AAAAI Journal Publishes Criticism, Finds No Reason to Withdraw Mold Paper

[Guest guest]

Hi All,

The AAAAI refused to retract their mold position statement, even though they

were provided much documentation in the form of a video deposition of one of

the listed authors indicating he did not agree with all aspects of the

paper, scientific research papers, and clear documentation that the concept

serious illness is " not plausible is based on no scientific foundation. They

did

however, agree to strengthen their conflict of interest disclosures (at the

urging of the Center for Science in the Public Interest), and the President

of the AAAAI, rendered the document useless as a litigation defense weapon

with the statement of " ..although reasonable persons might disagree with the

emphasis of the article in some areas or with any particular details.. " .

Although I am extremely appreciative of Dr. Leung's (JACI Editor) attention

to the matter. I am extremely disappointed over the AAAAI decision not to

retract this inaccurate mold statement. It is knowingly continuing to promote

junk science to the medical community. There is absolutely no sound

scientific foundation whatsoever that one could not be exposed to enough

mycotoxins

within an indoor environment to cause human illness.

This unscientific stance being endorsed by the AAAAI in the form of a weighte

d position statement and therefore implied to be the position of thousands

of physicians, is the root cause of the confusion and contention that leaves

illnesses untreated and keeps the issue within the courts.

Sharon Kramer

Mold Columns

____________________________________

BEYOND THE HEADLINES

(http://www.harrismartin.com/GenerateArticlePDF.cfm?articleid=7558)

____________________________________

Date: 1 September 2006 AAAAI Journal Publishes Criticism; Finds No

Reason to Withdraw Mold Paper MILWAUKEE, Wis. — A peer-review journal on

allergy issues published numerous responses critical of a March position paper

on

mold that found little or no scientific evidence for mold-related illnesses

beyond allergic responses, but rejected critics’ demands that the paper be

withdrawn.

The criticisms arose from conclusions reached by Bush, et al. in their

paper, “The medical effects of mold exposure,†published in the March 2006

issue

of the American Academy of Allergy, Asthma and Immunology’s Journal of

Allergy and Clinical Immunology (See ’s Columns: Mold, March

2006).

The authors of that paper concluded that “[e]xposure to molds can cause

human disease through several well-defined mechanisms,†but they limited that

conclusion to allergic responses, including asthma, allergic fungal sinusitis

and hypersensitivity pneumonitis.

It was what the authors didn’t find that initiated letters to the editor:

• “The occurrence of mold-related toxicity (mycotoxicosis) from exposure to

inhaled mycotoxins in nonoccupational settings ...is improbable.â€

• “Exposure to molds and their products does not induce a state of immune

dysregulation (eg, immunodeficiency or autoimmunity).â€

• “The occurrence of mold-related irritant reactions from exposure to

fungal irritants in nonoccupational settings are theoretically possible,

although

unlikely to occur in the general population given exposure and dose

considerations.â€

• “Measurement of antibodies to specific molds has scientific merit in the

assessment of IgE-mediated allergic disease, HP, and allergic

bronchopulmonary mucosis … [but] cannot be used as an immunologic marker to

define dose,

timing, and/or location of exposure to mold antigen inhalation in a

noninfections setting.â€

• “Testing for airborne mycotoxins in nonagricultural environments cannot

be used to diagnose mold exposure.â€

And despite the association’s decision to allow critics to respond in the

September issue of the journal, those conclusions will stand as representing

the AAAAI’s current position on mold.

Journal editor Platts-Mills, M.D., Ph.D., explained, “The authors of

the position paper have extensive experience in the field, and they applied

clearly defined criteria in evaluating the published evidence. In addition,

the position paper was reviewed by the Board of Directors of the AAAAI in

November 2005. Thus, although reasonable persons might disagree with the

emphasis

of the article in some areas or with any particular details, it has been

determined that there is no reason for withdrawing the position paper.â€

The Responses

Responders were allowed 500 words in which to present their views on the

issue.

Mold researchers C. Straus, Ph.D. and C. , Ph.D., of the

Texas Tech University Health Sciences Center took issue with the position

paper’s view of trichothecene mycotoxins, saying that Bush, et al., implied

that inhalation of Stachybotrys chartarum conidia was the most likely way

trichothecene mycotoxins could invade the body.

“We have recently shown that the number of SC conidia in the air in a

SC-infested building is not a good predictor for the amount of macrocyclic

trichothecene mycotoxins in the air,†Straus and countered.

Criticizing other findings, Straus and concluded, “we feel that the

following statements are true. SC has been shown to grow in buildings where

people are having health problems. SC definitely produces MTMs in these

situations. These MTMs definitely get into the air in these buildings, where

they

can be inhaled. They definitely are inhaled by people in these buildings.â€

The pair ended with a question of their own: “The following, then, is the

final question that remains to be answered: do the MTMs get into human beings

in concentrations sufficient to cause the health problems observed in

SC-contaminated buildings?â€

In his response, Maurice H.V. Strickland, M.D., FAAAAI noted the 500-word

limit and used it to point readers to a series of published articles.

“I disagree with much of the position paper by Bush et al.,†Strickland

wrote. “There is much evidence supporting illness caused by water-damaged,

moldy, or damp indoor spaces. Classic allergy accounts for only part of the

problem.â€

Strickland also commented, “New knowledge renders virtually every study of

indoor mold exposure obsolete. I have mentioned some of the pieces of the

puzzle that will have to be used to assemble the entire picture of indoor mold

effects. New knowledge and new studies will solve this puzzle.â€

Another letter questioned the thoroughness of the original paper’s research,

maintaining that “many important studies are not considered, and those

considered are often accepted or rejected without evidence-based discussion.â€

That opinion was contributed by Ritchie C. Shoemaker, M.D.; Harriett Ammann,

Ph.D.; Lipsey, Ph.D.; and Montz, Ph.D.

Noting that the original paper included “only 44 references,†Shoemaker, et

al., call the paper’s review “cursory,†and its positions “the opinions

of

a few, rather than the consensus of experts.’â€

“Rigorous, not cursory, reviews of the literature are needed to improve

clinical care and design studies that can further describe the mechanistic

pathways through which exposure to WDBs affects human health,†the Shoemaker

group

offered.

Jens U. Ponicau, M.D., and A. Sherris, M.D., commented that while

Bush, et al., found allergic fungal rhinosinusitis to be “readily

distinguishableâ€

from chronic rhinosinusitis, using “well delineated†criteria, “[r]ecent

advances in the detection methods for the criteria have resulted in the

demonstration of those criteria in the vast majority of CRS cases.â€

Citing several studies, Ponicau wrote, “None of these recent developments

are cited in the ‘state of the art’ review. Instead it is stated that ‘

evidence supporting a role for fungi in CRS does not exist,’ citing only Dr.

Bush’s

own editorial as evidence. Either the authors were unaware of the emerging

evidence for a role of certain molds or choose not to share it with the

readers, neither of which is acceptable in a position paper that carries the

weight and name of the American Academy of Allergy, Asthma and Immunology and

indirectly the Journal.â€

“To withhold crucial scientific information on the role of mold in CRS

questions the intentions of the authors,†Ponicau and Sherris said.

Another letter also faulted the authors for not considering other references.

Allan Lieberman, M.D., Rea, M.D., and Luke Curtis, M.S., CIH, wrote,

“When anyone writes a position paper, we question whose ox is being gored.â€

“You state in your article that ‘it is important for the members of the

allergy-clinical immunology community who are frequently asked by patients,

parents, and other interested parties to render opinions. Who are these other

interested parties? Was there a separate agenda for this position paper that

also agrees with the American College of Occupational and Environmental

Medicine

’s evidence-based statement on indoor molds?

Dr. Saxon [a coauthor of the Bush, et al. paper] co-authored both

these position papers.â€

Other writers called the paper “one-sided†and faulted the authors for

failing to note conflicts of interest.

The journal acknowledged that criticism in asking all letter writers,

including the authors of the position paper who replied to the letters, to cite

any

conflicts in their responses.

Most, but not all, of the letter writers cited expert testimony on behalf of

plaintiffs.

The Authors Respond

A. Wood, M .D., and K. Bush, M.D., submitted a reply in which

they said they appreciated the responses to their article, but continue to

believe that “the weight of the evidence does not support a clear

relationship

between mycotoxin exposure and adverse health effects.â€

“We did an exhaustive literature search in the preparation of this statement

and clearly did not overlook the many citations provided in the above

letters,†Wood and Bush stated. “We also made it clear in the statement’s

introduction that space constraints limited the number of references that could

be

included.â€

“In our final analysis,†they said, “we believed that the purported

adverse

health effects of mycotoxins are still not definitive. Many of these

citations, in fact, do support the adverse health effects of mold exposure but

not

necessarily the specific contribution of mycotoxins to these health effects.

We fully appreciate that this might be another example of an overly

conservative approach.â€

“It is clear that this is an area of great controversy,†they said. “It

is

also clear that this is a rapidly evolving science and that much of the

controversy will be settled with ongoing evidence-based research.â€