title: Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence.
abstract: OBJECTIVE
  Many studies have shown consistent associations between evident indoor dampness or mold and respiratory or allergic health effects, but causal links remain unclear. Findings on measured microbiologic factors have received little review. We conducted an updated, comprehensive review on these topics.
  
  
  METHODS
  We reviewed eligible peer-reviewed epidemiologic studies or quantitative meta-analyses, up to late 2009, on dampness, mold, or other microbiologic agents and respiratory or allergic effects.
  
  
  METHODS
  We evaluated evidence for causation or association between qualitative/subjective assessments of dampness or mold (considered together) and specific health outcomes. We separately considered evidence for associations between specific quantitative measurements of microbiologic factors and each health outcome.
  
  
  RESULTS
  Evidence from epidemiologic studies and meta-analyses showed indoor dampness or mold to be associated consistently with increased asthma development and exacerbation, current and ever diagnosis of asthma, dyspnea, wheeze, cough, respiratory infections, bronchitis, allergic rhinitis, eczema, and upper respiratory tract symptoms. Associations were found in allergic and nonallergic individuals. Evidence strongly suggested causation of asthma exacerbation in children. Suggestive evidence was available for only a few specific measured microbiologic factors and was in part equivocal, suggesting both adverse and protective associations with health.
  
  
  CONCLUSIONS
  Evident dampness or mold had consistent positive associations with multiple allergic and respiratory effects. Measured microbiologic agents in dust had limited suggestive associations, including both positive and negative associations for some agents. Thus, prevention and remediation of indoor dampness and mold are likely to reduce health risks, but current evidence does not support measuring specific indoor microbiologic factors to guide health-protective actions.
authors.affiliation: Indoor Air Quality Section, Environmental Health Laboratory Branch, California Department of Public Health, Richmond, California 94804, USA. mark.mendell@cdph.ca.gov
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Mendell
authors.forename: Anna G
authors.initials: AG
authors.lastname: Mirer
authors.forename: Kerry
authors.initials: K
authors.lastname: Cheung
authors.forename: My
authors.initials: M
authors.lastname: Tong
authors.forename: Jeroen
authors.initials: J
authors.lastname: Douwes
mesh_terms: D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D002648:Child; D005658:Fungi / Q000276:immunology*; D006801:Humans; D006813:Humidity / Q000009:adverse effects*; D012120:Respiration Disorders / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000382:microbiology*; D012130:Respiratory Hypersensitivity / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000382:microbiology*; D018570:Risk Assessment; D012307:Risk Factors