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Medscape

Home Mold Exposure Linked to Hypersensitivity Pneumonitis

A large case series in North Texas identified home mold as a modifiable cause of hypersensitivity pneumonitis (HP). Climate change and extreme weather patterns promoted mold growth, whereas remediation showed potential for improving outcomes. METHODOLOGY: Researchers conducted a retrospective analysis of 231 patients (mean age, 62.9 years; 40.7% men) diagnosed with HP from 2011 to 2019. The diagnosis of HP was confirmed through a combination of high-resolution CT patterns, bronchoalveolar lavage lymphocyte percentages (> 30%), transbronchial biopsy findings and surgical lung biopsy results. Investigators reviewed medical charts to confirm residential mold exposure, gathering information on exposure location, duration, and remediation efforts to better understand the patterns and effect of home mold exposure. TAKEAWAY: Home mold was identified as the triggering antigen in 54 (23.4%) patients diagnosed with HP, of whom 48 (89.9%) had fibrotic HP. Within homes, mold was most commonly found in central air conditioning units (22.2%), bedrooms (18.5%), and bathrooms (16.7%). Additionally, 33.3% of patients had molds present in multiple areas of the home. Among patients who eliminated mold exposure, 12.2% showed a greater than 10% improvement in predicted forced vital capacity (FVC%) within 3-4 months, 58.5% maintained stable lung function, and none experienced a greater than 10% decline in predicted FVC%. Transplant-free survival did not differ significantly between patients with home-related and non–home-related mold exposure. IN PRACTICE: 'The study results support that home mold may be an important and modifiable cause of HP,' the authors wrote. 'As climate change continues to disrupt weather patterns, causing storms and flooding in certain areas, clinicians should remain alert to the presence of mold and its potential contribution to development of HP.' SOURCE: Traci N. Adams, MD, with the University of Texas Southwestern Medical Center, Dallas, was the corresponding author of the study, which was published online on May 8 in PLoS One . LIMITATIONS: The study relied on brief clinician summaries and included inconsistent home evaluations by certified specialists. Follow-up time was limited for some patients, and high-resolution CT scans were not available for some patients where improvement in FVC% was suggested. DISCLOSURES: The authors reported having no conflicts of interest.