Do I have CIRS (Chronic Inflammatory Response Syndrome) from Indoor Mold?

MOLD MYTHS & MOLD ILLNESS DENIAL

Have you ever been told that mold or mildew really isn’t health hazardous unless it’s the notorious black mold? (Big myth). Truth be told, any water/moisture damage can lead to a variety of indoor biotoxins (usually grows within 24 hours of water damage) & can be detrimental to humans when we are living with it in our home.

Another common myth (even within the conventional healthcare system) is you only get sick from mold if you are allergic to mold. Yes, if you have a IgE Mold allergy, mold will trigger a problem, but mycotoxin hell doesn’t stop there.

MOLD ALLERGIES AREN’T THE ONLY MOLD HEALTH ISSUES

Mold doesn’t just contribute to allergenic responses, but can also be hepatoxic, neurotoxic, iatrogenic, nephrotoxic, carcinogenic etc to humans. Overall, Western medicine does a poor job at recognizing, diagnosing and treating the latter despite a plethora of research – over 1000 studies on mycotoxins and 1700 studies behind CIRS itself.

WHAT IS CIRS?

Mold (or any biotoxin) typically from a water damage building can over time enter the body and this can lead to Chronic Inflammatory Response Syndrome (CIRS). The peer-reviewed, scientifically published literature on this topic is largely thanks to Dr. Ritchie Shoemaker (See the graphic above that he pioneered).  

Dr. Shoemaker’s definition of CIRS is:

“An acute and chronic, systemic inflammatory response syndrome acquired following exposure to the interior environment of a water-damaged building with resident toxigenic organisms including, but not limited to fungi, bacteria, actinomycetes, and mycobacteria as well as inflammagens such as endotoxins, beta glucans, hemolysins, proteinases, mannans, and possibly spirocyclic drimanes; as well as volatile organic compounds.”

Other environmental triggers can lead to CIRS, but we are focusing on Mold induced CIRS here.

CIRS & HLA-DR GENES:

About 25% of the population who is consistently exposed to mold develops CIRS due to challenges of their immune system “removing” the mycotoxins (from mold). Due to having specific HLA-DR genes, their immune system isn’t able to correctly identify the mycotoxins and detox them on their own. The other 75% of people typically do not develop CIRS when exposed to biotoxins as their genetic make up leads to more effective release of mycotoxins; some symptoms may occur but “full on” CIRS is not likely.

CIRS IS A MAJOR, UNDERDIAGNOSED HEALTH PROBLEM

Even the EPA estimates up to 85% of homes have significant mold and other microbes from water damage. Given this stat coupled with about 25% of the population having HLA-DR genes, it is unfortunately estimated that tens of millions of humans are living with undiagnosed CIRS; the majority are living with this unknowingly as it often gets mislabeled by allopathic healthcare as another health problem and “downstream symptom whack a mole” occurs.

This is because only the downstream symptoms are addressed (the presenting subset of a much larger health problem) and then an ongoing medication usage is prescribed to suppress symptoms; consequently the root cause is still there in many cases. This is why many people don’t fully heal from their labeled condition if the underlying culprit (mycotoxins from mold) has not been found and fully dealt with.

Common downstream labels and what is typically going on:

Unexplained infertility (reduced sex hormones, increased cytokines, low VEGF)
Asthma (low VEGF, High TGFbeta1)
Chronic fatigue syndrome (low VEGF, increased cytokines, low MSH)
Fibromyalgia (low MSH)
Depression & Anxiety (mold is neurotoxic)
ADD/ADHD (mold is neurotoxic)
Irritable bowel syndrome (low MSH hormone, increased antigliadin antibody, SIBO growing)
Recurring sinus infections (actually MARCoNS growing in nasal passageway in many cases)
Acne (actinos colonized on the skin from water damage,, low stomach acid, sludgey bile, SIBO in gut)

Since CIRS impacts multiple systems in the body through the biotoxin pathway (see the genius graph above from Dr. Ritchie Shoemaker), mycotoxins in the body from mold exposure can cascade to a smorgasbord of symptoms. Here are some of the common symptoms of CIRS. Usually a person has 6 to 8 or more of these symptoms:

• Muscular related: Muscle aches, Joint pain, Headaches
• Energy related: Weakness/Fatigue, Non-restorative sleep
• Eye related: Light sensitivity, Blurred vision, Red eyes
• Respiratory related: Sinus problems, Cough, Shortness of breath, Asthma
• Gastrointestinal related: Diarrhea, Nausea, Abdominal pain, Histamine intolerance
• Neurological related: Confusion, Poor memory, Concentration issues, Depression, Anxiety, Vertigo, Tremors
• Metabolic related: Weight gain, Leptin resistance
• Urinary related: Frequent urination, Excessive thirst
• Other: Static shock, Metallic taste

CIRS DIAGNOSIS:

How is CIRS diagnosed?

1. History of water damage. Usually testing of the home will need to occur to confirm this and I would recommend to start with an ERMI test which is an at home dust you can order. Get Kit #1 if you just want to check mold but it is best to get kit #8 to also check for endotoxins and actinos in your home too which also can grow and can cause CIRS. Want way more info? Get my step by step program by taking the Healing from Mold Online Course.
2. CIRS symptoms. See above. Usually 6 to 8 or more symptoms will be present
3. Positive VCS test – can take this online test for free here. Basically, a positive VCS test means the optic nerve is detecting a biotoxin, such as mold
4. CIRS labwork. Abnormalities will be seen in the following biomarkers and some CIRS labwork can be self ordered here:

• HLA-DR (To confirm a mold susceptible haplotype aka genetic predisposition)
• MMP-9 (This marker is increased with mold exposure & leads to tissue disruption in blood vessel walls causing inflammation)
• VEGF (This marker is decreased with mold illness thus poor blood flow, reduced oxygenation and cell starvation occur)
• C4a (This inflammatory marker elevates within 12 hours of any mold exposure; can drop once out of exposure and CIRS is healed)
• C3a (Elevated C3a may indicate persistent immune system activation due to exposure to biotoxins like mold or Lyme disease organisms. Suggests the immune system is reacting to cell membranes in the presence of microbes, particularly those causing Lyme disease. Can cause hypoperfusion, or reduced blood flow, potentially contributing to fatigue, cognitive impairment, and respiratory problems)
• TGF Beta-1 (Will increase (but sometimes you will see decreased) from mold exposure and leads to various problems including neurological, respiratory and autoimmune)
• MSH (This will decrease and is responsible for helping control inflammation; 95% of CIRS patients have decreased MSH levels from mycotoxin accumulation in the body)
• VIP (This will decrease from mold; it helps manage the inflammatory response:  Depleted levels of VIP are common in mold illness and can subsequently cause diarrhea, shortness of breath)
• MARCoNS testing – see if nasal passageway is colonized which often leads to a low MSH

Other valuable testing (lots of nuance to mycotoxin testing) include:

1. Urine mycotoxin tests: This will measure what mycotoxins are being released in the urine. Often used by providers to see which mycotoxin is present which can help assist with which binder is needed as certain mycotoxins are better bound by certain binders or if someone doesn’t have access to a cash pay CIRS Physician to prescribed them Cholestyramine. Also helps rule in that mold is at least part of the CIRS equation as CIRS can be from Lyme and other endotoxins too.
2. Serum mycotoxin antibody tests: a blood test that shows current exposure to mycotoxins

These biomarkers above are ideal and most are needed to diagnose CIRS and to track progress over time. Note that other testing may be needed to see the sequelae from mold in the body (like candida overgrowth, SIBO in the gut, if gluthathione is low, is CoQ10 low? etc.) and adjunct testing and adjunct treatments will be needed.

WHAT TO DO ABOUT ALL THEE ABOVE?

• Schedule with a mold literate provider. This is nothing to go at alone.
• Schedule with a quality mold inspector if your ERMI test is a 5 or higher, and eventually mold remediation likely needed once the WHERE and WHY the mold grew is figured out.
  • Getting out of/remediating clinically significant levels of mold is the ONLY path to healing and the most foundational step that needs to occur. You can start caring for your body in the mean time as mold inspection and remediation will be a journey overtime but it NEEDs to happen to get better, especially for those with the HLA-DR genes.
• Get my FREE step by step checklist for anyone who suspects of knows they have mold and doesn’t know where to start (it’s overwhelming as hell!)
• Check out my online and on demand Healing from Mold Program which is the start to finish guide you need with protocols, access to self ordering labs, how to interpret, and all the granular details (and doing it all in the right order!) It is a steal for the price.
  
  The silver lining with CIRS is that it is an illness and it can go away. You just have to do the proper steps in the right order. Many previously diagnosed conditions often disappear because toxic indoor mold is the great masquerader.

References:

1. Shoemaker R. Diagnosis of Pfiesteria-human illness syndrome. Maryland Medical Journal 1997; 521-523.
2. Shoemaker R. Treatment of persistent Pfiesteria-human illness syndrome. Maryland Medical Journal 1998; 47: 64-66.
3. Grattan L, Oldach D, Perl T, Lowitt M, Matuszak D, Dickson C, Parrott C, Shoemaker R, Kauffman L, Wasserman M, Hebel R, Charache P, Morris G. Learning and memory difficulties after environmental exposure to waterways containing toxin-producing Pfiesteria or Pfiesteria-like dinoflagellates. The Lancet 1998; 352: 532-539.
4. Shoemaker R, Bullano K. Use of pioglitazone to prevent intensification of persistent symptoms following cholestyramine treatment of patients with Post-Lyme syndrome. 2000; American Diabetes Association Annual Meeting. (conference peer review)
5. Friedman M. 2000 Maryland Family Doctor of the Year, RC Shoemaker MD.
6. Shoemaker R. Endocrine Society 6/2001. Use of rosiglitazone in treatment of hyperinsulinemic obesity in non-diabetics (conference peer review).
7. Shoemaker R, Hudnell K. Possible Estuary-Associated Syndrome: Symptoms, vision, and treatment. Environmental Health Perspectives 2001; 109: 539-545.
8. Shoemaker R. Residential and recreational acquisition of possible estuary-associated syndrome: A new approach to successful diagnosis and treatment. Environmental Health Perspectives 2001; 109: 791-796.
9. Shoemaker R. Linkage disequilibrium in alleles of HLA DR: differential association with susceptibility to chronic illness following exposure to biologically produced neurotoxins. American Society of Microbiology 2003. (conference peer review).
10. Shoemaker R, Hudnell K, House D. Sick Building Syndrome in Water Damaged Buildings: Generalization of the Chronic Biotoxin-Associated Illness Paradigm to Indoor Toxigenic-Fungi Exposure. 9/2003 5th International conference on bioaerosols (conference peer review)
11. Shoemaker R. Use of visual contrast sensitivity and cholestyramine in diagnosis and treatment of indoor air acquired, chronic, neurotoxin-mediated illness. 9/2003 (conference peer review)
12. Shoemaker R, Hudnell K, House D, Domenico P. Association of nasal carriage of methicillin resistant and multiple antibiotic resistant coagulase negative staphylococci species with deficiency of alpha melanocyte stimulating hormone in Chronic Fatigue Syndrome: implication for expanded treatment options. American Society of Microbiology 2003. (conference peer review)
13. Shoemaker R, Hudnell D. A time-series study of sick building syndrome: chronic, biotoxin-associated illness from exposure to water-damaged buildings. Neurotoxicology and Teratology 2004; 1-18.
14. Shoemaker R, Rash J, Simon E. Sick Building syndrome in water damaged buildings: generalization of the chronic biotoxin associated illness paradigm to indoor toxigenic fungi. Bioaerosols, fungi, bacteria, mycotoxins and human health. Dr med Eckardt Johanning MD editor 2006.
15. Shoemaker R, Hudnell, House D, Kempen A, Pakes G. Atovaquone plus cholestyramine in patients coinfected with Babesia microti and Borrelia burgdorferi refractory to other treatment. Advances in Therapy 2006; 23: 1-11.
16. Shoemaker R, Lipsey R. Results of health screening and visual contrast testing. St. Bernard’s Parish, Louisiana. 2006. published on-line
17. Shoemaker R, House D. Sick building syndrome (SBS) and exposure to water-damaged buildings: Time series study, clinical trial and mechanisms. Neurotoxicology and Teratology 2006; 573-588.
18. Shoemaker R, Lawson W. Pfiesteria in Estuarine Waters: The question of health risks. Environmental Health Perspectives 2007; 115: A2-A3.
19. Shoemaker R, Lin K. Inside Indoor Air Quality: Environmental Relative Moldiness Index (ERMI). Filtration News 2007; 32-36.
20. Shoemaker R, Maizel M. Treatment of elevated C4a in patients with CFS using low doses of erythropoietin safely reduces symptoms and lowers C4a: a prospective clinical trial 2007, IACFS (conference peer review).
21. Shoemaker R, Giclas P, Crowder C, House D. Complement split products C3a and C4a are early markers of acute Lyme disease in tick bite patients in the United States. International Archives of Allergy Immunol 2008; 146: 255-261.
22. Shoemaker R, Maizel M. Innate immunity, MR spectroscopy, HLA DR, TGF beta-1, VIP and capillary hypoperfusion define acute and chronic human illness acquired following exposure to water-damaged buildings. 2008. International Healthy Buildings (conference peer review)
23. Shoemaker R, Maizel M. Exposure to interior environments of water-damaged buildings causes a CFS-like illness in pediatric patients: a case/control study. 2009 bulletin of the IACFS
24. Shoemaker R, House D. Characterization of chronic human illness associated with exposure to cyanobacterial harmful algal blooms predominated by Microcystis. 2009 Cyanobacterial harmful algal blooms pg 653.
25. Shoemaker R, Exposure to water damaged buildings causes a readily identifiable chronic inflammatory response syndrome successfully treated by a sequential intervention protocol. Biology of Fungi, International Mycology Congress 2009 (conference peer review)
26. Shoemaker R, House D, Ryan J. Defining the neurotoxin derived illness chronic ciguatera using markers of chronic systemic inflammatory disturbances: A case/control study. Neurotoxicology and Teratology 2010; 633-639.
27. Shoemaker R. ACOEM position statements on mold: ploys and lies. Published on line 2011.
28. Shoemaker R, House D, Ryan J. Vasoactive intestinal polypeptide (VIP) corrects chronic inflammatory response syndrome (CIRS) acquired following exposure to water-damaged buildings. Health 2013; 3: 396-401.
29. Shoemaker R. House D, Ryan J Structural Brain Abnormalities in Patients with Inflamatory Illness acquired Following Exposure to Water Damaged Buildings A Volumetric MRI Study Using Neuroquant. June 17, 2014
30. Ryan J. Wu Q. Shoemaker R. Transcriptomic Signatures in Whole Blood of Patients Who Acquire CIRS Following an Exposure to the Marine Toxin Ciguatoxin. August 8 2015
31. Medically sound investigation and remediation of water-damaged buildings in cases of chronic inflammatory response syndrome.Berndtson K, McMahon S, Ackerley M, Rapaport S, Gupta S, Shoemaker R, January 19, 2016
32. Indoor Environmental Professionals Panel of Surviving Mold CONSENSUS STATEMENT Medically sound investigation and remediation of water-damaged Buildings in cases of CIRS-WDB; Larry Schwartz CIEC, BSME, MBA, Greg Weatherman CMC, Michael Schrantz CIEC, CMI, BPI-BA/EP, Will Spates CIAQP, CIEC, Jeff Charlton, ACIEC, AACIEH, Keith Berndtson MD, Ritchie Shoemaker MD April 12, 2016
33. Reduction in Forebrain Parenchymal and Cortical Grey Matter Swelling across Treatment Groups in Patients with Inflammatory Illness Acquired Following Exposure to Water-Damaged Buildings. McMahon SW, Shoemaker RC, and Ryan, JC April 12, 2016
34. Internal Medicine Review- Intranasal VIP safely restores volume to multiple grey matter nuclei
35. in patients with CIRS- April 2017 Shoemaker, R., Katz, D., Ackerley, M., Rapaport, S., McMahon, S., Berndtson, K., Ryan, J.
36. Shoemaker, RC and Lark, D – 2016, HERTSMI-2 and ERMI: “Correlating Human Health Risk with Mold Specific qPCR in Water-Damaged Buildings” #658 in Proceedings of the 14th International Conference on Indoor Air Quality and Climate, International Society for Indoor Air Quality and Climate, Ghent, Belguim. 
37. 2018 Diagnostic Process for Chronic Inflammatory Response Syndrome (CIRS): A Consensus Statement Report of the Consensus Committee of Surviving Mold
38. Urinary Mycotoxins: A Review of Contaminated Buildings and Food in Search of a Biomarker Separating Sick Patients from Controls; Shoemaker, Ritchie; Lark, David
39. Shoemaker, R. Ryan, J. Medical Research Archives, Volume 4, Issue 7. RNA-Seq on patients with chronic inflammatory response syndrome (CIRS) treated with vasoactive intestinal peptide (VIP) shows a shift in metabolic state and innate immune functions that coincide with healing

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