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Epitope Health teaches what published research and FDA labels say, and how strong that evidence is. It cannot know your situation, and nothing here is a diagnosis, a dose for one person, or a decision about whether a food, medicine or procedure suits one person. Those decisions belong with a licensed clinician who can examine you.

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Home / Allergy and immune care / Environmental allergy
For clinicians

Environmental allergy: pollen, dust mite, pets and mold

What allergic rhinitis is, how it is diagnosed, the treatments guidelines describe, and what the research shows, and does not show, about mold.

4 minute read, written for clinicians5 sources, each checked word for wordLibrary checked October 18, 2026

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This is the clinician view. It keeps every sentence of the plain guide and adds, for each section, the study design and citations of its sources. Every added sentence is cited and checked like the rest. Back to plain language.

In short

  • Allergic rhinitis is caused by IgE reactions to inhaled allergens and is one of the most common chronic conditions in the world.Review1
  • It affects 10% to 40% of people, and it lowers quality of life and school and work performance.E2Good2
  • US guidelines name nasal steroid sprays as the preferred single treatment for persistent allergic rhinitis.E2Good3
  • Damp, moldy homes are consistently linked with asthma and allergy symptoms. But measuring specific molds is not supported as a way to guide health decisions.Review4

How sure each claim is:E1StrongE2GoodOfficial textReviewWhat the grades meanUnderlined words open a definition

What is allergic rhinitis?

Allergic rhinitis, often called hay fever, is caused by IgE reactions to allergens that are breathed in. It often comes with asthma and allergic conjunctivitis (itchy, watery eyes).Review1

It affects 10% to 40% of the population and reduces quality of life and school and work performance. It is also a frequent reason for visits to general practice.E2Good2

Cough is a common symptom of both allergic and nonallergic rhinitis.E2Good3

The evidence in this section (3 sources)
SourceDesignGradeCitations (NIH iCite)
1 Bousquet J, Nat Rev Dis Primers, 2020Expert reviewReviewNot tracked
2 Brożek JL, J Allergy Clin Immunol, 2017GuidelineE2GoodNot tracked
3 Dykewicz MS, J Allergy Clin Immunol, 2020Practice parameterE2GoodNot tracked

How is it diagnosed?

Diagnosis rests on the history. Skin tests or blood tests for IgE to specific allergens are added when needed. One example is when symptoms last a long time or are not controlled by medicines.Review1

Food allergy testing is not recommended in the routine evaluation of rhinitis.E2Good3

The evidence in this section (2 sources)
SourceDesignGradeCitations (NIH iCite)
1 Bousquet J, Nat Rev Dis Primers, 2020Expert reviewReviewNot tracked
3 Dykewicz MS, J Allergy Clin Immunol, 2020Practice parameterE2GoodNot tracked

What treatments do guidelines describe?

The most used medicines are antihistamines taken by mouth, in the nose or in the eyes. The others are nasal steroid sprays and a spray that combines a nasal antihistamine with a steroid.Review1

The 2020 US practice parameter names nasal steroid sprays as the preferred single treatment for persistent allergic rhinitis. It says studies support adding a nasal antihistamine spray.E2Good3

It recommends against long-acting steroid injections for allergic rhinitis because of their risks.E2Good3

It describes nasal decongestant sprays as generally for short-term use, to prevent rebound congestion.E2Good3

It found that neither acupuncture nor herbal products have enough study to support their use for allergic rhinitis.E2Good3

Allergen immunotherapy, prescribed by a specialist, is effective in selected people with persistent symptoms.Review1 More in Immunotherapy for allergies.

The evidence in this section (2 sources)
SourceDesignGradeCitations (NIH iCite)
1 Bousquet J, Nat Rev Dis Primers, 2020Expert reviewReviewNot tracked
3 Dykewicz MS, J Allergy Clin Immunol, 2020Practice parameterE2GoodNot tracked

What does the research say about mold?

An allergy society position paper explains that mold can cause disease through several well-defined mechanisms. It also notes that many newer mold-related illnesses have been proposed that remain largely or completely unproven.Review5

The established roles of mold in disease that it reviews are asthma, allergic rhinitis, allergic bronchopulmonary aspergillosis, sinusitis and hypersensitivity pneumonitis.Review5

A large review found indoor dampness or mold consistently linked with developing and worsening asthma. It found the same link with wheeze, cough, respiratory infections, bronchitis, allergic rhinitis, eczema and upper airway symptoms.Review4

The evidence strongly suggested that dampness and mold cause asthma flares in children.Review4

The review concluded that preventing and fixing indoor dampness and mold is likely to reduce health risks. But it concluded that current evidence does not support measuring specific indoor microbes to guide health decisions.Review4

The evidence in this section (2 sources)
SourceDesignGradeCitations (NIH iCite)
5 Bush RK, J Allergy Clin Immunol, 2006Expert reviewReviewNot tracked
4 Mendell MJ, Environ Health Perspect, 2011Expert reviewReviewNot tracked

What is not known yet

For most links between mold and health, the review could show association, not cause. Asthma flares in children were the exception, where evidence strongly suggested cause.Review4

Many proposed mold-related illnesses remain unproven.Review5

Questions you might bring to your clinician

  1. Which allergens do my symptoms and tests point to: pollen, dust mite, pets or mold?
  2. Is this allergic rhinitis, nonallergic rhinitis, or both?
  3. Which of the treatments in the guidelines fits this situation, and for how long?
  4. Could allergen immunotherapy be an option, and what would it involve?
  5. If there is dampness or mold at home, what does the evidence say is worth doing?

Every claim in this guide was written from its sources and checked against them word for word. Its clinical review by Dr. Recio, whose specialty is anesthesia, is pending; an allergist has not yet reviewed it. This line changes when each review is done.

Sources

Each source opens on PubMed, DailyMed or the publisher's page. Under each one are the exact words from it that this page relies on, copied word for word and checked against the original.

  1. Allergic rhinitis. Bousquet J, Nat Rev Dis Primers, 2020. Review Expert reviewPMID 33273461
    The words this page rests on
    Allergic rhinitis (AR) is caused by immunoglobulin E (IgE)-mediated reactions to inhaled allergens and is one of the most common chronic conditions globally.
    AR often co-occurs with asthma and conjunctivitis and is a global health problem causing major burden and disability worldwide.
    The diagnosis is based on the clinical history and, if needed in patients with uncontrolled rhinitis despite medications or with long-lasting symptoms, on skin tests or the presence of serum-specific IgE antibodies to allergens.
    The most frequently used pharmacological treatments include oral, intranasal or ocular H1-antihistamines, intranasal corticosteroids or a fixed combination of intranasal H1-antihistamines and corticosteroids.
    Allergen immunotherapy prescribed by a specialist using high-quality extracts in stratified patients is effective in patients with persistent symptoms.
  2. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. Brożek JL, J Allergy Clin Immunol, 2017. E2Good GuidelinePMID 28602936
    The words this page rests on
    Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school and work performance and is a frequent reason for office visits in general practice.
  3. Rhinitis 2020: A practice parameter update. Dykewicz MS, J Allergy Clin Immunol, 2020. E2Good Practice parameterPMID 32707227
    The words this page rests on
    Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR.
    Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis.
    Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks.
    While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks.
    Neither acupuncture nor herbal products have adequate studies to support their use for AR.
  4. Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence. Mendell MJ, Environ Health Perspect, 2011. Review Expert reviewPMID 21269928
    The words this page rests on
    Evidence from epidemiologic studies and meta-analyses showed indoor dampness or mold to be associated consistently with increased asthma development and exacerbation, current and ever diagnosis of asthma, dyspnea, wheeze, cough, respiratory infections, bronchitis, allergic rhinitis, eczema, and upper respiratory tract symptoms.
    Thus, prevention and remediation of indoor dampness and mold are likely to reduce health risks, but current evidence does not support measuring specific indoor microbiologic factors to guide health-protective actions.
    Evidence strongly suggested causation of asthma exacerbation in children.
  5. The medical effects of mold exposure. Bush RK, J Allergy Clin Immunol, 2006. Review Expert reviewPMID 16514772
    The words this page rests on
    Exposure to molds can cause human disease through several well-defined mechanisms. In addition, many new mold-related illnesses have been hypothesized in recent years that remain largely or completely unproved.
    The purpose of this position paper is to provide a state-of-the-art review of the role that molds are known to play in human disease, including asthma, allergic rhinitis, allergic bronchopulmonary aspergillosis, sinusitis, and hypersensitivity pneumonitis.