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Q:

2/6/2020
I recently saw a new patient with a history of CRSsNP s/p sinus surgery with ENT as a referral for from her PCP for persistent nasal congestion and rhinorrhea following surgery despite medical management. We did skin testing that was positive for dust mite and pollens and was negative for molds and offered her AIT but she declined. She was convinced her symptoms were due to chronic mold exposure. She brought outside lab results with her that were referred to as a "Shoemaker Panel" and consisted of levels of TGF-b, VIP, melanocyte stimulating hormone, VEGF, ADH, ACTH, C4a, and MMP.

I had never heard of these labs and tried to look them up. All I could find was information on functional medicine websites but no actual scientific data or studies. Are you aware of any other information regarding these tests?

A:

I am not aware of any value in this panel of various anolytes and have no recommendation on how to interpret. These tests are promoted through various websites with claims that the results are predictive of clinical mold exposure. This site advocates for the alternative, unproven medical practice of diagnosing “mold illness” advocated by Dr. Ritchie Shoemaker, MD. Dr. Shoemaker is a family physician who is US trained at Duke University and practices in Maryland. In addition to practice of medicine, he has published several books and posts information on the web here. He has published in peer reviewed medical journals, primarily related to laboratory tests for immunologic disorders or the neurologic effects of mold exposure (1-5).

In summary, this panel of laboratory tests is advocated as a means to diagnose mold exposure leading to adverse health effects. To my knowledge, this testing is unproven but others disagree.

1.Grattan, Lynn M., et al. "Learning and memory difficulties after environmental exposure to waterways containing toxin-producing Pfiesteria or Pfiesteria-like dinoflagellates." The Lancet 352.9127 (1998): 532-539.
2. Shoemaker, Ritchie C., and Dennis E. House. "Sick building syndrome (SBS) and exposure to water-damaged buildings: time series study, clinical trial and mechanisms." Neurotoxicology and Teratology 28.5 (2006): 573-588.
3. Shoemaker, Ritchie C., and Dennis E. House. "A time-series study of sick building syndrome: chronic, biotoxin-associated illness from exposure to water-damaged buildings." Neurotoxicology and Teratology 27.1 (2005): 29-46.
4. Shoemaker, Ritchie C., and H. Kenneth Hudnell. "Possible estuary-associated syndrome: symptoms, vision, and treatment." Environmental Health Perspectives 109.5 (2001): 539-545.
5. Shoemaker, Ritchie C., Dennis House, and James C. Ryan. "Defining the neurotoxin derived illness chronic ciguatera using markers of chronic systemic inflammatory disturbances: A case/control study." Neurotoxicology and Teratology 32.6 (2010): 633-639.

I hope this information is of help to you.

All my best.
Dennis K. Ledford, MD, FAAAAI

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