Chronic Inflammatory Response Syndrome (CIRS) affects roughly 25% of people with specific genetic predispositions. These individuals experience a cascading inflammatory response throughout multiple body systems after biotoxin exposure. At Today’s Integrative Health, we regularly see patients whose lives have been severely impacted by this condition, which remains largely unrecognized in conventional medical settings.
Most CIRS patients arrive at our Rockville office after consulting numerous specialists without receiving answers. This multisystem illness develops following exposure to biotoxins from sources like water-damaged buildings or tick bites, creating 13 distinct symptom clusters. A positive CIRS diagnosis typically requires eight or more of these symptoms, including persistent fatigue, joint pain, cognitive difficulties, and breathing problems. Many patients receive misdiagnoses of fibromyalgia or chronic fatigue syndrome due to overlapping symptoms.
The financial impact of CIRS can be substantial, with some patients reporting costs exceeding $200,000 for environmental remediation, medical consultations, and ongoing treatments. Finding qualified care presents another significant challenge—with fewer than 30 properly trained CIRS specialists in Australia, highlighting a serious gap in medical knowledge. This guide examines chronic inflammatory response syndrome, its symptoms, underlying causes, and treatment protocols that can help restore patients’ health and quality of life.
What is Chronic Inflammatory Response Syndrome (CIRS)?
“This paper reviews a recently discovered chronic biotoxin illness that affects as many as one in four people in the United States and elsewhere.” — Dr. Keith Berndtson, MD, Researcher on Chronic Inflammatory Response Syndrome
Chronic Inflammatory Response Syndrome (CIRS) was first identified in 1997 by Dr. Ritchie Shoemaker while studying patients exposed to toxin-forming dinoflagellates. CIRS fundamentally involves dysregulation of the innate immune system after specific biotoxin exposures. Approximately 25% of the population is affected by this condition, making it a significant yet largely unrecognized health concern.
How CIRS affects the immune system
CIRS creates a fundamental immune system malfunction. Most people exposed to biotoxins experience normal immune responses that eventually clear these toxins from their bodies. However, in genetically susceptible individuals (about 22-24% of the population), the immune system cannot properly identify and eliminate these harmful substances.
The patient’s innate immune system—their body’s first line of defense—remains continuously activated while the adaptive immune system cannot “see” the biotoxins to create antibodies against them. This creates a persistent inflammatory cascade where the immune response itself becomes the illness. Ongoing inflammation disrupts important regulatory neuropeptides, particularly MSH (melanocyte-stimulating hormone), and elevates inflammatory markers such as TGF-β1, C4a, and MMP-9.
Why CIRS is considered a syndrome, not a disease
CIRS qualifies as a syndrome rather than a disease because it presents as a collection of symptoms and biological markers across multiple body systems without a single cause or pathology. This distinction matters—the illness stems from the body’s abnormal response rather than direct damage from the toxins themselves.
Dr. Shoemaker’s published case definition requires multiple criteria for CIRS diagnosis: documented exposure, symptoms affecting several body systems, abnormal biomarkers, and response to appropriate treatment. This complex presentation differs significantly from diseases with singular pathologies and defined progression patterns.
The role of biotoxins in triggering CIRS
Biotoxins—toxic substances produced by living organisms—serve as primary triggers for CIRS. These fat-soluble molecules travel from cell to cell without entering the bloodstream, making standard blood tests ineffective for detection.
Primary sources of biotoxin exposure include:
- Water-damaged buildings harboring mold species like Aspergillus, Chaetomium, and Stachybotrys
- Tick-borne infections such as Borrelia (Lyme disease)
- Spider bites containing specific venoms
- Consumption of contaminated reef fish (ciguatera poisoning)
- Contact with water containing harmful algal blooms
These biotoxins don’t simply cause direct poisoning—they initiate a complex inflammatory cascade that, in susceptible individuals, creates widespread dysfunction across multiple biological systems. At Today’s Integrative Health, we see this dysfunction manifest in numerous ways requiring a personalized treatment approach.
Recognizing the Symptoms of CIRS
Identifying CIRS symptoms presents significant challenges for both patients and healthcare providers. At Today’s Integrative Health, patients frequently describe feeling “sick all over” with seemingly unrelated symptoms affecting multiple body systems simultaneously.
Common CIRS disease symptoms across body systems
CIRS typically manifests through symptoms that impact virtually every body system. Our patients most commonly report:
- Cognitive issues: Brain fog, memory problems, difficulty concentrating, and struggling to find words
- Respiratory complications: Breathing difficulties, persistent cough, chronic sinus congestion, and asthma-like reactions
- Musculoskeletal pain: Morning joint stiffness, muscle cramping, and characteristic “ice-pick” pain sensations
- Neurological disturbances: Numbness, tingling sensations, balance problems, tremors, and electric shock-like feelings
- Gastrointestinal problems: Stomach pain, chronic diarrhea, unexplained nausea, and fluctuating appetite
Understanding the 13 symptom clusters
Dr. Shoemaker’s research identified 13 distinct symptom clusters crucial for CIRS diagnosis. Adults showing 8 or more clusters (or children with 6+) should undergo evaluation for CIRS. These clusters include fatigue, cognitive dysfunction, breathing issues, unusual pain patterns, and mood changes among others.
These symptoms stem from innate immune system dysregulation, resulting in decreased levels of regulatory neuropeptides (particularly MSH) and elevated inflammatory markers including TGF-ß1, C4a, and MMP-9.
How symptoms mimic other chronic conditions
CIRS is commonly misdiagnosed because its symptoms overlap with many other conditions. Patients often receive incorrect diagnoses of fibromyalgia, chronic fatigue syndrome, depression, ADHD, or early-onset Alzheimer’s before CIRS is identified.
Standard medical testing typically shows normal results, leading some doctors to suggest symptoms are psychosomatic. This diagnostic confusion often results in years of ineffective treatments and deteriorating health before proper CIRS testing occurs.
Causes and Risk Factors Behind CIRS
“It often develops when someone who is genetically susceptible to the types of molds and bacteria that are prevalent in water-damaged buildings gets exposed to those pathogens.” — Rooted in Rights, Disability rights organization
Water-damaged buildings and specific genetic factors create the perfect storm for CIRS development. Understanding these elements helps explain why certain patients develop this inflammatory condition while others exposed to identical environments remain symptom-free.
Mold exposure and water-damaged buildings
Water-damaged buildings represent the primary culprit in CIRS development, accounting for approximately 80% of all cases. These environments harbor a “biochemical stew” of molds, bacteria, actinomycetes, mycobacteria, and other toxic substances. Studies indicate that nearly 50% of all buildings in the United States have experienced water damage, potentially exposing over 160 million Americans to these harmful environments.
The most problematic mold species include Aspergillus penicilloides, Aspergillus versicolor, Chaetomium globosum, Stachybotrys chartarum, and Wallemia sebi. Importantly, visible mold isn’t always necessary for illness—water damage alone creates conditions for microbial growth within 24-48 hours.
Tick and spider bites
Approximately 20% of CIRS cases originate from tick-borne infections or spider bites. The primary culprits include:
- Tick-transmitted Borrelia burgdorferi (causing Lyme disease)
- Tick-transmitted Babesia microti (causing Babesiosis)
- Venom from brown recluse or Mediterranean recluse spiders
These exposures can trigger inflammatory responses identical to those seen in mold-related CIRS.
Genetic susceptibility and immune response
About 25% of the population carries specific Human Leukocyte Antigen (HLA) gene variants on chromosome 6 that make them vulnerable to developing CIRS. These genetic factors explain why:
- Only certain people develop CIRS despite similar exposures
- Multiple family members can exhibit vastly different responses to the same environment
- Some patients continue experiencing symptoms even after leaving contaminated spaces
Individuals with these genetic markers cannot properly clear biotoxins, leading to persistent immune activation.
Other environmental and biological triggers
Beyond mold and infectious agents, CIRS can also result from exposure to:
- Cyanobacteria and harmful algal blooms in water sources
- Dinoflagellates (producing ciguatera toxin in reef fish)
- Volatile organic compounds (VOCs) from paints, cleaning agents, and solvents
- Inflammagens from bacterial fragments and beta glucans
At Today’s Integrative Health, we find these diverse triggers all contribute to the same fundamental problem: persistent immune dysregulation in genetically susceptible individuals.
How CIRS is Diagnosed and Treated
Identifying Chronic Inflammatory Response Syndrome requires specialized testing and clinical expertise beyond standard medical evaluations. At Today’s Integrative Health, we utilize a structured approach to accurately diagnose and treat this complex condition.
CIRS diagnosis: tests and clinical criteria
Our diagnostic process begins with evaluating symptom clusters – patients with symptoms in eight or more of the 13 clusters have a high probability of CIRS. Dr. Leo and Dr. Rosenberg first conduct a thorough exposure history, followed by comprehensive physical examination to rule out other conditions. Laboratory testing includes HLA genetic testing to identify susceptibility, as 95% of CIRS patients have specific HLA haplotypes. Blood tests must show abnormalities in at least five biomarkers, which typically include:
- MSH (melanocyte stimulating hormone)
- MMP-9 (Matrix Metalloproteinase-9)
- TGF-beta-1 (Transforming Growth Factor)
- ADH/osmolality
- C4a
- VEGF (Vascular Endothelial Growth Factor)
Visual contrast sensitivity and MRI scans
Visual Contrast Sensitivity (VCS) testing serves as a cost-effective screening tool with 92% accuracy. This test measures the ability to detect visual patterns, which becomes impaired in CIRS patients as biotoxins affect blood flow to the optic nerve within 24-36 hours of exposure. NeuroQuant MRI analysis reveals distinctive brain abnormalities in CIRS patients, including atrophy of the caudate nucleus and enlargement of the pallidum.
Shoemaker Protocol and treatment steps
Treatment follows Dr. Shoemaker’s 12-step protocol, the only published approach demonstrating clinical efficacy. Key steps include:
- Removing patients from biotoxin exposure
- Administering binders like cholestyramine to eliminate toxins
- Eradicating MARCoNS (nasal bacteria)
- Eliminating gluten if antibodies are present
- Correcting hormonal imbalances
- Treating remaining inflammatory markers
- Eventually using VIP nasal spray to restore regulation
Challenges in accessing proper care
Patients seeking CIRS treatment face several obstacles, primarily limited access to trained physicians, as most CIRS-knowledgeable doctors practice in major cities. Testing costs present another barrier – several tests must be sent to specialized laboratories in the United States at considerable expense without insurance coverage. Treatment adherence challenges also arise from medication sensitivities common in CIRS patients.
Conclusion
CIRS remains among the most misunderstood conditions in modern medicine. Throughout this guide, we’ve explored how this complex inflammatory response affects multiple body systems, creating symptoms that leave patients searching for answers for years. The combination of genetic susceptibility and environmental triggers creates serious health challenges for approximately 25% of the population who cannot properly clear biotoxins.
Proper diagnosis and treatment are possible despite these difficulties. The Shoemaker Protocol provides a structured, evidence-based approach that has helped many patients recover their health after appropriate testing identifies the underlying inflammatory markers. Patients should prepare for a recovery process that requires patience and persistence.
Finding qualified medical support presents another significant challenge. Though awareness about CIRS is growing, many conventional medical practitioners still lack familiarity with biotoxin illness. Connecting with specialists who understand these complexities becomes essential for successful treatment.
At Today’s Integrative Health our passion is YOUR health, and our mission is to provide you with the guidance, care and education necessary to achieve it. Our unique Pathway to Health system draws on diagnostic testing and powerful natural therapies to create a sustainable, individualized care plan just for you. We are located in Rockville, Maryland and can be contacted by phone at tel:+1-301-770-6650 or by email here!
While living with CIRS can feel overwhelming, recovery is achievable with proper identification of triggers, appropriate medical support, and a comprehensive treatment approach. Understanding this condition represents the first crucial step toward healing and reclaiming your quality of life.
