Week of April 29 2024

Week of April 29 2024

Spring into Summer Questions:



1/ Gardening


Q: Since being diagnosed with CIRS, I am unable to garden. Anytime I work in the dirt if makes me sick. Is it normal for CIRS patients to not be able to garden or dig in the dirt?


A: It is unlikely that working in the dirt will make you ill even if you have CIRS. If you are an organic gardener and have lots of compost, that may be the source of the trouble for you. 


2/ Air conditioners, window units


Q: I found mold on the outside window sill and cover of my window air conditioner. Are window air conditioners safe for those with biotoxin illness?


A: Any air conditioning unit can create problems with condensation and possible microbial growth. In my experience, the normal organisms found around condensation areas from air conditioners are Cladosporium and Alternaria. These organisms can create some problems with allergy but are not toxin formers.


To be certain, if there is evidence of microbial growth on the inside of your home related to the extra moisture created by the dehumidifier effect of the air conditioner, I would suggest that you have that looked at with a tape lift sample. This procedure costs approximately $35 in a mycology lab.


3/ Alcohol use


QUESTION: I think I become less tolerant of alcohol when I developed CIRS. Does this happen to other people to?


ANSWER: Changes in alcohol sensitivity is quite variable with the most intolerant being people with ciguatera. As a general rule, use of alcohol does not create an additional burden for affected patients understanding that excessive use of a known chemical toxin is not a great idea.


4/ Indoor Mold versus Outdoor Mold


Q: Are there studies that review the difference in illness acquisition from indoor mold and outdoor mold?


A: Yes, the work done on the SAIIE papers clearly shows that exposure to outdoor mold is not adequate to result in reacquisition of inflammatory response syndrome in people previously sickened by water-damaged buildings.


The prospective study design (called ABB`AB) is one that enables us to assign causation to exposure. To date, no outdoor exposures have shown worsening of inflammatory markers. Particularly sensitive individuals, namely Erik Johnson and Jonathan Wright, have noticed abrupt deterioration of symptoms with certain outdoor exposures. Erik is well known for his discussion of “plumes” of air containing bioaerosols that have sickened him while he was hang gliding. I suggest that you review the chapters from Erik Johnson

In both of my books, Surviving Mold as well as Mold Warriors.


For others without the sensitivity of Erik and Jonathan to date outdoor exposures are not confirmed to sicken people.


5/ Infection from mold


Q: I have been ill for many years. I am wondering if my exposure to moldy hay could be making me ill from an infection. My home is also moldy.


A: To aid in understanding of CIRS/mold illness, the chronic inflammatory response syndrome acquired following exposure to interior environments of water-damaged buildings is not an infection but a multi-symptom illness that affects multiple systems in the body. There is a peer-reviewed published protocol that establishes diagnosis and then treatment. It also helps to understand that allergies caused by common environmental factors such as grasses, hays, molds, are different from CIRS/mold illness.


To confirm CIRS/mold illness, there must be exposure to an environment water intrusion and microbial growth typically found in an indoor building or home. Secondly there must be presence of a multisystem, multisymptom illness followed by performance of differential diagnosis to establish what are the possible sources of making you feel bad for so long.


Testing with an visual contrast sensitivity screening (which can be done on this site) is extremely helpful for checking your symptoms and looking for inflammatory responses from biotoxins that cause CIRS/mold illness. If the common CIRS-related symptoms and VCS deficits are present, then it is reasonable to proceed with diagnosis and obtaining the labs listed in the diagnosis section of this website. At this point working with a Shoemaker Protocol™ practitioner is highly recommended and advantageous for recovery. You can also point your attending physician to the testing and lab order sheet and physician resources on this site.


6/ Mold versus Lyme


Q: I have HLA types that are both mold and post-Lyme susceptible. How do I confirm I do not have Lyme disease? I am taking CSM; my VCS has improved to negative.


A: The distinction between mold and Lyme can be difficult. The CDC suggests making a clinical diagnosis of Lyme disease which in turn suggests to some that presence of a multi-symptom illness is a reasonable parameter to use for diagnosis. Unfortunately, there are no differences between symptoms of Post-Lyme and mold; further, there is no difference between these groups of symptoms and those found in illness acquired following exposure to toxigenic dinoflagellates and cyanobacteria. Symptoms won’t separate mold and Lyme.


Newly created objective studies are our best bet to separate mold and Post-Lyme with genomics and NeuroQuant leading the way. These two new techniques give a distinct fingerprint for both Lyme and mold. If you aren’t familiar with NeuroQuant (NQ), you

can get started by reviewing the PowerPoint talk on NQ that I gave to the group at the EPA-supported Hurricane Sandy conference in March 2013. The NQ on Lyme from the 3/21/14 talk at the Lyme Round Table is also on the site. The NQ paper (doi:

10.1016/j.ntt.2014.06.004) is accepted for publication.


Blood tests focus on the presence of elevated C3a in Lyme but not in mold. A high C3a indicates presence of a bacterial membrane in blood that supports attachment of additional elements of the complement cascade. What this means is that high C3a occurs

very often in Lyme but hardly ever in mold. High C4a can be elevated in both these conditions.


Visual contrast sensitivity screening (VCS) gives indirect evidence about the source of biotoxin illness. If a person has untreated Lyme disease and takes cholestyramine, visual contrast will not improve.


The NeuroQuant Analysis available on this site, is also a useful screening, designed for CIRS patients to specifically analyze the initital NeuroQuant report for mold and lyme points.



7/ Joint pain, arthritis, Lyme and mold related


Q: Since developing CIRS I note that I have had a gradual increase in joint pain. I have been using cholestyramine for 2 months but I am getting worse. My MMP-9 is very high. I might have rheumatoid arthritis.


A: If you have concerns about small joint arthritis a differential diagnosis performed by a physician can help sort out rheumatoid arthritis versus other kinds of inflammatory joint problems. If the problem is simply due to MMP-9, which is extremely common, then the reduction of MMP-9 will improve joint symptoms rapidly. For those patients who have IL 17-associated arthritis, particularly those with Lyme disease, correction of TGF beta-1 will help fix the arthritic problem. Do not forget that rheumatoid arthritis is a symmetric illness; the discomfort of inflammation is not intermittent and the joints involved are not migratory.