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Abstract

To the Editor: The recent position paper entitled “The medical effects of mold exposure,” by Bush et al1Bush R.K. Portnoy J.M. Saxon A. Terr A.I. Wood R.A. The medical effects of mold exposure.J Allergy Clin Immunol. 2006; 117 ([published correction appears in J Allergy Clin Immunol 2006;117:1373]): 326-333Abstract Full Text Full Text PDF PubMed Scopus (309) Google Scholar has stimulated considerable comment. The comments, particularly those in the letter from Kilburn et al,2Kilburn K.H. Gray M. Kramer S. Non-disclosure of conflicts of interest is perilous to the advancement of science.J Allergy Clin Immunol. 2006; 118: 766-767Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar raise several questions. First, they correctly point out that the article should have been published with a conflict of interest (COI) statement. The failure to include a COI was an oversight shared between the American Academy of Allergy, Asthma and Immunology (AAAAI) and the Journal. We have now published the conflict statements for these authors,1Bush R.K. Portnoy J.M. Saxon A. Terr A.I. Wood R.A. The medical effects of mold exposure.J Allergy Clin Immunol. 2006; 117 ([published correction appears in J Allergy Clin Immunol 2006;117:1373]): 326-333Abstract Full Text Full Text PDF PubMed Scopus (309) Google Scholar and we have changed the procedures so that a COI statement will be part of all position statements in the future, as they are for other JACI publications. Among the possible conflicts in relation to the mold article was the fact that 2 of the authors have acted as witnesses in law cases concerning possible mold-related illness. COI forms for all speakers and authors have been updated for both for the Journal and for the AAAAI to specifically ensure that appropriate disclosures will be provided in relation to acting as a witness in relevant cases. Second, the authors raise the question of whether the position paper had sufficient scientific rigor in the review or presentation of the evidence. It is important to point out that there are a wide range of scientific questions about which many of us disagree. There are other important issues over which opinions have changed radically over relatively short periods of time. The authors of the position paper have extensive experience in the field, and they applied clearly defined criteria in evaluating the published evidence. In addition, the position paper was reviewed by the Board of Directors of the AAAAI in November 2005. Thus, although reasonable persons might disagree with the emphasis of the article in some areas or with any particular details, it has been determined that there is no reason for withdrawing the position paper. It is clear that there is still disagreement about the medical effects of exposure to mold products and particularly about the effect of mycotoxins on the health of both allergic and nonallergic subjects. The current position paper is not the last word on the subject. What is needed is more research designed to answer definitively in what ways mold exposure in buildings does or does not contribute to health problems. The Journal and the AAAAI both welcome scientific research in this area. We look forward to a continuation of the dialogue of which this position paper is part.