Beyond the lungs: fungal and mould-related illness as a significant cause of, or contributor to, a range of chronic diseases. A set of testable hypotheses

Background. The respiratory harm from damp and mouldy housing is established. Whether indoor fungi, fungal colonisation and fungal toxins also contribute to chronic illness beyond the lungs has not been properly tested. Clinical practice rarely asks about the home, validated tests are limited, and housing conditions are not recorded in health data. Hypotheses. The central hypothesis is that, beyond its proven role in respiratory illness, fungal and mould-related illness is a significant cause of, or contributor to, a range of chronic diseases. Here this means fungal colonisation or infection, and exposure to mould and its products (spores, fragments, mycotoxins and volatile compounds). The diseases in scope include fatigue (ME/CFS), dysautonomia, mast cell activation, autoimmunity (including thyroiditis), osteoporosis, joint disease and neurological disease (multiple sclerosis, Alzheimer’s and Parkinson’s), cardiovascular disease, some cancers and recurrent bladder infection. A corollary is that some conditions treated as irreversible may be partly reversible if the fungal root cause is treated. Nine cross-cutting and thirteen condition-specific hypotheses follow from this premise. Method. Each hypothesis is written as a testable question, graded (accepted, emerging, hypothesis or gap), and paired with the evidence for and against it and a study to test it. Implications. If even part of the central hypothesis holds, a share of chronic illness currently labelled unexplained would be preventable by remediating homes and treatable by removing exposure and treating colonisation with an antifungal matched to the organism. Several proposed studies are small, inexpensive and could begin with tests already available in UK general practice.