WebMD Live Events Transcript

Allergy season lasts all year for those sensitive to indoor allergens such as dust mites and animal dander. And as folks who have suffered the effects of toxic mold attest, the reactions can range from annoying to debilitating. If your indoor environment is making you sick, see what allergist Brian Smart, MD, had to say about the subject on July 29, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MEMBER QUESTION:
What does toxic mold look like?

SMART:
There's lots of controversy as to whether there is such a thing as toxic mold. But mold growth will look like mildew. The growth is usually black, will usually be damp and shiny, and usually has a moldy odor as well. The other big hint that you're looking at mold is that there is some water source for the mold to grow, like wet carpet, a leaky pipe, or a flooded basement.

MEMBER QUESTION:
How can I keep mold from forming on my concrete basement walls?

SMART:
That is an excellent question. The basic concept is that mold follows dampness. So a very dry basement will usually never have mold growth. If there is a seepage problem, such as poor drainage from the gutters, or water that flows in from the yard, or the foundation is cracked, then you are likely to have growth. So the answer, quite simply, is that if the basement is kept dry, you won't have mold growth.

The other thing for you to know is that a concrete surface is porous, and this is not usually a big deal for the walls, but for the basement flooring this can be problematic. Therefore, many people seal their concrete basement floor for that reason.

MEMBER QUESTION:
What is the best way to clean mold from concrete (that won't gag me!)?

SMART:
The most reliable way to clean mold is with bleach. We usually suggest that you make a one part bleach to nine parts water solution, and while wearing gloves use this to clean up mold.

"Mold looks bad and it smells bad, but it doesn't always cause symptoms when you see it."

MEMBER QUESTION:
Hello, Dr. Smart. I have lived with black toxic mold for about seven to eight years in my apartment. I have allergies to mold; the mold has come from an air conditioner unit like a motel has. I have sinusitis and respiratory infections. I have a doctor, but I think it has really damaged me in a lot of ways. I have been trying to find a doctor that can tell me just what it has done to me. I need testing that I don't think my doctor knows how to do. I hope you can give me some options.

SMART:
The first question that you need to have answered is whether you have mold allergy. Go to a board-certified allergist for allergy testing. If you are proven to have mold allergy, you're right in that this could really cause you some harm. Probably the best solution for you, if you have mold allergy, is to change homes.

MODERATOR:
What do you mean by "do some harm?"

SMART:
Long-term contact with an allergy trigger such as mold, can cause chronic nasal allergy symptoms such as runny nose and congestion, and trigger chronic sinusitis problems, and may also trigger asthma. There are also some syndromes with mold sensitivity, for instance, allergic fungal sinusitis.

But really, the fundamental question to have answered right now is whether you do have mold allergy. Mold looks bad and it smells bad, but it doesn't always cause symptoms when you see it.

MEMBER QUESTION:
How do you tell if there is mold in the walls of your home?

SMART:
The only way to really know if you have mold buried in your walls is to tear the covering surfaces off. But most mold experts feel that this is not necessary for most situations. Most people who have clinically relevant mold allergies, or symptoms related to mold, will have much more obvious mold contact. Mold that you can't see probably won't cause you problems.

MEMBER QUESTION:
I have been recently diagnosed with asthma. The onset coincided with the addition of a second dog to the home. This dog, a yellow lab, sheds terribly. Can I be having an ongoing reaction to just one specific dog?

SMART:
People ask me this question all the time. Lots of people notice that one breed or one new pet versus the other seems to cause worse symptoms. So that is possible. What you need to know is that all dogs make dog dander. This comes from the sebaceous glands, from the skin's surface. So therefore, dogs that are larger have more sebaceous glands, so they make more dander. Dogs with longer fur can store more dander in the fur, and dogs that shed more will distribute the dander more around the house. But even tiny, hairless dogs make dander also.

The other interesting thing that you may notice when dog shopping, the more the dog costs, the more likely the breeder is to tell you that the dog won't cause allergies.

For people who suffer from asthma or allergy symptoms related to pets, the best thing you can do is to find ways to reduce their pet contact. For most people, their pets are family members. So most people find it unreasonable to ask your family member to move out. But on the other hand, it's very reasonable to ask your family member to sleep someplace else.

MEMBER QUESTION:
I have been receiving allergen desensitization shots for a couple of years. I will soon be reducing visits to once a month. First of all, when I am through, how likely is it that I will still suffer from some of my allergy symptoms (allergic to grasses, trees, dust, mold, dander) and also, as a pet lover, will I ever be able to let my kitty sleep in the same room with me? I really miss her purring.

SMART:
Published data suggests that after you've had allergy shots for a three- to five-year period there's an 80% chance that you will feel just as good off of the allergy shots as on the allergy shots. This benefit will last probably 10 or more years. There's a 20% chance your symptoms may worsen. We can't predict people who will worsen after they end allergy shots, but there are some clues. For instance, if you notice your symptoms worsen when you are late for allergy shots, you should probably go for a longer period. If your symptoms are not significantly better from the allergy shots, then you are probably more likely to worsen once you go off the allergy shots. But the real truth is that we simply can't tell who is going to worsen once they go off the allergy shots.

The other part of your question was whether you can let your cat share your bedroom once more, and the answer is very likely no. While allergy shots are very highly successful for such things as bee stings and pollens, they have somewhat less success with pets. Since pet dander particularly is so potent, very large sustained contact from sharing your bed with your pet would probably cause symptoms.

"Ion-based filters have been well advertised and have become very popular, but they don't work as well as a freestanding unit for a bedroom, for instance."

MEMBER QUESTION:
Are air purifiers worth the money? Do they do what they say they will as far as removing mold spores and allergens out of the air?

SMART:
Yes. Many people who have allergies feel better when they run air filters. But you need to be careful with the air filter that you purchase. Consumer reports published a very good article last summer that tested the various air filter types, and found that the HEPA air filters work best, whereas the ion-based filters have been well advertised and have become very popular, but they don't work as well as a freestanding unit for a bedroom, for instance.

The other thing to know regarding air filters is that you have to be careful to match the air filter size to the room size. Usually the packaging will say the proper room size for the filter.

A third point is in order for the filter to work properly for the room the space needs to be kept closed. For a freestanding air filter for the bedroom you need to keep the bedroom doors and windows closed at all times and run the filter 24 hours per day. This will force you to run the air conditioning for the home, and most people notice they feel better with the air conditioning running anyway.

MEMBER QUESTION:
Is CO2 concentration a good indicator of room air quality? Should you always maintain humidity below 50%?

SMART:
I don't know how useful following CO2 levels is for measuring the home air quality; it's probably not very useful. But, yes, you are right, it is important for mold management, and also for dust mite management, to keep the home as dry as is reasonable. Most people feel too dry when the level drops below 30%. So for most people, you want the level between 30% and 50%.

MEMBER QUESTION:
After allergy testing I learned I am allergic to mold, dust mites, pollen, and certain trees. The asthma is only four months old and I have tried everything to relieve my symptoms. I just purchased dust mite-proof bedding -- cases, encasings, pillows, etc. How soon would one notice a change if mites are a big asthma/allergy trigger?

SMART:
Your particular situation is that you have multiple allergies, so making one single change for one of the allergies that you have may not lead to the huge change in symptoms that you seek. Most people, though, notice that they feel better with the dust mite covers fairly quickly; for instance, in a week or so.

Now, most people find that just the home measures, such as the dust mite covers and air filters and mold clean up, help them to feel better but are not adequate to fully manage their symptoms. That's the reason most people with allergies need medications, also.

MEMBER QUESTION:
Can allergies cause asthma?

SMART:
Yes. There are numerous things that can cause asthma, but the most common trigger is allergies. This is particularly true for children, for whom 85% with asthma do have allergies also.

MEMBER QUESTION:
I was tested for allergies and one of the allergens that I tested positive for was roaches! I've never heard of such a thing. Is this a common thing? How many roaches do you have to have to react to them?

SMART:
Yes. Roach allergy is very common. There was a paper published within the last year or so that showed that roaches cause allergies even for people in relatively affluent areas. Roaches aren't just an inner-city problem. You don't have to have a very large roach population to cause problems. So it's critical to act quickly when you find roaches.

What I usually suggest for patients with allergies is that when roaches are found you have them removed from the home as quickly as possible. The second point, though, is that the roaches themselves don't cause allergies, but it's the feces that they leave behind. So don't just have the roaches removed, but carefully clean up the area where they've been found.

Patients that I see who have roach allergy are usually surprised that they have the allergy, and they tell me they've never had a roach problem, which is very likely true. But there are lots of places to have roach contact that they don't think of like vacations, restaurants, schools, and even in formerly warehoused items. For instance, a couch that has been warehoused may have had some roach contact. So when the couch is brought into your home that may be the source of the roach allergy.

"Most people find that the home measures, such as dust mite covers and air filters and mold clean up, help them to feel better but are not adequate to fully manage their symptoms."

MEMBER QUESTION:
When one has a mold allergy should I assume this is all molds, including foods containing mold, such as wine, cheese, mushrooms, yogurt, etc.?

SMART:
No. The molds that cause allergies are the environmental molds, such as the molds that cause mildew or are growing on rotting leaves or other vegetation. Foods that are made with molds, such as cheese, won't cause mold allergy problems. Furthermore, foods that have some mold growth, such as bread that's become moldy, may or may not cause mold allergy problems.

The other question that people ask me regarding mold allergies is whether medications such as penicillin, which is made from mold products, may cause mold allergy problems, and the answer is no. So penicillin allergy is completely separate from mold allergy.

MODERATOR:
Dr. Smart, before we wrap things up, do you have any final words for us?

SMART:
As a closing comment I'd like to point out that you don't need to suffer with your allergy symptoms. Many people think that symptoms like sneezing or runny nose or coughing or wheezing are just normal for them and they keep suffering with these symptoms. These people should seek help. The vast majority of people who are suffering from asthma symptoms and from allergy symptoms can be helped to feel better. So you will sleep better, you will function better when working or when you're driving, and your overall health will be better.

MODERATOR:
Our thanks to Brian Smart, MD, for sharing his expertise with us. For more information, please be sure to visit our message boards to talk with others and ask questions of our experts.

QUESTION

Allergies can best be described as: See Answer

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