American Academy of Pediatrics Council on Environmental Health

View all recommendations from this society

Released May 17, 2021

Do not order mold sensitivity testing on patients without clear allergy or asthma symptoms (particularly those with chronic fatigue, arthralgia, cognitive impairments, and affective disorders). For those with allergy or asthma symptoms who have not responded to environmental interventions to reduce allergen exposures, mold sensitivity testing may be performed by an allergist or pulmonologist, but should not routinely be performed in the primary care setting.

Mold can cause sensitization and clinical disease. Skin prick and in vitro tests can effectively identify patients who are sensitized to molds, although this does not always translate to clinical disease. Results of these tests must be interpreted in the context of the patient’s clinical presentation.

Exposure to dampness and mold can increase the risk of developing asthma in children regardless of their atopic status and increased symptoms of asthma and rhinitis in individuals who already have these conditions. Interventional studies have found that a multifaceted series of interventions aimed at reducing indoor moisture, removing contaminated building materials, and reducing reservoirs (including carpeting and dust) can reduce exposure sufficiently to reduce symptoms in affected individuals. This implies a causal relationship between exposure to fungi and morbidity and provides a rationale for environmental interventions to reduce it.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific
questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists
dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

The American Academy of Pediatrics’ Council on Environmental Health (COEH) consists of pediatricians who have a special interest in children’s exposures to
environmental contaminants and the care of the environment in which we live. COEH strives to inform pediatricians, parents, communities, and policy makers on
environmental issues that can result in harm to children. As a result, the members of the Executive Committee of COEH were queried to provide their scientifically
informed opinions as nationally recognized experts in pediatric environmental health to identify diagnostic and management decisions that have resulted in
patient harm either from a misdiagnosis or inappropriate therapy. These 5 clinical issues are the result. Various expert committees, councils, and sections of the
AAP reviewed and approved the list. The list was approved by the AAP Board of Directors and Executive Committee.

Note: Pediatricians should consult with specialists who are trained in toxicology or environmental health when questions such as these arise. The American
Academy of Pediatrics has partnered with the American College of Medical Toxicology (ACMT) to co-administer the Pediatric Environmental Health Specialty
Units (PEHSU), a network of pediatricians and medical toxicologists serving individual federal regions to help with education and consultation of children with
environmental exposures. PEHSUs are funded by the US Department of Health and Human Services Agency for Toxic Substances and Disease Registry and the
US Environmental Protection Agency with a cooperative agreement with AAP and ACMT. Visit: www.pehsu.net

Sources

Portnoy JM, Jara D. Mold allergy revisited. Ann Allergy Asthma Immunol. 2015;114(2):83-89