There is no uniformity in the suggested guidelines for acceptable levels of fungi in indoor ambient air. Thus, health professionals have no way to determine what levels of fungi may pose a threat to human health. The authors reviewed the published literature to identify data reported for noncomplaint structures, that is, structures in which occupants did not have health concerns associated with the quality of the indoor air. For both commercial and residential structures, fungal concentrations detected were often higher than currently suggested guidance values. The average indoor air concentration in 149 noncomplaint commercial buildings was 233 colony forming units (CFU) per cubic meter, whereas outdoor ambient air levels averaged 983 CFU/m(3). Total indoor spore counts ranged from 610 to 1040 spores/m(3) in three commercial buildings. Outdoor total spore counts associated with these buildings ranged from 400 to 80,000 spores/m(3). The average indoor concentration reported for 820 noncomplaint residential structures was 1252 CFU/m(3) with an average outdoor level of 1524 CFU/m(3). Total spore counts detected indoors at 85 residential structures ranged from 68 to 2307 spores/m(3). Outdoor spore levels associated with these structures ranged from 400 to 80,000 spores/m(3). A large proportion of both commercial and residential noncomplaint structures have indoor ambient air fungal concentrations above 500 CFU/m(3), a level often advocated as requiring remediation in structures when occupants complain of nonspecific adverse health symptoms.

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The multiple chemical sensitivity (MCS) phenomenon can cause signi cant dysfunction and symptomatology and presents a difcult challenge for patient management. Central to the MCS debate is whether this phenomenon results from a primary emotional response to perceived chemical exposures or from pathological interactions between chemicals and biological systems. Those who believe the latter argue that toxic interactions result in physiological impairment and that subsequent emotional problems derive from such impairment. Distinguishing between psychogenic (emotional) or a toxicodynamic (chemical toxicity) origin is essential to the medical management of an MCS patient. A psychogenic basis requires treatment with appropriate behavioral therapies; in contrast, a belief in a strictly toxicodynamic etiology argues for avoidance and often precludes treatments that address the psychological responses. Current scienti c evidence strongly suggests that behavioral or psychogenic explanations predominate for reported MCS symptoms. Acceptance of a purely toxic origination (i.e., pathological abnormalities result from a low level chemical exposure) de es known toxicological and medical principles; whereas psychogenic explanations are consistent with these principles. Because symptoms are the end points of many diseases with many causes, both physical and emotional, modern medicine is charged with and expected to consider both when treating MCS patients. The argument can be made that insuf cient information exists about the causal nature of many diseases, and future research may provide support for a strict toxicodynamic cause. However, the practice of medicine must be based upon current knowledge, not future possibilities. Proper care of MCS patients requires identifying the existence of both psychological and organic pathological dysfunction. The rejection of a psychological aspect of the MCS phenomenon and appropriate behavioral treatments is both illogical and detrimental to MCS sufferers.

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