Determining the Sequence of Evaluations
When addressing patient complaints potentially linked to mold in military housing or other settings, the sequence of evaluations—medical versus environmental—is determined by the nature of the complaint and presenting circumstances.
- If health symptoms are the primary concern, a medical evaluation may come first, followed by an environmental health referral if mold exposure is suspected.
- If visible mold is observed by the resident and reported to the housing office or environmental health, an evaluation of the residence may be the initial step.
Most importantly, the military emphasizes a collaborative approach. If a medical evaluation identifies potential mold-related health effects, it may trigger an environmental health investigation of the housing unit. Conversely, if mold is discovered during an environmental health inspection, residents may be referred for medical evaluation to rule out or address potential mold-related health concerns.
Detailed Patient History
Your patient evaluation for mold-related complaints starts with a detailed patient history, a focused physical exam, and any needed ancillary studies.
Document an exposure history, as reported by the patient, for mold and/or moisture in the home, including but not limited to—
- Visible mold.
- Water damage or standing water.
- Water-damaged furnishings.
- Damp carpeting or flooring.
- Moldy or musty odors.
Document a symptom history, including symptom onset, duration, progression of symptoms and improvement when out of the home.
Document any medical history of conditions such as allergies, asthma, autoimmune and immunodeficiency disorders.
Physical Exam
Conduct a targeted physical exam focused on—
- Eyes, nose, throat and sinuses.
- Skin, especially rashes and hives.
- Neurologic symptoms, particularly headaches.
- Respiratory symptoms, notably wheezing and dyspnea.
Ancillary Studies
Consider ordering relevant ancillary studies, such as allergy testing, pulmonary function testing, imaging (e.g., chest X-ray, chest CT) and lab studies (e.g., CBC with differential, CRP, ESR).
Clinical mold testing may include—
- Immunoassays (blood tests) for allergen-specific IgE/IgG antibodies to common molds like Alternaria, Aspergillus, Cladosporium and Mucor.
- Skin prick tests, typically performed by an allergist, using diluted mold extracts.
IgE/IgG allergy panel results are best interpreted by a qualified healthcare provider. IgE tests measure immediate hypersensitivity (allergic) reactions, while IgG tests indicate past or ongoing exposure to mold. Positive IgE results only indicate sensitization and not that the mold is causing symptoms.
Use an evidence-based approach. Avoid questionable labs, inappropriate tests and unproven detoxification methods. For example, unvalidated diagnostic tests for mycotoxins (e.g., mycotoxin antibody testing, urine mycotoxin tests) are costly and of doubtful clinical value.
Additional Considerations
Ensure optimal patient care by—
- Seeking appropriate specialist input. Have a low threshold for consulting with or referring patients to allergists, immunologists, pulmonologists, or infectious disease specialists.
- Integrating environmental health findings. Use the results from an environmental health investigation to guide clinical decisions and communicate findings to the patient to help them understand the situation.
- Treating both the patient and environment. Optimal management involves treating the patient's symptoms and their triggers while ensuring the environmental remediation of the mold source from their home.
Additional Resources
Defense Health Agency (DHA)
DHA Public Health (DHA PH)
Other Government Resources
