The role of Stachybotrys mycotoxins in building-related illness

Recently there has been increased attention among both the public and health professionals regarding the potential role of mycotoxins, primarily from fungi of the genus Stachybotrys, as etiologic agents related to illness among persons exposed in the indoor (nonindustrial) environment. Recommendations for the remediation of buildings are being made based in part on reported health effects believed to be due to mycotoxins. A search of NIOSHTIC (a literature database maintained by the National Institute for Occupational Safety and Health) and MEDLINE (from 1965 to present) for literature related to fungi, mycotoxins, and the indoor environment was conducted. References from relevant articles also were reviewed. This strategy yielded a total of 13 articles. Important issues concerning exposure assessment and case definitions are inadequately addressed in the literature reviewed, making it difficult to implicate mycotoxins as a cause of building-related illness. The literature review indicates that currently there is inadequate evidence supporting a causal relationship between symptoms or illness among building occupants and exposure to mycotoxins. Research involving the identification and isolation of specific fungal toxins in the environment and in humans is needed before a more definitive link between health outcomes and mycotoxins can be made.