[Medical clinical diagnostics for indoor mould exposure - Update 2023 (AWMF Register No. 161/001)].

Autor:	Hurraß J; Sachgebiet Hygiene in Gesundheitseinrichtungen, Abteilung Infektions- und Umwelthygiene, Gesundheitsamt der Stadt Köln., Heinzow B; Ehemals: Landesamt für soziale Dienste (LAsD) Schleswig-Holstein, Kiel., Walser-Reichenbach S; Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit München., Aurbach U; Labor Dr. Wisplinghoff.; ZfMK - Zentrum für Umwelt, Hygiene und Mykologie, Köln., Becker S; Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Tübingen., Bellmann R; Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck., Bergmann KC; Institut für Allergieforschung, Charité - Universitätsmedizin Berlin., Cornely OA; Translational Research, CECAD Cluster of Excellence, Universität zu Köln., Engelhart S; Institut für Hygiene und Public Health, Universitätsklinikum Bonn., Fischer G; Landesgesundheitsamt Baden-Württemberg im Regierungspräsidium Stuttgart., Gabrio T; Ehemals: Landesgesundheitsamt Baden-Württemberg im Regierungspräsidium Stuttgart., Herr CEW; Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit München.; Ludwig-Maximilians-Universität München, apl. Prof. 'Hygiene und Umweltmedizin'., Joest M; Allergologisch-immunologisches Labor, Helios Lungen- und Allergiezentrum Bonn., Karagiannidis C; Fakultät für Gesundheit, Professur für Extrakorporale Lungenersatzverfahren, Universität Witten/Herdecke.; Lungenklinik Köln Merheim, Kliniken der Stadt Köln., Klimek L; Zentrum für Rhinologie und Allergologie, Wiesbaden., Köberle M; Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München., Kolk A; Institut für Arbeitsschutz der DGUV (IFA), Bereich Biostoffe, Sankt Augustin., Lichtnecker H; Medizinisches Institut für Umwelt- und Arbeitsmedizin MIU GmbH Erkrath., Lob-Corzilius T; Wissenschaftliche AG Umweltmedizin der GPAU, Aachen., Mülleneisen N; Asthma und Allergiezentrum Leverkusen., Nowak D; Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Mitglied Deutsches Zentrum für Lungenforschung, Klinikum der Universität München., Rabe U; Zentrum für Allergologie und Asthma, Johanniter-Krankenhaus Treuenbrietzen., Raulf M; Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung, Institut der Ruhr-Universität Bochum (IPA)., Steinmann J; Institut für Klinikhygiene, Medizinische Mikrobiologie und Klinische Infektiologie, Paracelsus Medizinische Privatuniversität Klinikum Nürnberg., Steiß JO; Zentrum für Kinderheilkunde und Jugendmedizin, Universitätsklinikum Gießen und Marburg GmbH, Gießen.; Schwerpunktpraxis Allergologie und Kinder-Pneumologie Fulda., Stemler J; Translational Research, CECAD Cluster of Excellence, Universität zu Köln., Umpfenbach U; Arzt für Kinderheilkunde und Jugendmedizin, Kinderpneumologie, Umweltmedizin, klassische Homöopathie, Asthmatrainer, Neurodermitistrainer, Viersen., Valtanen K; FG II 1.4 Mikrobiologische Risiken, Umweltbundesamt, Berlin., Werchan B; Stiftung Deutscher Polleninformationsdienst (PID), Berlin., Willinger B; Klinisches Institut für Labormedizin, Klinische Abteilung für Klinische Mikrobiologie - MedUni Wien., Wiesmüller GA; Labor Dr. Wisplinghoff.; ZfMK - Zentrum für Umwelt, Hygiene und Mykologie, Köln.; Institut für Arbeits-, Sozial- und Umweltmedizin, Uniklinik RWTH Aachen.
Jazyk:	němčina
Zdroj:	Pneumologie (Stuttgart, Germany) [Pneumologie] 2024 Oct; Vol. 78 (10), pp. 693-784. Date of Electronic Publication: 2024 Feb 09.
DOI:	10.1055/a-2194-6914
Abstrakt:	This article is an abridged version of the updated AWMF mould guideline "Medical clinical diagnostics in case of indoor mould exposure - Update 2023", presented in July 2023 by the German Society of Hygiene, Environmental Medicine and Preventive Medicine (Gesellschaft für Hygiene, Umweltmedizin und Präventivmedizin, GHUP), in collaboration with German and Austrian scientific medical societies, and experts. Indoor mould growth is a potential health risk, even if a quantitative and/or causal relationship between the occurrence of individual mould species and health problems has yet to be established. There is no evidence for a causal relationship between moisture/mould damage and human diseases, mainly because of the ubiquitous presence of fungi and hitherto inadequate diagnostic methods. Sufficient evidence for an association between moisture/mould damage and the following health effects has been established for: allergic respiratory diseases, allergic rhinitis, allergic rhino-conjunctivitis, allergic bronchopulmonary aspergillosis (ABPA), other allergic bronchopulmonary mycosis (ABPM), aspergilloma, Aspergillus bronchitis, asthma (manifestation, progression, exacerbation), bronchitis (acute, chronic), community-acquired Aspergillus pneumonia, hypersensitivity pneumonitis (HP; extrinsic allergic alveolitis (EEA)), invasive Aspergillosis, mycoses, organic dust toxic syndrome (ODTS) [workplace exposure], promotion of respiratory infections, pulmonary aspergillosis (subacute, chronic), and rhinosinusitis (acute, chronically invasive, or granulomatous, allergic). In this context the sensitizing potential of moulds is obviously low compared to other environmental allergens. Recent studies show a comparatively low sensitization prevalence of 3-22,5 % in the general population across Europe. Limited or suspected evidence for an association exist with respect to atopic eczema (atopic dermatitis, neurodermatitis; manifestation), chronic obstructive pulmonary disease (COPD), mood disorders, mucous membrane irritation (MMI), odor effects, and sarcoidosis. (iv) Inadequate or insufficient evidence for an association exist for acute idiopathic pulmonary hemorrhage in infants, airborne transmitted mycotoxicosis, arthritis, autoimmune diseases, cancer, chronic fatigue syndrome (CFS), endocrinopathies, gastrointestinal effects, multiple chemical sensitivity (MCS), multiple sclerosis, neuropsychological effects, neurotoxic effects, renal effects, reproductive disorders, rheumatism, sick building syndrome (SBS), sudden infant death syndrome, teratogenicity, thyroid diseases, and urticaria.The risk of infection posed by moulds regularly occurring indoors is low for healthy persons; most species are in risk group 1 and a few in risk group 2 ( Aspergillus fumigatus , A. flavus ) of the German Biological Agents Act (Biostoffverordnung). Only moulds that are potentially able to form toxins can be triggers of toxic reactions. Whether or not toxin formation occurs in individual cases is determined by environmental and growth conditions, water activity, temperature and above all the growth substrates.In case of indoor moisture/mould damage, everyone can be affected by odor effects and/or mood disorders.However, this is not an acute health hazard. Predisposing factors for odor effects can include genetic and hormonal influences, imprinting, context and adaptation effects. Predisposing factors for mood disorders may include environmental concerns, anxiety, condition, and attribution, as well as various diseases. Risk groups to be protected particularly regarding infection risk are immunocompromised persons according to the classification of the German Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, KRINKO) at the Robert Koch-Institute (RKI), persons suffering from severe influenza, persons suffering from severe COVID-19, and persons with cystic fibrosis (mucoviscidosis); with regard to allergic risk, persons with cystic fibrosis (mucoviscidosis) and patients with bronchial asthma must be protected. The rational diagnostics include the medical history, physical examination, and conventional allergy diagnostics including provocation tests if necessary; sometimes cellular test systems are indicated. In the case of mould infections, the reader is referred to the specific guidelines. Regarding mycotoxins, there are currently no useful and validated test procedures for clinical diagnostics. From a preventive medical point of view, it is important that indoor mould infestation in relevant magnitudes cannot be tolerated for precautionary reasons.For evaluation of mould damage in the indoor environment and appropriate remedial procedures, the reader is referred to the mould guideline issued by the German Federal Environment Agency (Umweltbundesamt, UBA). Competing Interests: Eine Übersicht der Interessenkonflikte findet sich im Internet unter http://awmf.org; AWMF-Registriernummer 161/001. (Thieme. All rights reserved.)
Databáze:	MEDLINE
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