Mold Illness and Bio-toxin Illness

What is CIRS:

The 2009 “WHO guidelines for indoor air quality: dampness and mould” states that based on studies done in the United States, the prevalence of dampness or mold in houses to be approximately 50%. In the United Kingdom, 52% of owner occupied homes had dampness and 24% had mold, while 58% of lower income or rented homes were damp and 56% were moldy. Water damage or humidity high enough to initiate or maintain indoor microbial growth is very common.

Chronic Inflammatory Response Syndrome acquired following exposure to Water Damaged Buildings [CIRS-WDB] is a multi-system, multi-symptom illness mediated by a persistent innate immune inflammatory response to toxins, antigens, and inflammagens present in the interior environment of WDBs. These contaminants include but are not limited to fungi, bacteria, actinomycetes, mycobacteria and their toxins; as well as inflammagens from fragments of fungal structures. [beta glucans, mannans, hemolysins, proteinases, spirocyclic drimanes and microbial volatile organic compounds (VOCs)].

Many patients acquire CIRS following exposure to a WDB after water intrusion followed by presence of either:

1) visible microbial growth;

2) speciation of molds as demonstrated by ERMI or HERTSMI [QPCR DNA] testing; or

3) musty smells.

Other biological sources of biotoxins and neurotoxins that are recognized as causes of CIRS include tick borne illnesses including Lyme disease, dinoflagellates like Pfiesteria, blue green algae like Cylindrospermopsis and Microcystis and also Ciguatera.


The inflammatory domino cascade:

The innate and adaptive immune systems normally function together to remove biotoxins from the body: immune pattern recognition by the innate immune system lead to antibody formation through a complex multi-step process. Antibodies bind to offending substances, leading to their clearance from the body. Clearance of offending biotoxins lead to cessation of innate immune system driven inflammation and not getting sick from biotoxins, like mold particulates and mycotoxins.


Genetically susceptible people have a problem with the production of protective antibodies. Offending material left in the body will be detected by the innate immune system in a continuous manner, resulting in a chronic inflammatory response. This ongoing inflammation leads to recruitment of additional immune inflammatory pathways. The same is true for when there is ongoing exposure.

Hypothalamic regulation is significantly affected: cytokines damage leptin receptors which leads to reduced MSH, VIP and ADH production. Hypothalamic dysregulation is linked to many of the problematic symptoms in numerous body system.

Symptoms of CIRS:

Differential inflammatory responses dependent on individual genetic susceptibility drives the symptomatic presentation of CIRS. Dr. Shoemaker’s research revealed that CIRS patients can have 13 different clusters of symptoms. Dr. Shoemaker recommends that if a patient has symptoms present in 6 or more of the symptom clusters, biotoxin illness is possible and further testing and evaluation must be done. Symptoms in 8 or more clusters is consistent with biotoxin illness.

The summary diagram below, by Dr. Yvonne Berry MD, represents the 13 symptom clusters identified by Dr Shoemaker through his research.


CIRS Case Criteria:

1. Symptoms consistent with biotoxin illness. 6 of the symptom clusters listed above is grounds for a thorough diagnostic workup and 8 symptom clusters is consistent with biotoxin illness;

2. History consistent with biotoxin exposure to WDB’s, toxicogenic blue green algae, tick bites or consumption of reef fish;

3. Visual Contrast Sensitivity (VCS) testing to assess and document capillary hypoperfusion from neurotoxins;

4. Genetic predisposition as determined through HLA haplotype;

5. Presence of genomically active MARCoNS in the nasal cavity;

6. An abnormal rise in pulmonary arterial systolic hypertension during exercise;

7. Biomarkers consistent with CIRS: neuro-regulatory, neuro-endocrine, neuro-immune, inflammatory, vascular and endocrine abnormalities.

When case criteria are met, proceed with the Shoemaker protocol. Sequential treatment steps [see treatment steps pyramid below] must be followed step by step without any changes in sequence or skipping steps. Dr. Shoemaker recommends repeating a VCS test and checking innate immunity labs after each successive step of the protocol. (repeat abnormals of the following biomarkers: MMP9, C4a, TGF-B1 and CD4+CD25++T-reg levels).