The early industry was conflicted about how water-damaged and damp buildings affected health. The engineers and industrial hygienists (who dominated the early industry) recognized that some people had mold allergies and that damp building materials released volatile chemicals. The people who got extremely ill from water-damaged and damp buildings were an enigma and usually under-served. In the early 2000’s Dr. Ritchie Shoemaker changed everything when he defined a new inflammatory disease that was caused by several triggers, with one of them being water-damaged buildings. A whole research team formed around Dr. Shoemaker and several other doctor-led groups organized who started to focus on people sickened by water-damaged buildings. The field of “mold assessments” became far more advanced with changes occurring even today.

These various health professionals and laboratory researchers have shown that water-damaged buildings are more than just mold allergies and chemicals. Some people appear to have different types of immune-cell reactions to the various types and components of bacteria (mainly bacteria in the group actinomycetes and endotoxin that releases from Gram-negative bacteria). Some people are reacting to the dust mites and other allergenic critters that thrive in damp environments. Some people aren’t able to remove the various toxins produced by the mold and bacteria from the their bodies.

Often, people can’t afford or don’t have access to the type of testing that can specifically indicate which component of a water-damaged building is causing their health symptoms. The starting point is usually a person realizing that a specific building causes them symptoms or they are told by a health professional that their symptoms may be from a water-damaged building. Most consultants start by first assessing the building to identity locations of water damage or biological growth caused by dampness. Eliminate the sources and thoroughly clean the spaces. Usually, the consultants rely on various types of mold testing - not because mold is the sole issue - but because mold is usually present in these situations and is easier to track than bacteria and other contaminants.

Of all the FAQs, this answer is the most fluid and changes every few years. Here is our current understanding.

In our decades of experience with working with thousands of people in water-damaged buildings we find that only about 25% of people get sick with most of them experiencing low-level symptoms that are more of a nuisance or barely are noticed. There are whole fields of professionals that encounter water damage on a daily basis and never get sick - plumbers, foundation repair specialists, renovators, mold remediation technicians, etc.

Genetics, lifestyle, and past trauma/burdens all appear to influence whether a person experiences health illness from water-damaged buildings. People are frequently fine in a building until they experience a car accident or the sudden loss of a loved one. Or, the person experienced a long illness or extreme environmental exposure and their sensitivity to environmental triggers is forever changed. We now know that the hypersensitivity can be driven by the nervous system, the immune system, and by the general functioning of other bodily systems.

Genetics and life make people different.

The simplest analogy is the common allergy response. A cat will jump on one person’s lap and get petted. They jump on another lap and cause a significant immune reaction (sometimes life threatening). Same cat, different people. The public understands and accepts that cat allergies are real and we believe the person who is reacting. Unfortunately, the same isn’t true for water damage and damp buildings. Spouses, family, employers, and friends can sometimes not understand or believe that a person is reacting in a building that they themselves are not.

There is a significant contingent of doctors, holistic providers, mental health advocates and therapists that are advancing the field of diagnosing and treating people who have been impacted and emotionally traumatized by hypersensitivity to the various components of water-damaged and damp environments. Visit our Links page for information from some of these health providers and researchers.

Over the years the consultants who assessed water-damaged buildings have been called by different terms. The current and most used term is Indoor Environmental Professional (IEP) that was popularized by language in the industry standard documents S500 and S520. These are the ground-level basic standards for drying and mold remediation that are produced by the Institute for Inspection Cleaning and Restoration Certification (IICRC).

Whether a consultant uses the IEP designation or not is of little consequence. What matters is their actual experience and training.

No one can go to school to be a good consultant. No single certification or training program truly encompasses what is needed to be a good consultant.

Being a good mold/water damage consultant also means you must be a good indoor air/environmental consultant (IAQ/IEQ), have a strong understanding of construction, plumbing and HVAC, understand psychology and the nervous system. The consultant must know the different beliefs and ways healthcare professionals diagnose people with sensitivities to building contaminants. They must be effective communicators both in-person and through emails/reporting.

This amount of diverse experience and education can be completed by anyone who has the dedication. Starting with formal training in the right sciences (microbiology, immunology, chemistry, medical) or being formally trained in building science and construction gives the consultant an initial headstart.

Do not chose a consultant just based on what is written on a website or a snazzy YouTube video. Talk to them. Did they communicate in a way that helped you understand the topic? Did they appear to be aware of their own limits of knowledge? Will they look at the situation as a whole and not be blinded by bias?

We can collect any type of samples you want. However, usually we only need to use the microscope with our on-site analysis and unlimited number of air, dust, and surface samples to know where the mold/bacteria grew and how far it spread through the structure. Occasionally we also collect samples that we then grow in our lab to identify lower concentrations of mold or to identify specific types of bacteria.

For additional third-party laboratory fees we can also collect and interpret results for ERMI, mycotoxins, endotoxin, actinomycetes, and other types of testing. But, you very likely won’t need to spend the money on these tests if we find the sources of the organisms during our extensive and detailed physical assessment and microscope testing.

When working with consultants that don’t have the luxury of using a microscope on-site, the question as to which type(s) of samples are useful depends on the sensitivity of the occupants and the building situation. The consultant must at least rely mostly on a very detailed physical assessment using different types of moisture detection tools. If the consultant doesn’t start with the most intense scrutiny of the building or areas of interest - then you need to choose a different consultant.

If nothing of interest was physically identified and no one in the building is experiencing health symptoms or observing odd odors, then lab tests of dust or air may not be warranted. However, if health symptoms or odors are present, then here is the common types of samples collected:

Surface swab or tape: These two samples are applied directly to a surface to identify if the surface supports mold growth or has an elevated presence of loose mold particles. These samples are very lowest cost, easy to collect, and tell very specific information. This type of sample is great in areas that experienced water or dampness but mold isn’t yet thick enough to see with unaided eyes.

Surface contact plates:‍ ‍These are one-fourth the size of a Petri plate and can be pushed directly onto a surfaced. Mold spores and bacteria get stuck to the agar in the plate and grow into colonies. This type of testing can detect lower concentrations of some types of mold and bacteria versus a surface tape or swab sample. But, some organisms won’t grow on the plates and will be missed. For situations involving the molds Penicillium and Aspergillus, and sewage bacteria - these samples work very well.

Air spore trap: Allergists have been using devices to capture airborne mold and pollen for decades to produce outdoor allergen reports. This same type of sampler can be used indoors to determine which types and concentrations of mold spores are floating around an environment. This type of testing is low cost but subject to false negatives (mold really is present but not represented on the sample). On the other hand, there are many situations where the consultant did not find current sources of mold, but the air sample results show that the consultant either missed the mold or mold residue is present from a past source that was removed. This type of testing is extremely useful but has a bad reputation because of the misuse of the data.

Petri plates: Home stores sell Petri plates. These plates are left out for 1 hour or more and airborne spores fall upon them and colonies grow. This type of testing has the worst reputation but is a low-cost test method that is useful IF the Petri plate is immediately mailed to the laboratory for analysis and the person understands the high amount of false negatives that occur (mold is present but not represented on the Petri plate). Mold will ALWAYS grow on the Petri plate because outdoor mold spores are always floating around indoors. The mere presence or concentrations of colonies in general is meaningless. The lab must identify which molds are present and you CANNOT rely on computer-driven visual analysis where you send in a picture of the Petri plate. A good lab person can look at a picture and personally identify many of the colony types of a well lit and in-focus picture, but a direct analysis is preferred as many indoor molds produce nearly identical colonies as the outdoor molds.

ERMI: The Environmental Relative Moldiness Index (ERMI) tests for 36 different molds by detection the DNA of the molds in dust. It was invented by the EPA in the early 2000s and was quickly scrapped by the consulting world for two reason. First, early consultants weren’t very good at finding concealed and smaller sources of mold so they assumed the ERMI results were wrong. Second, the EPA researchers who designed the test didn’t really understand how to interpret the data and the labs simply copy the original and flawed interpretation methods in the lab reports. The raw data (which molds are present and the relative concentrations) are very useful to a person who understands which molds grow in which environments. Do not trust any interpretation that relies on cookie-cutter comments, use of the ERMI score, or use of the asterisks that designate the mold as being 10x, 100x, or 1,000x higher than normal. Call someone that will look at the mix of molds present to provide comments. This test can be collected by laypersons, which is great. But the method of collection can give both false negatives and false positives.

HERTSMI: Dr. Ritchie Shoemaker popularized the use of ERMI after the consulting world scrapped the test. He found that it was useful in situations where his patient was getting sick but was told by a consultant that there wasn’t a water-damage issue present. This is a pricey test and he had pushback from clients regarding the cost. He went through ERMI results from his patients and found that 5 of the molds were more correlated to when his patients got sick or got better after effective remediation. He termed the shortened test Health Effects Roster of Type-Specific Formers of Mycotoxins and Inflammagens (HERTSMI). Dr. Shoemaker likes quippy acronyms (HERTSMI - hurts me). Dr. Shoemaker does NOT believe these five molds are more specifically more harmful than other molds. These are just the molds that are more associated with the right types of water damage that cause the inflammatory disease that he discovered. The inflammatory disease that his group says could be from either (or combination) of the molds and bacteria present. HERSTMI is not appropriate for all situations. For example, there are some people who have allergies or delayed-type hypersensitivities to specific molds that are on the ERMI list but not on the HERTSMI list. So, usually start with ERMI and use HERTSMI later based on the situation.

Mycotoxin dust or air samples: Some healthcare providers believe the mycotoxins produced by molds are the sole or primary cause of health issues from water-damaged buildings. Thus, testing for the mycotoxins (versus just knowing if mold is present) is of more importance in this line of reasoning. This type of testing will miss many types of molds and will give false positives for Alternaria and other outdoor-associated molds that are abundant in the dust (they float in from outdoors). We don’t suggest starting with this type of test. A general assessment with other types of testing to locate sources of growth is more useful. However, this type of testing may be useful after remediation (removal of the issue) to ensure the space is well cleaned if specific mycotoxins are of concern to the healthcare provider.

If you are having allergy or irritation symptoms or inflammation symptoms that lessen when you are out of the building and worsen in the building - then the source/issue was probably missed.

If you have symptoms that may have been diagnosed as “CIRS”, “mycotoxin”, “biotoxins,” “mold infection”, or other such wording AND the symptoms don’t appreciably lessen when you are away from the building for more than a week, then you may be carrying the contaminants in your body from a past exposure. Whether you are following advice from groups associated with Dr. Ritchie Shoemaker (such as people associated with CIRSx), Dr. Neal Nathan (such as people trained through him and Dr. Jill Crista), or Dr. Andrew Campbell (who treats fungal infections in the body), all three groups say that medical intervention is needed to rid the body of specific types of illnesses from water-damaged buildings. Your building may be currently fine while you still carry the biotoxins or infection in you.

Proper remediation does not require special chemicals (except for de-staining), fogging, or (in most instances) any type of antimicrobial. Good remediation involves detailed cleaning performed in a way that doesn’t spread contaminants to other areas. Sometimes, remediation can be completed by a very handy and non-sensitive occupant.

Although there is no great training or certifications available for the consultants (see discussion above), remediation is a much more focused profession and descent training and certification is available. There are very experienced remediation contractors that do not pay for certification, but most good contractors are certified through a couple of the more prominent organizations.

Chose a remediation contractor the same way you would chose a consultant: talk directly to the person who would be the project manager. Are they patient? Do they understand their work well enough to explain it simply to you? Do they have a good number of positive online reviews? Is there a common theme with the negative reviews? Is it clear that they rely on hard work to clean versus relying on antimicrobials or other chemicals? You can’t just kill the microbes. You have to remove them.