Beyond Mold: Understanding Chronic Inflammatory Response Syndrome (CIRS) and Its Hidden Triggers
Too often, I meet patients here in Albany, GA, who have seen multiple doctors and still haven’t found relief from their complex and unexplained symptoms. If you or someone you care about is in this situation, it’s understandable to feel frustrated and overwhelmed.
When many well-intentioned efforts haven’t led to improvement, it’s important to widen the diagnostic lens. That’s when we begin to consider less commonly recognized conditions such as Chronic Inflammatory Response Syndrome (CIRS). Due to its complex presentation, CIRS can easily be overlooked.
Diagnosing CIRS isn’t always straightforward. It requires a careful, stepwise approach that uses a proven roadmap and rules out more common explanations before arriving at this diagnosis. My goal is to help guide you through this process with clarity and compassion.
Expanding Our Understanding of CIRS: More Than Just Mold
CIRS stands for Chronic Inflammatory Response Syndrome. It's a complex, chronic illness that impacts every system in the body, including the brain, hormones, immunity, and the gut. A key takeaway from a recent conference I attended was the recognition that CIRS isn’t limited to mold exposure. Any biotoxin can potentially trigger CIRS. This includes bacteria such as actinomycetes, endotoxins from faulty sewage tanks, Lyme disease, and even lingering effects from infections like COVID-19. Mold is just one piece of the puzzle.
Not everyone exposed to these biotoxins becomes ill, and genetics play a key role. Certain HLA gene types can make someone much more susceptible to developing CIRS, which explains why one family member may struggle with symptoms while others do not. HLA genetic testing can help clarify your own risk or that of loved ones.
Disrupted Gut Health: A Missing Link in CIRS
One of the most important, and often overlooked, aspects of CIRS is its profound effect on the gut. CIRS can deregulate almost every system in the body, and the gut is no exception. Since up to 70% of your immune system resides in the gut, inflammation and immune dysregulation from CIRS can wreak havoc on digestion, nutrient absorption, and healthy gut bacteria balance.
That’s why restoring gut health is a top priority of the Shoemaker Protocol. Cleaning up the gut environment helps reduce inflammation, strengthens the immune response, and supports overall recovery. For this reason, I often use the GI-MAP stool test in all my CIRS patients—to pinpoint hidden infections, imbalances, and inflammation—so I can create the most effective and personalized treatment plan possible.
During the Shoemaker Protocol, healing the gut is a top priority. Cleaning up your gut environment can reduce inflammation, strengthen your immune system’s response, and improve your overall recovery. This is why I often use the GI-MAP stool test to identify hidden infections, imbalances, and inflammation in all my CIRS patients, allowing me to build the most effective, personalized treatment plan possible.
Updated Case Definition of CIRS
A 2013 consensus paper describes CIRS as a chronic, multisystem, multi-symptom syndrome, often involving:
Direct exposure to biotoxins or neurotoxins (now known to include actinomycetes, endotoxins, Lyme, and others—not just mold)
Genetic predisposition, often identified through HLA gene types
Imbalances in both innate and adaptive immunity
Reduced blood flow to various areas of the body (peripheral hypoperfusion)
Disruption in the delicate communication between the brain’s hormone centers and the body’s endocrine (hormone) organs, affecting both immune function and hormones
Home Testing: Taking the First Step
If you’re experiencing ongoing, unexplained symptoms, it’s important to test your environment comprehensively, and not just for mold. The good news is that home test kits for mold, actinomycetes, and endotoxins have become more accessible than ever. These simple, do-it-yourself kits can help identify possible environmental sources that are contributing to ongoing illness.
The SM-AEE Actino®, Endotoxin, ERMI home test kit by EnviroBiomics is a simple, Swiffer-based dust collection kit that gives you a thorough look at your home’s air quality risks. With this one test, you get science-backed screening for:
Actinomycetes (Actino) - These bacteria are the most common found in water-damaged buildings and produce biotoxins similar to mold toxins. The test identifies the 40 main Actino species linked to building-related illness (BRI), based on research in homes with health concerns.
Endotoxins - Toxic substances from the cell walls of Gram-negative bacteria. They can be present in both live and dead bacteria and often come from water-damaged environments or sewage. Endotoxin exposure—by breathing it in or from contaminated food/water—can trigger inflammation and illness.
ERMI (Environmental Relative Moldiness Index) - A DNA-based analysis developed by the EPA to rank a home's level of mold contamination using settled dust. It provides a standardized measure of moldiness and is used to assess indoor air quality and potential health risks. The kit also includes a HERTSMI-2 score, which helps further evaluate mold-related health risk.
If your results are positive or your history strongly suggests environmental risk, I also recommend a professional home inspection to identify sources and create an effective remediation plan. I highly recommend Critterad. I’ve used them myself and have found their certified, accredited lab reports and written correction protocols to be top notch.
What Should You Do if You Suspect CIRS?
If you are experiencing persistent symptoms affecting several systems in your body, and have a history or suspicion of indoor environmental exposure (such as water damage, musty odors, tick bites, or long-term illness), consider the following steps:
Consult with a functional medicine provider familiar with CIRS and complex chronic illnesses. I am one of only three Shoemaker Protocol Proficiency Partner Diplomates in the state of Georgia!
Explore home testing options for mold, actino, and endotoxins.
Consider genetic testing (specifically HLA types) if recommended.
Early intervention can significantly improve outcomes. If you have questions about CIRS, environmental home testing, or home health, please contact me. I’m here to support you on your health journey.