{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T22:14:23Z","timestamp":1787004863372,"version":"build-2736575974"},"reference-count":757,"publisher":"Georg Thieme Verlag KG","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pneumologie"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title>\n                  <jats:p>Die von der Gesellschaft f\u00fcr Hygiene, Umweltmedizin und Pr\u00e4ventivmedizin (GHUP) federf\u00fchrend aktualisierte Leitlinie \u201eMedizinisch klinische Diagnostik bei Schimmelpilzexposition in Innenr\u00e4umen \u2013 Update 2023\u201c ist Gegenstand des vorliegenden Beitrags. Schimmelwachstum im Innenraum ist als ein potenzielles Gesundheitsrisiko zu betrachten, auch ohne dass ein quantitativer und\/oder kausaler Zusammenhang zwischen dem Vorkommen einzelner Arten und Gesundheitsbeschwerden gesichert werden kann. Es liegt keine Evidenz f\u00fcr einen kausalen Zusammenhang zwischen Feuchte-\/Schimmelsch\u00e4den und Krankheiten des Menschen vor. Wesentliche Gr\u00fcnde daf\u00fcr sind das ubiquit\u00e4re Vorkommen von Schimmelpilzen und und bislang unzureichende diagnostische Methoden. Es liegt lediglich ausreichende Evidenz f\u00fcr folgende Assoziationen von Feuchte-\/Schimmelsch\u00e4den und folgenden Erkrankungen vor: allergische Atemwegserkrankungen, allergische Rhinitis, allergische Rhinokonjunktivitis, Allergische bronchopulmonale Aspergillose (ABPA), andere Allergische bronchopulmonale Mykosen (ABPM), Aspergillom, Aspergillus-Bronchitis, Asthma (Manifestation, Progression, Exazerbation), Beg\u00fcnstigung von Atemwegsinfekten, Bronchitis (akut, chronisch), Community-acquired Aspergillus-Pneumonie, Exogen-allergische Alveolitis (EAA), invasive Aspergillosen, Mykosen, Organic Dust Toxic Syndrome (ODTS) [Arbeitsplatzexposition], pulmonale Aspergillose (subakut, chronisch) und Rhinosinusitis (akut, chronisch invasiv oder granulomat\u00f6s, allergisch). Dabei ist das sensibilisierende Potenzial von Schimmelpilzen im Vergleich zu anderen Umweltallergenen deutlich geringer einzusch\u00e4tzen. Aktuelle Studien zeigen europaweit eine vergleichsweise geringe Sensibilisierungspr\u00e4valenz von 3\u201322,5\u200a% gemessen an der Gesamtbev\u00f6lkerung. Eingeschr\u00e4nkte oder vermutete Evidenz f\u00fcr eine Assoziation liegt vor hinsichtlich des atopischen Ekzems (atopische Dermatitis, Neurodermitis, Manifestation), Befindlichkeitsst\u00f6rungen, chronisch obstruktive Lungenerkrankung (COPD), Geruchswirkungen, Mucous Membrane Irritation (MMI) und Sarkoidose. Inad\u00e4quate oder unzureichende Evidenz f\u00fcr eine Assoziation liegt vor f\u00fcr akute idiopathische pulmonale H\u00e4morrhagie bei Kindern, Arthritis, Autoimmunerkrankungen, chronisches M\u00fcdigkeitssyndrom (CFS), Endokrinopathien, gastrointestinale Effekte, Krebs, luftgetragen \u00fcbertragene Mykotoxikose, Multiple chemische Sensitivit\u00e4t (MCS), Multiple Sklerose, neuropsychologische Effekte, neurotoxische Effekte, pl\u00f6tzlicher Kindstod, renale Effekte, Reproduktionsst\u00f6rungen, Rheuma, Schilddr\u00fcsenerkrankungen, Sick-Building-Syndrom (SBS), Teratogenit\u00e4t und Urtikaria. Das Infektionsrisiko durch die in Innenr\u00e4umen regelm\u00e4\u00dfig vorkommenden Schimmelpilzarten ist f\u00fcr gesunde Personen gering, die meisten Arten sind in die Risikogruppe 1 und wenige in 2 (Aspergillus fumigatus, Aspergillus flavus) der Biostoffverordnung eingestuft. Nur Schimmelpilze, die potenziell in der Lage sind, Toxine zu bilden, kommen als Ausl\u00f6ser einer Intoxikation in Betracht. Ob im Einzelfall eine Toxinbildung im Innenraum stattfindet, entscheiden die Umgebungs- und Wachstumsbedingungen und hier vor allem das Substrat. Von Geruchswirkungen und\/oder Befindlichkeitsst\u00f6rungen kann bei Feuchte-\/Schimmelsch\u00e4den im Innenraum grunds\u00e4tzlich jeder betroffen sein. Hierbei handelt es sich nicht um eine akute Gesundheitsgef\u00e4hrdung. Pr\u00e4disponierende Faktoren f\u00fcr Geruchswirkungen k\u00f6nnen genetische und hormonelle Einfl\u00fcsse, Pr\u00e4gung, Kontext und Adaptationseffekte sein. Pr\u00e4disponierende Faktoren f\u00fcr Befindlichkeitsst\u00f6rungen k\u00f6nnen Umweltbesorgnisse, -\u00e4ngste, -konditionierungen und -attributionen sowie eine Vielzahl von Erkrankungen sein. Besonders zu sch\u00fctzende Risikogruppen bez\u00fcglich eines Infektionsrisikos sind Personen unter Immunsuppression nach der Einteilung der Kommission f\u00fcr Krankenhaushygiene und Infektionspr\u00e4vention (KRINKO) beim Robert Koch-Institut (RKI), Personen mit schwer verlaufender Influenza, Personen mit schwer verlaufender COVID-19 und Personen mit Mukoviszidose (zystischer Fibrose), bez\u00fcglich eines allergischen Risikos Personen mit Mukoviszidose (zystischer Fibrose) und Personen mit Asthma bronchiale. Die rationale Diagnostik beinhaltet die Anamnese, eine k\u00f6rperliche Untersuchung, eine konventionelle Allergiediagnostik einschlie\u00dflich gegebenenfalls Provokationstests. Zum Vorgehen bei Schimmelpilzinfektionen wird auf die entsprechenden Leitlinien verwiesen. Hinsichtlich der Mykotoxine existieren zurzeit keine brauchbaren und validierten Testverfahren, die in der klinischen Diagnostik eingesetzt werden k\u00f6nnten. Pr\u00e4ventivmedizinisch ist wichtig, dass Schimmelpilzbefall in relevantem Ausma\u00df aus Vorsorgegr\u00fcnden nicht toleriert werden darf. Zur Beurteilung des Schadensausma\u00dfes und zum Vorgehen wird auf den \u201eSchimmelpilzleitfaden\u201c des Umweltbundesamtes verwiesen.<\/jats:p>","DOI":"10.1055\/a-2194-6914","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T17:06:13Z","timestamp":1708535173000},"page":"693-784","source":"Crossref","is-referenced-by-count":10,"title":["Medizinisch klinische Diagnostik bei Schimmelpilzexposition in Innenr\u00e4umen \u2013 Update 2023 (AWMF-Register-Nr. 161\/001)"],"prefix":"10.1055","volume":"78","author":[{"given":"Julia","family":"Hurra\u00df","sequence":"additional","affiliation":[{"name":"Sachgebiet Hygiene in Gesundheitseinrichtungen, Abteilung Infektions- und Umwelthygiene, Gesundheitsamt der Stadt K\u00f6ln"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birger","family":"Heinzow","sequence":"additional","affiliation":[{"name":"Ehemals: Landesamt f\u00fcr soziale Dienste (LAsD) Schleswig-Holstein, Kiel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Walser-Reichenbach","sequence":"additional","affiliation":[{"name":"Bayerisches Landesamt f\u00fcr Gesundheit und Lebensmittelsicherheit M\u00fcnchen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ute","family":"Aurbach","sequence":"additional","affiliation":[{"name":"Labor Dr. Wisplinghoff"},{"name":"ZfMK \u2013 Zentrum f\u00fcr Umwelt, Hygiene und Mykologie, K\u00f6ln"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Becker","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinik f\u00fcr Hals-, Nasen- und Ohrenheilkunde, Universit\u00e4tsklinikum T\u00fcbingen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romuald","family":"Bellmann","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinik f\u00fcr Innere Medizin I, Medizinische Universit\u00e4t Innsbruck"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Christian","family":"Bergmann","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Allergieforschung, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver A.","family":"Cornely","sequence":"additional","affiliation":[{"name":"Translational Research, CECAD Cluster of Excellence, Universit\u00e4t zu K\u00f6ln"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Engelhart","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Hygiene und Public Health, Universit\u00e4tsklinikum Bonn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Fischer","sequence":"additional","affiliation":[{"name":"Landesgesundheitsamt Baden-W\u00fcrttemberg im Regierungspr\u00e4sidium Stuttgart"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Gabrio","sequence":"additional","affiliation":[{"name":"Ehemals: Landesgesundheitsamt Baden-W\u00fcrttemberg im Regierungspr\u00e4sidium Stuttgart"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline E. W.","family":"Herr","sequence":"additional","affiliation":[{"name":"Bayerisches Landesamt f\u00fcr Gesundheit und Lebensmittelsicherheit M\u00fcnchen"},{"name":"Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, apl. 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