Re-exposure FAQ
10 Total Items
Question Volume 1
How long does it take for C4a and TGF beta to rise after re-exposure to mold? Is it on the order
of minutes or hours?
Answer
For people sickened before and successfully treated, C4a will rise in blood in 4 hours following 15 minutes of exposure to ERMI > 2. It doesn’t take much… TGF beta will usually parallel C4a, but some patients, usually those with higher CD4+CD25++CD127 lo/-, don’t show the swings of TGF beta-1 that I see with C4a. As the “sicker, quicker” phenomenon (auto-activation of MASP2, the enzyme that splits C4) kicks in, some people will show measurable increases in C4a in as short as 60 minutes following 5 minutes of exposure. No kidding. Not common, but real nonetheless.
Question Volume 1
If a mold-susceptible person is being exposed to mold, how soon after stopping CSM will C4a
begin to rise?
Answer
C4a goes up on day 1. Take a look at the two presentations on PP on the site on SAIIE.
Question Volume 1
I bought the PP, but am not clear on specifics of timing.
-Is the last dose of CSM taken the evening before day 1?
-What time are the baseline and follow-up labs draw?
Answer
Yes, the clock for HOC starts after the AC1 labs are drawn. No more CSM for three days, then draw for the HOC; re-enter the affected building for 8 hours on day 1, draw BOC-1 labs in AM of day 2. Re-enter on Day 2, draw BOC-2 on day 3 then re-enter for 8 hours on day 3. Draw BOC-3 on AM of day 4 and re-start CSM.
Question Volume 1
With the SAIIE, what are the criteria for determining when it can be run? Does the VCS or C4a
have to be a certain level first?
Answer
Ideally, VCS and symptoms will equal controls after AC-1 to then go to SAIIE. Life isn’t ideal often so sometimes people will still have some residual symptoms before beginning the prospective trial.
Question Volume 1
Would using serial C4a’s (just the 1 week) be a good tool to nudging someone to run an ERMI or
determining if mold remediation was successful. Many of my patients are reluctant to run an
ERMI if they are Lyme WB+ even though I explain that mold could cause the same symptoms.
Answer
Makes sense as the results would be helpful, though delayed by the 4 weeks NJC takes to report the test. If you use the blood work, then I would suggest using the full SAIIE protocol, with sequential exposures off meds for three days measuring C4a, leptin, MMP9, VEGF, von Willebrand’s each day. TGF beta and CD4+CD25++CD127 lo/- have excellent roles here too.
Question Volume 1
Is a rise in TGF beta after one week of stopping CSM as specific and sensitive as a rise in C4a in
determining mold re-exposure?
Answer
Excellent question. I have not looked at that as an answer. Seems easy enough to do.
Question Volume 1
When looking at serial C4a’s after stopping CSM, how much of a rise in C4a is considered
significant?
Answer
If the C4a goes up over the levels following treatment that will meet criteria of arise. Seeing the levels double or triple isn’t unusual but when we did the SAIIE weighting system no one could agree that doubling was more important than just going up 10%.
Question Volume 1
When running serial C4a to help distinguish mold from Lyme, what is the rationale for waiting
one week after baseline even though C4a will rise within one day of exposure to a WDB?
Answer
You can run C4a as often as you like. I give one week for ease of discussion as some people will only enter a church or a Post Office once a week, for example. The point is that I have never seen C3a negative patients convert to + in less than three weeks. Living Lyme organisms are themselves not necessarily biologically active.
Question Volume 1
Can you help me interpret the following labs? The patient had their work and home remediated
and wanted to check the success through serial C4a and VEGF. Previous C4a’s have been over
20, 000 on 2 occasions.
Works Mon-Fri. Stopped mold binder Wednesday evening.
Thursday morning: C4a 11309 / VEGF 149
Friday afternoon: C4a 2069 / VEGF 129
Tuesday morning: C4a 10277 / VEGF 142
Answer
A rise in the Thursday C4a needs to be compared to a prior baseline. If you choose ill before all Rx, then no, he gets no points for illness. Same for VEGF. I feel that including three days away from potentially affected home (“HOC”) adds a great deal to the evaluation. Seeing the yo-yo in C4a over time begs the question of other sources. The VEGF should rise on day 1 and fall on day 2 and 3. Didn’t obviously do that here.
Question Volume 1
I’ve been told that mold found in an attic is usually not a concern because most of it will vent to
the outside and only a little will go into the house. What is your experience with attic mold?
Answer
There is a great deal of communication of air between attics and lower floors. I would not assume outdoor venting of all bioaerosols in an attic.
