Mycotoxins are metabolites produced by some forms of fungi and mold and are common in our environment at low levels. Health problems can arise when someone is exposed to inordinately high levels of mycotoxins or has physiologic difficulty clearing mycotoxins from their body.

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Mycotoxin-related illness is often overlooked and very difficult to diagnose. Although the list of possible symptoms associated with mycotoxin illness is both broad and long, there are scientific studies linking mycotoxin exposure to the following diseases:

• Peripheral neuropathy
• Chronic fatigue
• Chronic sinusitis
• Asthma
• Sarcoidosis  
• Neurobehavioral dysfunction, such as difficulties with short-term memory, concentration, and executive function

Mycotoxin Facts

When narrowing down the need for mycotoxin testing, it is important to understand every patient’s home and work environment. Here are some statistics to keep in mind:

• Molds are very common in buildings and homes
• Mold will grow in places with a lot of moisture, such as around leaks in roofs, windows, or pipes or where there has been flooding
• People with allergies may be more sensitive to molds
• People with immune suppression or underlying lung disease are more susceptible to fungal infections and increased risk for infection from molds
  

How Do Practitioners Screen for Mycotoxins?

Low levels of mycotoxins are often found in the urine of healthy adults; therefore, urine is the most popular method of testing, although nasal secretions, sputum, or tissue biopsies can be used.

Urine mycotoxin testing is the best way to assess recent exposure to mycotoxins or how someone is clearing toxins from an internal reservoir of infection.

Things to Keep in Mind Prior to Testing

• Each lab uses its own values for what is considered a “normal” reference range for mycotoxins, so it’s essential to follow each lab’s standard ranges.
• Most labs recommend against using any sort of provoking agents before urinary mycotoxin testing (such as charcoal or glutathione) as they may raise the urinary levels of mycotoxins.

The Most Popular Mycotoxin Tests

Here are the most ordered mycotoxin tests:

MycoTOX

Mosaic Diagnostics (formerly Great Plains) offers the MycoTOX test, which uses a tried-and-true method for detecting mycotoxins known as advanced mass spectrometry combined with liquid chromatography (LC-MS). Numerous studies are validating LC-MS in the detection of mycotoxins.

Mosaic Diagnostics is unique in that it uses a method for creatinine correction on each individual sample. One key vulnerability in any urine test is the potential for dilution or concentration based on how much water someone has had to drink. Mosaic Diagnostics eliminates the variability associated with adjusting the sample in accordance with an individual’s urinary creatinine level. It can detect mycotoxin levels down to the parts per trillion (ppt).

Total Mycotoxin Panel

RealTime Laboratories offers a Total Mycotoxin Panel, which uses a unique method for mycotoxin detection. They created an ELISA immunoassay that detects the presence of mycotoxins in urine using antibodies directed to specific toxins. A validation study of this specific technique was published in the International Journal of Molecular Sciences in 2009. Real-Time Labs was recently granted a US patent for one of its mycotoxin tests.

It can detect mycotoxins down to 0.2 ppb for trichothecenes, 1.0 ppb for aflatoxins, and 2.0 ppb for ochratoxins.

Are These Tests Accredited?

Mosaic Diagnostics, and Real-Time - are CLIA-certified laboratories. CLIA stands for Clinical Laboratory Improvement Amendments and is the result of a 1988 congressional amendment that created quality and reliability standards for laboratories. CLIA certifications verify that the lab has met the quality and analytic standards necessary to ensure accurate and reliable results.

The CLIA standards do not address the clinical utility of a test. FDA approval of a test assures that the test has adequate clinical validation and that it is safe and effective at what it claims to test for. To date, there are no FDA-certified urinary mycotoxin tests.  

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Summary

Mycotoxin-related illness can range from fatigue to long-lasting and severe neurologic deficits. As we experience more extreme weather with increased severity of flooding and storms, we can expect a subsequent increase in mycotoxin-related disease.

Clinical history and professional experience play a huge role in the diagnosis and management of mycotoxin-related illnesses. Keep in mind that there remains clinical controversy on what reference ranges to use for mycotoxin testing, so it’s essential to follow each lab’s standard ranges.