Frequently Asked Questions
What are Mycotoxins?
Mycotoxins (literally Mold-Poisons) are small molecules produced by organisms of the fungi kingdom, commonly known as molds that are toxic to humans and other animals. Although hundreds have been identified, only a small portion are associated with indoor molds and pose a human health risk.
Why do you test for mycotoxins and not mold?
We generally test the patient for the presence of mycotoxins in their urine. The major health threat of mycotoxins is due to the toxins being released into the environment. Patients can, however, develop actual fungal infections from a mold that is present in the building. This generally occurs in patients with impaired immune systems (e.g., HIV, Cancer, Transplant) and is generally rare in people who are not immunocompromised. Mycotoxins have the potential for both acute and chronic health effects via ingestion, skin contact, and inhalation. These toxins can enter the bloodstream and lymphatic system; they inhibit protein synthesis, damage macrophage systems, inhibit particle clearance of the lung, and increase sensitivity to bacterial endotoxins.
RealTime Labs tests the indoor environment for both fungal spores using the ERMI Test developed by the EPA (Environmental Relative Moldiness Index) and mycotoxins.
RTL can also test for sensitivity to mold as an allergen, in individuals that are particularly sensitive to mold spores.
Why can’t you test for mycotoxins and mold inside my body?
At RTL, we generally test for mycotoxins in urine, sputum, BAL and nasal wash. It is, however, also possible to test tissue samples. Your physician would need to consult with our Medical Team to discuss preparation of the tissue. For mold, we can test sputum, nasal washes, tissue, BAL and urine, in the case of suspected Candida.
Which mycotoxins do we test for?
RTL’s mycotoxin test panel is the most comprehensive test panel available, testing for 15 of the most toxic mycotoxins produced by indoor molds. This includes:
- Ochratoxin A
- Aflatoxin Group (B1, B2, G1, G2)
- Trichothecene Group (Satratoxin G, Satratoxin H, Isosatratoxin F, Roridin A, E, H, L-2, Verrucarin A, Verrucarin J)
- Gliotoxin derivative
Can you test for mycotoxins in my blood instead of my urine?
We have not validated the mycotoxin test in blood components. It is also easier and less invasive to test urine. There are, however, published papers that describe testing in sera using a similar assay.
How do I order the test?
For clinical testing: Through your Health Care Provider who has to sign the test order
For environmental testing: The Environmental Inspector or the homeowner, through a chain of custody documentation.
To put more of control of health care decisions in the hands of the consumer, 25 states + DC now allow the patient to order their own lab tests. If you reside in one of the following states, you may purchase your RealTime Lab Mycotoxin Test online through Direct Access testing (DAT).
How much does the test cost?
Please contact RTL for a price
Do you have a discount if we are testing more than one family member?
Yes, the terms and conditions are as follows:
- All applicable patients must live in the same residence
- All tests must be paid for with one credit card
- The discount structure for families is as follows:
- The first test is full price ($699)
- If a variety of different tests is being ordered, the higher priced test will be the full-priced test
- All other tests are 15% off ($594)
- Insurance claims can be filed for family discounted tests
- The family discount does NOT apply to the already discounted “follow-up” test price.
Does Insurance Cover Testing?
Our experience has been that the private insurance companies will reimburse patients based on what their out-of-network plan will cover after the patient has met their out-of-network deductible.
RTL’s Patient Navigator provides CPT codes for the urine mycotoxin and other tests performed by RTL and further explains that the patient can contact their insurance company, in advance of submitting the specimen, to find out how much their insurance company will reimburse for testing.
Does Medicare cover the cost of testing?
Yes, only if you have a MEDICARE CARD.
Medicare Patients: We are now billing Traditional Medicare ONLY (Note: not Medicare Advantage Plans) for testing and accepting assignment from Medicare. A completed Medicare Advanced Beneficiary Claim form must be sent back with your laboratory specimen in order for RealTime Laboratories, Inc. to accept and complete your lab testing and Medicare Insurance processing. Please contact the Patient Navigation department at RealTime Lab for more information at 855-MYCO-SOS (855-692-6767).
What diagnosis codes will get me the best reimbursement?
Your healthcare provider can only provide diagnosis codes based on their clinical evaluation of your symptoms and other relevant information.
Do you offer a cash discount price for patients without insurance?
What is the turnaround time for results?
10 business days from receipt of sample.
Should I go back to my moldy apartment to “get exposed” again before producing my urine sample? Will this give me better results?
No. Our tests are very sensitive in detecting very low traces of mycotoxins (ppb = ng/ml)
Do I need to fast before producing my specimen?
Are there any medications or supplements that affect the test results?
No. But please inform your Health Care Provider about any medications that you are taking.
I’m menstruating, will this affect the test results?
I’m on a medication (Rifampin, Pyridium, etc) that turns my urine bright orange, will this affect my test results?
Does my specimen need to be first-morning urine?
What if my urine is highly diluted?
It will not affect the test results.
My doctor asked me to take glutathione and use the sauna before producing my urine sample. Will I get better results?
Our observation is that you may have high mycotoxin levels in the urine as the above are detoxifying methods.
I heard that I should have done sauna and taken glutathione before producing my sample, but I didn’t. Would I have gotten better results?
Talk to your Health Care Provider. Our observation is that you may have higher mycotoxin levels in the urine as the above are detoxifying methods.
Is the lab able to send me results directly?
Yes. Per the following, patients have the right to request and receive their lab reports directly from the clinical laboratory:
CLIA Program and HIPAA Privacy Rule; Patients’ Access to Test Reports
A Rule by the Health and Human Services Department and the Centers for Medicare & Medicaid Services on 02/06/2014
Results are sent to the patient in an encrypted e-mail for confidentiality.
Which molds produce these mycotoxins?
- Species Mycotoxin
- Aspergillus flavus Aflatoxin (AT)
- A. ochraceus Ochratoxin A (OTA)
- A. niger OTA
- Penicillium verrucosum OTA
- Stachybotrys chartarum Macrocyclic
- Tricothecenes (MT)
- A. versicolor Sterigmatocystin
- A. fumigatus Gliotoxin
- Chaetomium globosum Chaetoglobosin A, C
- Fusarium sp. Simple Trichothecenes (e.g. T-2 and DON)
Can I get a positive urine mycotoxin test result from eating food?
Aflatoxin and Ochratoxin producing molds can grow on various crops and food items. The government regulates levels for these mycotoxins and crops and suspect food items are routinely tested. There is not enough information on this subject to rule out food as a source of aflatoxin or ochratoxin positive urine, but it is unlikely. Macrocyclic Trichothecenes (the ones detected by RTL) and Gliotoxin are not produced by food contaminating molds and a positive urine test is therefore not caused by eating foods.
What does a positive mycotoxin result mean?
It means that you have detectable levels of mycotoxin in the sample tested.
Is my positive level good or bad?
Positive is not normal and may be a risk factor for a variety of health issues.
My daughter’s test results are completely negative, but the rest of my family is positive for mycotoxins. She is the sickest of all of us, how can her test results be entirely negative?
We see mycotoxins in urine when the body is working to detoxify and remove them (via urine). It is possible to be negative for mycotoxins in urine, but the mycotoxins are still present in the cells in the body where they are causing damage. Talk to your Health Care Provider and discuss the clinical history of exposure.
From my positive results can you tell me if I’m currently being exposed or if it is from a previous exposure?
It is not possible to determine this based on your positive test results alone. Mycotoxins can be stored inside cells and released later, especially during detoxification treatments. We would recommend having your home tested for mycotoxins. If the test is positive, you are still being exposed.
What is the standard treatment for mycotoxins in humans?
There is no generally accepted “standard treatment”. There are many protocols developed by individual doctors who specialize in mold and mycotoxin associated illnesses. These include FIR Sauna, Glutathione, use of sequestering agents such as Cholestyramine or charcoal, antioxidants, probiotics and intra-nasal anti-fungal treatments. It is important to note that avoidance is the most important criteria. Leave the dwelling where you are being exposed until it is inspected by an Environmental Inspector and remediated, if necessary.
Do patients ever completely get rid of mycotoxins in their body and get well?
Yes. We have seen many patients who did follow up testing that are negative for mycotoxins after treatment by their Health Care Provider.
How can my doctor learn to treat me for mycotoxins?
The medical Team at RTL can provide some level of education on the current treatment options that are being used by various practitioners.
How does treatment differ for pediatric patients?
Please refer this question to your Health Care Provider.
How do I know where I’m being exposed to these mycotoxins?
Start by assessing your home. Make a visual inspection yourself. Are there obvious signs of mold growing in the house? Are there obvious signs of dampness that can lead to mold growth? Does the house or certain areas smell “musty”? Do you experience more symptoms when you are in the house such as itchy eyes, nausea, fatigue, headaches, frequent respiratory infections, difficulty concentrating etc?
Do other family members who work in a different environment experience these when they are at home? If the answer to any of these is yes, the house should be tested for mold and mycotoxins using a reputable Environmental Inspector. If the results come back showing high indoor spore counts on the ERMI, and/or positive environmental mycotoxin testing, it is likely this is where you are being exposed.
Some conditions that have been found to be associated with chronic exposure to mycotoxins include:
- Kidney toxicity
- Immune suppression
How do I get my home tested?
RTL offers environmental testing for molds and mycotoxins. This can be done by an Environmental Inspector or directly by the homeowner by obtaining kits from RealTime Labs. The mold testing is called ERMI (Environmental Relative Moldiness Index), and determines the type and number of mold spores in a sample taken from the building. The mycotoxin testing is done using this same sample, and the test is virtually identical to that used to test clinical samples.
I need to prove to my landlord (or employer) that the mold in my apartment (office) is causing my illness. How can I link my positive urine mycotoxin test to my apartment (office)?
Submit 3 samples from different locations in the house and perform both mold (ERMI) and Mycotoxin testing. Ideally, the tests show the presence of the same mycotoxins as detected in your urine, and the presence of spores from organisms that produce those mycotoxins. The presence in the environment of the same mycotoxins is most critical. For many reasons (e.g., see question below on Stachybotrys), sometimes the mycotoxin producing fungal spores are not detected.
How do I get my things tested (clothes, car, couch, carpet, bed)?
Send 3× 3 inches of the unwashed material or sample swabs to RTL.
If there are mold/mycotoxins in my home, how do I get rid of them?
An Environmental inspector can help you clean up the mold in the house. Talk to them.
I’m positive for Trichothecenes but the mold testing done in my home is not positive for Stachybotrys. Is this normal?
This is not unusual. We see many cases where we do not detect Stachybotrys spores in the environmental sampling, but do detect Macrocyclic Trichothecenes, produced by Stachybotrys. Stachybotrys spores are large and heavy and generally are wet, since Stachybotrys requires high levels of moisture. This makes it more difficult for the spores to be disseminated throughout the house like smaller Penicillium or Aspergillus spores. However, the presence of the trichothecenes is key.
The air testing results in my home are not that bad. What is an acceptable amount of mold to have in a normal home?
Virtually any house will have spores from many different fungi. These generally come into the house from the outdoors, but may also be on building materials, furniture, carpet etc. This is not usually a problem unless the house becomes wet and the spores germinate and begin to colonize damp areas, where some fungi grow and can produce toxic mycotoxins.
The ERMI test will indicate how your house compares to approximately 1200 houses that were tested when the EPA developed this indicator. The “acceptable level” also depends on the inhabitants and their health. Are they highly allergic to fungal spores? Are they immunocompromised, and therefore more susceptible to infection from opportunistic pathogens like Aspergillus fumigatus?
Is there an acceptable level of mycotoxins for an attic or below home crawl space that is acceptable versus my living space?
Anything positive for mycotoxins, at any location in the house, is not normal and could represent a major health risk.
What personal things can I take with me when I move into a new home?
Cross contamination is something to seriously consider when moving items from a mold/mycotoxin contaminated home into a new, non-contaminated environment. If you or your family members tested positive on the urine mycotoxin test, your environment samples tested positive for mycotoxins, and your ERMI results come back showing a high indoor mold spore count, there is potential for items inside this environment to be contaminated with mold and/or mycotoxins. We recommend you consult with your environmental inspector and specifically ask which items will be safe to move into your new, non-contaminated environment.
How do I find a home/apartment that is safe and doesn’t have mold/mycotoxins?
Use environmental inspectors in your area.
What is the best test to test my sinuses for mold?
Molecular Fungal DNA panel by RTL
Do I have mold in my lungs producing mycotoxins?
Talk to your healthcare provider.
Do I have mold in my intestines producing mycotoxins?
Talk to your healthcare provider.
I just had my follow up urine mycotoxin test. On my original test my Trichothecene level was 0.21 ppb and the other mycotoxins were negative. Now my Trichothecene level is 1.0 ppb and my Ochratoxin level is 5 ppb. Why?
This could be due to changes in your lifestyle, or the treatment given by the healthcare provider is working, and you are detoxifying the mycotoxins, and excreting them from your body. Talk to your healthcare provider.
I have been in treatment for 3 years and I feel great! I just did a follow-up test, and my Ochratoxin level is 15 ppb! It was completely negative 6 months ago. What happened?
Are you still under treatment? If yes, it might be working and your body is detoxifying the mycotoxins. Are you still in the same environment? Talk to your healthcare provider.