Mold Toxicity Testing & Interpretation Notes

Mold Toxicity Testing & Interpreting Results

Urine Mycotoxin Testing: Why Start There?

• Urine mycotoxin tests are more specific for diagnosing mold toxicity compared to biochemical markers.
• Biochemical markers can indicate inflammation but don't specify if the cause is toxic or infectious.

Benefits of Urine Mycotoxin Testing

• It provides a good indication of mold toxicity.
• A positive urine test confirms mold toxicity, though infection can also be a factor.
• It identifies the specific toxins involved, allowing for more targeted binder selection.

Research on Mycotoxins

• "Mycotoxin detection in human samples from patients exposed to environmental molds," Hooper, D, Guilford, F, Straus, D Int J Mol Sci, 2009, 10, 1465-1475
• "Measurement of mycotoxins in patients with chronic rhinosinusitis" Lieberman, S, Jacobs J, Lebowitz, R, Fitzgerald, M, Feigenbaum, B, Otolaryng Head Neck Surg, 2011, 145, 327-329

Fungal Sinusitis

• "The diagnosis and incidence of allergic fungal sinusitis", Ponikau, J, Sherris D, Kern, EB, Homburger, H, Frigas E, Gaffey T, Roberts, G, Mayo Clin Proc 1999 Sep; 74 (9): 877-84.
• In a study, 96% of surgical nasal cultures were positive, with eosinophils being prominent.

Mycotoxin Lab Tests

• Two main types:
  • ELISA testing through RealTime Laboratories
  • Liquid Chromatography/Mass Spectrometry through Great Plains Laboratories

Mass Spec vs. Elisa Testing

• Mass spectrometry:
  • Theoretically more accurate and reproducible.
  • More specific about what it measures.
• ELISA testing:
  • May measure toxins and their metabolites.
  • Semi-quantitative.

RealTime Laboratories Test

• Measures:
  • Ochratoxin A
  • Tricothecene group (macrocyclics)
  • Aflatoxin group (B1, B2, G1, G2)
  • Gliotoxin
  • Chaetoglobosin

Great Plains Laboratories (GPL) Test

• Tests for:
  • Zearalenone (made by fusarium)
  • Aflatoxin M1
  • Ochratoxin A
  • Sterigmatocystin (related to aflatoxin)
  • Riordin E (macrocyclic tricothecene)
  • Verrucarin A (macrocyclic tricothecene)
  • Enniatin B1 (made by fusarium)
  • Gliotoxin
  • Mycophenolic acid
  • Chaetoglobosin
  • Citrinin

Comparing Tests

• The two tests don't measure the same things in the same way, making direct comparison difficult.
• Both tests provide valuable clinical information; using both is ideal if possible.
• Cost can be a deciding factor.

Mycotoxin Evaluation - Preparation

• Measure mycotoxins in urine or nasal washings.
• Challenge testing is preferred for accurate results.
• Use 500mg glutathione twice daily for 7 days, collecting urine on the 7th day.
• Consider using sweating methods like sauna, bath, or hot tub.

Preparation Continued

• If possible, sauna or hot bath the night before collection.
• Stop all binders 3 days before urine collection.
• Exercise caution with provocation, as it can mobilize toxins faster than some patients can process them.

Cautions for Urine Mycotoxin Testing

• Mobilizing mold toxins can overwhelm the body.
• This can lead to exacerbation of mold toxic symptoms, potentially severe.
• If exacerbation occurs with glutathione or sauna, stop immediately and collect urine.

Urine Mycotoxin Testing - Interpretation

• Any positive testing may be significant.
• Initial numbers may not reflect total toxin load due to compromised detoxification abilities.
• Initial testing is viewed as just the "tip of the iceberg."

Interpretation Continued

• As patients improve with treatment, subsequent testing may show higher mycotoxin levels, more accurately reflecting baseline.
• Urine testing reflects the presence of mycotoxins and the body’s ability to mobilize and release them.
• Testing numbers must align with the clinical picture to be meaningful.

Repeat Testing Interpretation

• Higher results on repeat testing may indicate:
  1. Re-exposure to mold
  2. Improved detoxification
  3. Excessive binding of toxin
  4. Excessive killing of mold-releasing toxin
  5. Stimulating mold to make mycotoxins
  6. Results must be interpreted in context!