Re: More misconceptions From Dr. Marinkovich

[Guest guest]

The Editors, JACI, and the Board of Directors, American Academy of

Allergy, Asthma and Immunology.

As a long time member of the Academy, I was shocked and disappointed by the “

Position Paper†printed in the February issue of the JACI (Bush RK, et al.

The medical aspects of mold exposure). A number of criticisms come quickly to

mind:

1. At least two of the authors earn a substantial income testifying

against patients in mold related litigation. The potential conflict of interest

is not addressed.

2. This is not a position paper generated from free and open discussion

among Academy members. It is a one-sided opinion paper.

3. The authors seem to be ignoring one of the basic tenets of allergy:

when symptoms appear following an exposure and abate on its cessation,

chances are the patient is reacting to something in that exposure. Before we

label

her a hypochondriac, let’s explore the details. Perhaps we can learn.

4. The authors draw conclusions about the health effects of indoor mold

exposure for which they offer no positive support from the literature. The

lack of evidence is not evidence against.

5. The authors have selected from the literature articles that, however

tenuously, support their opinions and ignore the mountain of evidence which

refutes their conclusions. c.f. Straus D, (ed). Sick Building Syndrome:

Advances in applied microbiology. 55, 2004, and Johanning E. Bioaerosols,

fungi,

bacteria, mycotoxins and human health. Fungal Research Group Foundation,

Albany, 2005.

6. Two peer-reviewed literature references that do not support the

authors’ conclusions are cited and rejected as “poor quality†without

discussion.1,2

7. The authors’ review of the literature involving the presence of mold

specific IgG antibodies reflecting the patients’ exposure to mold is

completely distorted. They seem to suggest that the measurement of mold

specific IgG

antibodies cannot be a useful clinical parameter in diagnosing and

monitoring the progress of patients with mold related illness.

8. The conclusion that mycotoxins are not proteins and therefore

mycotoxin antibodies are not possible ignores the enormous literature on

penicillin

reactions (a mycotoxin). One of the papers cited by the authors specifically

identifies IgG antibodies against mycotoxins but is given no value in

reading their conclusion.3

9. No reference is made to the very important work done by Dr. Sherris’

group, formerly of the Mayo Clinic, now at the University of Buffalo, in

which mold specific IgG antibodies are identified as markers of chronic

rhinosinusitis, and no difference between patients and controls is seen with

IgE

antibodies. 4

I am astounded that the Academy would take such a blatant stand against the

best interest of patients and disburse biased opinions as facts to its

membership. I believe this paper does not meet the minimal standard for a

position

paper by the Academy. It should be withdrawn. The Academy would de well to

sponsor an open forum in which to debate the issues of health effects from mold

exposure in the Journal.

Sincerely Yours,

A. Marinkovich, M.D.