While the symptoms seen in patients exposed to high ambient levels of fungal elements can vary a great deal among different individuals, a fairly consistent pattern of illness is seen in patients presenting with sufficient symptoms to warrant seeing a physician. Most patients describe a progression of symptoms beginning a few months to a few years after the onset of exposure (e.g., moving into a mold-infested house). Initially the complaints are nasopharyngeal (sore throats, hoarseness, stuffy nose, transient hearing loss), or pulmonary (cough, wheezing, shortness of breath). With time, symptoms progress to include headaches, fatigue, rashes, vertigo, muscle and joint pain, fever, recurrent sinus or ear infections, etc (Rylander, 1994). Many of these symptoms are the result of an overactive immune system trying desperately to overcome what it perceives to be an overwhelming infection.
The immune system generates antibodies to the absorbed materials (or antigens). These antibodies react with the antigens to form immune complexes, which is all part of the body’s normal immune elimination function. These complexes are quickly taken up by scavenger cells, which remove the complexes from the circulation thus limiting their inflammatory effects. When complex formation continues over a long period of time, this clearing mechanism can become overloaded. The complexes then remain in the blood stream causing myriad symptoms, known to clinical immunologists as serum sickness or immune complex disease (Cochrane et al., 1973). To the patient, the symptoms appear to be a severe, unrelenting flu syndrome. When one looks up in the older literature the classical symptoms seen in serum sickness, they are exactly those symptoms the patients with fungal illness describe to their physician (Von Pirquet, 1951).
Since hypersensitivity states develop only after relatively long exposure times, normal children under ten years of age do not have significant antibody titers to fungi. However, when children experience very high exposure levels in the home or school, measurable antibody levels appear rather quickly, i.e., within a few months of exposure. Normal mature adults living in temperate or tropical climates commonly show antibody activity toward fungi and experience symptoms following unusual exposures. The onset of symptoms often follow exposures by one or two days, are not recognized for what they are, and are likely to be diagnosed as a virus infection.