Agents in organic dust: criteria for a causal relationship.

Identification of agents of disease causation in organic dust is complicated by the fact that multiple agents may be involved, and these agents may act in a synergistic or additive fashion and cause a number of conditions resulting from chronic toxic or inflammatory effects. A new systematic approach to evaluating available data for evidence of disease-causing agents in organic dust is proposed. It combines, in a matrix fashion, principles of Koch's postulates, River's postulates, principles of epidemiologic determinants, and weight of evidence theory. By applying these principles in a systematic fashion, the strength of the scientific evidence for a specific agent can objectively be evaluated.