Mold exposure remains one of the most underrecognized environmental drivers of chronic illness, particularly when symptoms present gradually or mimic more common conditions like asthma or seasonal allergies. For Black patients, the risk is compounded by disproportionate exposure to substandard housing conditions, where moisture damage, poor ventilation, and delayed repairs can allow mold to persist unnoticed.
Clinicians are often the first point of contact when symptoms escalate, yet mold is rarely prioritized in diagnostic conversations. According to allergist and pediatrician Michael A. LeNoir, MD, and patient advocate Marika Murray, founder of Undiagnosed Society, closing this gap requires providers to look beyond standard treatment and actively consider environmental contributors to health. Their insights highlight how clinicians can better identify hidden mold exposure, guide patient awareness, and support long-term recovery.
The symptoms of mold exposure can be subtle and confusing to describe. Dr. LeNoir explains that “many patients are unaware that mold may be the underlying cause of their persistent symptoms, and unfortunately, many clinicians do not prioritize mold in their diagnostic reasoning.” This lack of awareness can delay both diagnosis and intervention. Clinicians can begin to close this gap by encouraging patients to observe and document their environments more carefully. “We can empower patients by encouraging them to proactively document their living conditions through photography and by seeking professional environmental home testing. However, it is vital to educate patients that standard over-the-counter ‘mold plates’ often fail to detect clinically significant species. Precise identification requires professional assessment and a high index of suspicion from the treating physician,” he says.
Murray spent 30 years suffering with unexplained symptoms until she was diagnosed with Chronic Inflammatory Response Syndrome (CIRS), a condition associated with exposure to environmental biotoxins such as mold. Her experience navigating misdiagnosis, medical dismissal, and the financial burden of seeking answers informs her patient advocacy work today.
She says clinicians can help patients identify water damage, pointing out what mold looks like under paint and in various household settings. Asking about musty odors at home is one approach, but clinicians can also teach them how to control humidity, advocate for air filters and scrubbers, and explain the basics of how mold grows. With this key knowledge, many patients can be empowered to partner with their provider to identify and combat mold exposure.
Respiratory symptoms are often the first sign of alarm, but mold-related illness rarely presents in a single, predictable way. Dr. LeNoir notes that beyond “persistent asthma, chronic cough, and sinus issues,” patients may experience persistent fatigue, ‘brain fog,’ joint pain, skin irritations, and insomnia. These symptoms are frequently difficult to measure, which can lead to dismissal or misdiagnosis if clinicians are not attuned to environmental triggers. He emphasizes that these symptoms are difficult to evaluate objectively. “Because these symptoms can be non-specific, the clinician must focus on documenting objective findings and maintaining a detailed patient history to establish a potential correlation with their housing environment,” he advises.
Murray adds that there may be neurological symptoms, such as unexplained rage or trouble thinking and processing information. If people notice they feel better at work if mold is at home, then this contrast between environments can be a critical diagnostic clue.
“Patterns of moisture damage often lead to a cycle of chronic inflammatory responses. If the source of the mold is not removed, medical treatment is limited to symptomatic management — we are essentially treating the effect rather than the cause,” Dr. Lenoir says. “Documentation becomes the clinician’s most powerful tool in these instances, as these cases frequently become a battle between the patient and the property owner. It is also critical to distinguish between a ‘mold allergy’ and other mold-related pathologies; if an allergy evaluation is negative, many clinicians dismiss the case entirely. However, mold can cause significant health issues through toxicity or hypersensitivity pathways even in the absence of a traditional IgE-mediated allergy.”
Murray says that moisture isn’t the only cause for concern. Humidity can encourage mold growth in HVAC systems and ductwork, compromising the whole house. “If the patient isn’t removed from the exposure, they will not get better,” she reiterates. Air purifiers, ventilation, and binders can help, but they are Band-Aids that will not ultimately stop the body’s reaction. She says that many patients struggle because home-based mold exposure also robs them of a safe place to heal.
People who have suffered in silence for decades may not notice how deteriorated their health actually is. This may be even more true when living in polluted or contaminated spaces with other people who also have similar, persistent symptoms.
Dr. Lenoir says clinicians must encourage patients not to ‘normalize’ or ignore persistent coughs or fatigue. “For vulnerable populations — where housing quality may be compromised by socioeconomic or geographic factors — it is essential to reject the idea that chronic symptoms are simply a part of life.” He advises maintaining rigorous documentation of both the physical environment and the progression of symptoms. “Clinicians serving these communities must take a definitive stand; if the evidence suggests the environment is toxic, our clinical documentation must reflect that clearly to provide the patient with the necessary leverage for remediation or relocation.”
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