Mycotoxin Testing - 3 considerations

Mold and mycotoxcin illness can be one of the causes for complex symptoms that are usually considered within a central sensitization syndrome umbrella. When I evaluate patients for this possibility due to hints from their history and exam, we often have to evalute the 1) body burden and excretion of mycotoxins, 2) possibility of ongoing exposure, and 3) immunologic / inflammatory consequences of exposure.

Body Burden and Excretion of Mycotoxins

There is no perfect test for this that is readily available to assess true body burden of mycotoxins. The body can store toxins in a variety of areas that are not readily measured - most usually adipose tissue. A fat biopsy that assesses for toxin level is not readily available, and the testing we have in use clinically for information gathering purposes measures what is mobilized, as opposed to the total body burden.

This would include blood testing for toxins as well as urine testing for mycotoxins.

We use two main labs for mycotoxin testing in the urine. Realtime Labs has a mycotoxin panel which uses ELISA (immunological methods, antibody based) and Great Plains lab has a Mycotox profile which uses mass spectrometry. They both have different advantages and disadvantages, but essentially both measure the patient’s excretion of mycotoxins. If the exposure is high, or the body burden is high, the excretion is usually high as well.

Possibility of Ongoing Exposure

While there is much debate if colonized mold in the gastrointestinal or respiratory tract can contribute to mycotoxin exposure, unusual colonization of the nasal and sinus cavity, or the intestines, may be useful to identify if it is thought to contribute to the inflammation and central nervous system sensitization of a patient.

From a symptomatic point of view, patients who tend to also complain of abdominal bloating and distention, worse after meals, especially carbohydrate rich meals, and better after an overnight fast; or those who have concurrent candida vaginitis or candida thrush may benefit from assessment of colonization and subsequently reduction of fungal burden. Note - this is very different from an invasive fungal infection which is very rare outside of the profoundly immunocompromised.

Assessement of such may be from a fungal nasal / sinus culture, stool culture, or an indirect test looking at urinary fungal metabolites.

The usual source of ongoing exposure is in the environment. Note that environmental mold can commonly cause respiratory problems from the inhalation of airborne spores, which would show up on either air quality testing or mold plate testing (from a company such as Immunolytics).

However, in patients affected by mycotoxins, the spore count within the air may not be high, but rather the mold may be most detectable with analysis of settled dust, such as that done by Environmental Relative Moldiness Index testing or ERMI. I do like the report from Envirobiomics as it is presented in a very clear fashion. It is important to note that this can give a historical viewpoint of the mold of the building - as the dust can be from even years prior.

Immunologic and Inflammatory Consequences of Mycotoxins

This can be a very important part of the puzzle, especially in those patients who may have remediated their environment, or who may have been ill from exposure years previous but are in a new, clean environment. Importantly, what causes the onset of inflammation and symptoms (or the trigger) can be removed and sometimes the inflammation and symptoms persist.

Assessing the cytokines of the immune system for imbalances and excesses can give therapeutic targets - in which treatments can be attempted to normalize the immune response. The reset of the immune system can then lead in some patients to an improvement in the symptoms.

The testing for this is a blood test to look at a variety of cytokines, including the interleukins, interferon gamma, tumor necrosis factor, VEGF (vascular endothelial growth factor). Elevations and abnormalities in such cytokines are not specific to any one illness, including mycotoxin related illness, but nonetheless provide evidence of immune system abnormalities that can then be targeted.