cases depends on environmental and growth conditions and, in this regard, most notably on the substrate [ , ].
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No predisposing factors for mycotoxin intoxication in humans are known. For example, it is imaginable that pre-existing liver disease e. Whether this also applies to airborne toxin intake remains hitherto unclear [ 8 ]. It is unclear to date whether persons affected by MMI or chronic bronchitis are particularly sensitive individuals and react even to small doses, or whether sensitized individuals react differently, independent of dose, compared with non-sensitized individuals [ ].
Other inflammatory processes in the area of the mucosa of the eyes and respiratory tract, such as infections, atopic mucosal disorders, keratoconjunctivitis sicca and dry nasal mucosa, can be possible predisposing factors for MMI and chronic bronchitis [ 8 ]. Predisposing factors for odour effects may include genetic and hormonal influences, character, context, and adaptation effects [ ]. Predisposing factors for mood disorders may be environmental concerns, fears, conditioning, and attributions, as well as numerous diseases [ ]. Patients generally seek medical advice in conjunction with mould exposure for the following reasons [ , ]:.
Medical history [ ] and physical examination are the basic elements of any medical diagnostic work-up. On the basis of these, further special investigations are performed within the relevant medical specialty depending on the diagnostic question and differential diagnostics. Giving equal priority to psychological and social aspects rarely produces difficulties in the consultation setting once the approach has been explained to the patient.
In addition to the general and differential diagnostic history, the following elements should be considered during medical history taking in the case of suspected health disorders due to mould:. The method of physical examination is based on inspection, palpation, percussion, auscultation and functional testing.
Synonyms and antonyms of Holzfußboden in the German dictionary of synonyms
The target organs noted in the medical history should take priority in the examination. Particular attention should be paid to the mucosa of the eyes and, as far as possible, upper airways, as well as to the skin, since the nonspecific symptoms that patients often complain of relate to these organs in particular [ 22 , ].
The differential diagnosis always takes priority when assessing the health effects of mould exposure. Since the effect of mould depends primarily on the disposition of the affected individual, any delay caused through mould determination in taking steps may put persons requiring particular protection from mould at increased risk. In the above-mentioned patient groups, tests on the basis of relevant suspicion are seldom medically indicated to assess risk purely for preventive purposes. The diagnostic work-up here does not differ from that in other allergic diseases.
Allergic disorders due to mould allergens can essentially manifest as conjunctivitis, rhinitis, rhinosinusitis, allergic bronchial asthma, urticaria, HP and ABPA. In individual cases, the allergic reaction needs to be confirmed and the allergy trigger identified. However, the repertoire of commercially available mould allergen extracts is limited and primarily covers typical species found in outdoor air. Particularly in in vitro testing, it is important to bear in mind that increased mould-specific IgE levels, for instance, can indicate sensitization to mould allergens, but do not equate to allergic disease.
Given the possibilities for exposure ubiquitous outdoor exposure, indoor exposure and occupational exposure , evidence of positive sensitization to mould needs to be regarded critically in the assessment of causality. In principle, the same recommendations and guidelines apply to the diagnostics of mould allergy as to other allergen sources that cause immediate-type allergies [ ].
Serological in vitro tests include specific IgE antibody determination in the case of IgE-mediated disease, or specific IgG antibody determination in the case of HP. The identification of allergen-specific IgE indicates specific sensitization, but not necessarily disease; results can only be correctly interpreted in conjunction with medical history, clinic picture and the results of organ-specific provocation tests. Positive reactions caused by cross-sensitivity are of only partial clinical relevance.
A quantitative comparison of results from different test systems is challenging call for international standards. A call needs to be made for the improvement of reagent quality by standardizing the allergens and defining minimum requirements for the allergen-carrier material determining diagnostic efficacy. Extracts of indoor-relevant moulds should also be commercially available in adequate quality.
The spectrum of available single allergens from the relevant moulds needs to be expanded. The latter is markedly elevated compared with patients allergically sensitized to A. There is no special indication for these nonspecific markers of eosinophil activation and recruitment in the identification of mould allergy. The analysis of immune complexes is confined to particular disorders in the realm of type III allergic reactions, such as HP, and has no place in the diagnostics of mould exposure beyond this see mould-specific IgG determination above. The detection of serum galactomannan for diagnostic purposes is only indicated in invasive aspergillosis [ ].
Its application is not indicated in conjunction with indoor mould [ ]. Current analytical possibilities do not permit the reliable determination or evaluation of indoor mycotoxin exposure. The determination of mycotoxins in blood, serum or urine is of no relevance in practical medicine and must remain confined to scientific investigations for the time being.
The histamine release test HRT is not helpful in the diagnostics of mould allergy. This test is beneficial in the case of inhalant allergens, particularly when skin testing and specific IgE measurements are not possible. Rare indications include samples with low total IgE, failed serological specific IgE detection and possibly negative skin tests in suspected sensitization or exotic allergens. This test is also complex to perform and not suited to routine diagnostics. Organ-specific provocation testing is aimed at confirming the clinical relevance of existing sensitizations or supposedly observed symptoms.
Skin test extracts of the outdoor mould Alternaria are an exception here. After medical history, skin tests ST form the basis of the allergy diagnostic work-up and are fast and relatively cost-effective to perform. ST should be performed according to the relevant German or European position papers [ ].
A distinction is made in skin testing between epicutaneous patch, friction and cutaneous scratch, skin prick and intracutaneous tests. The allergen concentration in solutions used for intracutaneous testing is usually to fold lower compared with skin prick test solutions. However, since intracutaneous test solutions have not been commercially available since June , this diagnostic method to detect mould sensitization no longer applies. Inhalation allergies to mould spores generally cause persistent respiratory tract symptoms; this can make it challenging to establish an unequivocal relationship to the medical history.
NPT is also indicated in cases where skin testing is contraindicated or local allergic rhinitis is suspected, and to monitor the course of treatments such as allergen specific immunotherapy SIT. The conjunctival provocation test CPT should only be performed when the patient is free of symptoms; standardized skin prick test solutions 1: Medical history is generally not helpful, particularly in perennially occurring indoor moulds.
As such, the BPT plays an important role in suspected allergic perennial asthma due to indoor moulds. Allergen selection should be guided by the spectrum of sensitization. The evidence for provocation testing in the event of failure to detect sensitization is insufficient, meaning that no recommendation can be made in this regard.
The spectrum of commercial extracts available for provocation testing is progressively narrowing. The test must be performed according to the relevant guidelines. When assessing allergen provocation tests, one should expect false-positive as well as false-negative reactions. Recent Finnish studies on occupational mould exposure show that provocation testing with commercial mould extracts may be significantly more sensitive compared with the detection of sensitization [ ].
These data require validation. It is therefore challenging to assess provocation reactions in mould provocation tests, partly since often isolated delayed reactions are described [ ]. The reader is referred to the relevant guideline for details on the procedure in mould infections systemic mycoses. There are currently no practicable and validated test methods that could be applied in clinical diagnostic practice.
The reader is referred to the relevant guidelines for more details on organ-specific drug treatment of allergies. Specific immunotherapy SIT using mould extracts should be applied as early in the disease course as possible, particularly if drug treatment and avoidance have previously failed to stabilize symptoms [ ]. The relevant mould allergens need to be unequivocally confirmed at diagnosis as the trigger of allergic symptoms.
The combination of different test methods, together with medical history, provides an adequate basis for SIT. In this regard, the reader is referred to the current guideline [ ].
There is insufficient scientific evidence to date to support the efficacy of sublingual immunotherapy SLIT in terms of hyposensitization to indoor-relevant moulds. As with all allergic diseases, exposure avoidance allergen avoidance takes priority. The AWMF mould guideline [ 1 ] provides recommendations for indoors, outdoor air and foods recommendations without evidence. As with all medical procedures, unconventional treatment procedures [ — ] need to be tested and evaluated according to current scientific knowledge and will only be reimbursed by health insurers if the therapeutic benefit is proven.
Details of these procedures do not form part of this guideline. More detailed information can be found in the relevant mould guidelines [ 2 , 3 , 5 ], as well as the revised version of the UBA guideline due to be published German Federal Statistical Office, Prevention and exposure avoidance are paramount in all cases of health-related disorders associated with exposure to environmental factors. This applies in particular to moulds. To ensure allergy prevention, it is essential to avoid an indoor climate that promotes mould growth high air humidity, lack of ventilation [ ].
Further information can be found in the UBA guideline on mould [ 2 ], as well as the revised version of the UBA guideline due to be published Allergens are antigens which cause allergy. Most allergens reacting with IgE and IgG antibody are proteins, often with carbohydrate side chains, but in certain circumstances pure carbohydrates have been postulated to be allergens. In rare instances, low molecular weight chemicals, e. National Center for Biotechnology Information , U. Published online Feb Birger Heinzow 3 Formerly: Thomas Gabrio 11 Formerly: Hans Peter Seidl 24 Formerly: This article has been cited by other articles in PMC.
Mould, Health risk, Indoor, Diagnostics, Guideline. Relevant levels of indoor mould infestation must not be tolerated for precautionary reasons. The most important measures in indoor mould exposure include cause identification and appropriate remediation see mould remediation guides [ 3 , 5 ]. Medically indicated indoor mould measurements are rarely helpful. In general, both quantitative and qualitative determinations of the mould species can be dispensed with in the case of visible mould infestation. Instead, identifying the cause of infestation is far more important, followed by the elimination of infestation and its primary causes.
Mould exposure can generally lead to mucous membrane irritation MMI , odour effects and mood disorders. Specific clinical pictures seen in mould exposure are pertinent to allergies and fungal infections mycosis. Risk groups warranting particular protection include: It is likely that all moulds are capable of causing sensitization and allergies. Their allergenic potential is considered lower compared with other environmental allergens [ 12 , 13 ]. As polysensitized individuals, atopics those susceptible to hypersensitivity reactions, such as allergic rhinitis hay fever , allergic asthma, and atopic dermatitis on contact with environmental substances often also exhibit IgE antibodies to moulds; however, this does not necessarily indicate relevant disease.
The core elements of allergy diagnostics include medical history, skin testing skin prick test , in vitro serological examination of specific IgE antibodies in type I sensitization or specific IgG antibodies in hypersensitivity pneumonitis HP; extremely rare in non-occupationally related indoor exposure and provocation testing.
Negative in vitro and in vivo tests do not exclude sensitization or mould allergy. The determination of specific IgG antibodies as part of the diagnostic work-up for immediate-type mould allergy type I allergy is of no diagnostic relevance and is therefore not recommended. Mould-related infections are rare and are most likely to occur via the inhalative route.
ALLERGOSE - Definition and synonyms of Allergose in the German dictionary
Individuals with local or general immunodeficiency are by far those most frequently affected. Core elements of the diagnostic work-up for mould infection include microbiological, immunological, molecular biological and radiological methods. Mould-allergic individuals, as well as patients with diseases that weaken the immune system, should be provided with specialist patient information on the hazards of indoor mould exposure and the preventive steps that can be taken to minimize this exposure.
Aim of the AWMF mould guideline The guideline is intended to close the existing gap in the rational and efficient medical diagnostics of indoor mould exposure. Classification of moulds Fungi are eukaryotes with cell walls consisting of chitin and glucans. Causal link Insufficient evidence Sufficient evidence for an association: Allergic airway diseases Asthma manifestation, progression, exacerbation Allergic rhinitis Hypersensitivity pneumonitis extrinsic allergic alveolitis Promotion of airway infections, bronchitis Limited or suspected evidence for an association: Mucous membrane irritation MMI Atopic eczema manifestation, progression, exacerbation Inadequate or insufficient evidence for an association: Open in a separate window.
Allergic rhinitis As polysensitized individuals, atopics i. A distinction is currently made between five forms of rhinosinusitis triggered by fungi: Positive fungal stain of sinus contents removed at surgery [ 60 , 61 ].
Translation of «Allergose» into 25 languages
Allergic bronchial asthma As in allergic rhinitis, seasonal allergic bronchial asthma is primarily induced by moulds occurring at seasonally high levels in outdoor air e. Atopic dermatitis atopic eczema As airborne allergens, mould allergens can likely trigger atopic dermatitis [ 86 — 88 ]. Urticaria In rare cases, the ingestion of foods contaminated by mould components can trigger urticaria [ 86 , 87 ]. Mycoses Infections caused by environmental fungi are referred to as exogenous mycoses. Organic dust toxic syndrome ODTS Organic dust toxic syndrome is an acute, systemic flu-like disease caused by the inhalation of high concentrations of bioaerosols found almost exclusively in workplaces.
Sarcoidosis and moulds In sum, there is only unreliable evidence that different forms of microbial inhalation exposure, including water damage, can increase the risk of developing sarcoidosis; no causal link between mould exposure and sarcoidosis has been established as yet [ , ]. Rheumatic disorders Infections bacterial, viral have long been discussed as triggering factors in numerous inflammatory rheumatic diseases.
Mycotoxicosis Systemic effects poisoning caused due to the mycotoxins produced by moulds are referred to as mycotoxicosis and are known to occur upon oral ingestion of contaminated foods [ ]. Odour effects Mould metabolites can cause relevant odours to be perceived [ ]. Gastrointestinal effects, renal effects, teratogenicity and cancer To date, there have been no systematic investigations or case descriptions that provide evidence of, or suggest an association between, indoor moisture damage or mould and gastrointestinal or renal disease, reproductive disorders, teratogenicity or cancer see [ 20 , ].
The current German Biological Agents Act, which regulates occupational tasks involving the handling of moulds, classifies the risk of infection from biological agents at the workplace into four risk groups [ ], whereby moulds fall into risk groups 1 and 2: Biological agents that are unlikely to cause human disease.
Diagnostic work-up Reason for seeking medical advice Patients generally seek medical advice in conjunction with mould exposure for the following reasons [ , ]: In addition to the general and differential diagnostic history, the following elements should be considered during medical history taking in the case of suspected health disorders due to mould: Allergy diagnostic work-up The diagnostic work-up here does not differ from that in other allergic diseases.
A pathogenic mould antigen is present in the environment. There is an unequivocal temporal relationship between allergic symptoms and exposure to the mould allergen. A CPT may be indicated if symptoms are predominantly conjunctival,. Diagnostic work-up for infections The reader is referred to the relevant guideline for details on the procedure in mould infections systemic mycoses. Toxicological diagnostics There are currently no practicable and validated test methods that could be applied in clinical diagnostic practice. Specific immunotherapy hyposensitization Specific immunotherapy SIT using mould extracts should be applied as early in the disease course as possible, particularly if drug treatment and avoidance have previously failed to stabilize symptoms [ ].
Exposure avoidance As with all allergic diseases, exposure avoidance allergen avoidance takes priority. Unconventional treatment methods As with all medical procedures, unconventional treatment procedures [ — ] need to be tested and evaluated according to current scientific knowledge and will only be reimbursed by health insurers if the therapeutic benefit is proven. Arbeitsgemenschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. Angemessene Antworten auf das komplexe Problem der Schimmelursachen?
Board of Health Promotion and Disease Prevention. Damp indoor spaces and health. National Academies Press; Guidelines for indoor air quality: World Health Organization Europe; Gesundheitsrisiko Schimmelpilze im Innenraum. GA 2 LEN harmonization of skin prick testing: Schimmelpilze und allergische Erkrankungen.
Schimmelpilze und toxische Reaktionen. Remediating buildings damaged by dampness and mould for preventing or reducing respiratory tract symptoms, infections and asthma Review Evid Based Child Health. Palaty C, Shum M. Health effects from mould exposure or dampness in indoor environments evidence review Vancouver: National Collaborating Centre for Environmental Health; Respiratory and allergic health effects of dampness, mold, and dampness-related agents: Relevance of microfungi and their secondary metabolites mycotoxins for indoor hygiene.
Molds and mycotoxins in dust from water-damaged homes in New Orleans after hurricane Katrina. Stachybotrys chartarum, trichothecene mycotoxins, and damp building-related illness: Bioaerosole — Risiken durch biologische Luftinhaltsstoffe. Charakteristika von Bioaerosolen und Einzelkomponenten. Wirkungen biologischer Luftinhaltsstoffe und praktische Konsequenzen. Effect of relative humidity on the aerosolization and total inflammatory potential of fungal particles from dust-inoculated gypsum boards. Fungal fragments as indoor air biocontaminants.
Bacterial strains from moldy buildings are highly potent inducers of inflammatory and cytotoxic effects. Tischer CG, Heinrich J. Int J Hyg Environ Health. Kespohl S, Raulf M.