Week of February 5, 2024

1/ Absence of HLA susceptibility and illness


QUESTION: Is it possible to become ill and stay ill without one of the HLA haplotypes associated with susceptibility?


ANSWER: We see approximately 95% of cases having one of the six HLA haplotypes that in turn comprise 24% of the normal population. That means 5% of ill people (cases) do not have HLA-driven susceptibility. The good statistical news is that for those 5% their prognosis is much better than those of the other 95% of cases.


Treatment is still necessary for the non-HLA susceptible individuals. Even though they don’t have the HLA we are accustomed to seeing in cases, they will not self-heal. The standard response to the predictable response of “how does HLA alone determine susceptibility” that I have used in the past is that “biology is never 100% and HLA research is in its infancy.” That statement is still correct. In order to perform the research needed to show how defective antigen presentation is occurring, we would need a very large prospective study to be done on a multi-site basis. Don’t forget, once MSH falls to below 35, additional susceptibilities to inflammatory illness develop.


2/ Absence of HLA susceptibility and illness due to MARCoNs


QUESTION: If a non-susceptible individual acquires an CIRS illness, could that condition solely be due to colonization for MARCoNs with its own genomic affects?


ANSWER: This is an interesting question from a reader from Australia. Specifically we are still counting on fingers on one deformed hand the number of people with true MARCoNs without MSH deficiency. If MSH deficiency is the mechanism for MARCoNs colonization (please don’t say infection; it is not an infection) then we can restate your question. Is there a mechanism to get sick solely due to MSH deficiency? That answer is yes. What we don’t see are people ill just from MARCoNs and without low MSH. What this means is that treatment with BEG spray alone will not take care of an inflammatory illness acquired following exposure to an interior environment of water-damaged buildings. Similarly, use of cholestyramine and subsequent protocols will not eradicate the MARCoNs. That treatment is specific for this biofilm-forming commensal. Please note that researchers from Newcastle University in Australia were among the first to note the importance of MARCoNS first in facial pain first and then in Chronic Fatigue Syndrome. As I recall Dr. Timothy Roberts and Dr. Butts were early and prolific researchers in this field. It has been years since I have spoken with that group and hope that they have adopted use of MSH profiling as part of their susceptibility rosters for acquisition of MARCoNS.


3/ Self-treating


QUESTION: Is it possible to self-treat using your protocol?


ANSWER: The Shoemaker Protocol™ employs lab tests and diagnostic procedures that must be ordered by a licensed health care professional. I do not agree that it is safe for individual to take on this task without the ability to share what they want to do and what they should be doing with a trained expert. There are multiple Shoemaker Protocol™ trained and certified physicians and practitioners listed on this website.


4/  ACTH, suppression by use of oral cortisone


QUESTION: I know cortisone can suppress immune system as well as suppress the adrenal output but generally those rebound after cortisone is stopped. How does CIRS change this?


ANSWER: I am uncertain what you mean when you say cortisone can “suppress the immune system,” but please recall that both ACTH and MSH are members of a hormone system called melanocortins. There is interaction between ACTH and MSH in the production pathway involving proopiomelanocortin in the hypothalamus. 13 For those with MSH deficiency, persistent suppression of ACTH following exogenously administered cortisol (or any of the related adrenal steroid compounds) is common and can be an ominous finding. Steroids have an important role in medicine; if the use will bring about needed changes in physiologic parameters, then the risk of suppressed ACTH is not too great. But optional use of prednisone for dermatitis, a mild flare of lung disease or sinus problems, for example, is best avoided.


5/ Activated charcoal


QUESTION: My doctor thinks I am too ill to take cholestyramine and wants me to use activated charcoal in the middle of the night instead. Will that be as effective as cholestyramine?


ANSWER: There are a number of questions that we have answered on this website regarding alternatives to cholestyramine. We have abundant objective data showing that Welchol performs the same duties as cholestyramine but to date no other nostrum has been shown to be effective by publication of objective parameters before and after individual use. I am aware that a number of people value use of activated charcoal, particularly since it is not a prescription item. If you are going to use activated charcoal, please be sure to collect a database on inflammatory mediators before you start the medication and after one month to see where you are. Also, please don’t use multiple simultaneous interventions if you are collecting data. I am uncertain as to why you would take activated charcoal in the middle of the night if you have a chronic fatiguing illness where restorative restless sleep is compromised. As always, of course, your physician has a duty to answer your questions and if your physician feels that taking charcoal in the middle of the night is the right way to go, then by all means you should listen to your doctor.



6/ Acute exposure


QUESTION: I went camping this past weekend at Camp Woodlands in Annapolis. Shortly after we turned in for the night, one of my friends developed a significant cough, headache and congestion. Another friend had a flare of her pre-existing asthma. We left after one hour. Should we seek medical care?


ANSWER: Exposure to any number of environments can cause the acute onset of respiratory symptoms without necessarily being an inflammatory response syndrome caused by exposure to the interior environment of a water-damaged building. Classic chronic inflammatory response syndrome is symptomatic for over a month; we cannot say that applies to an exposure of less than 3 hours associated with an illness of less than 3 days. You mentioned that you are beginning to feel better now several days after your exposure. If you do not have a multisystem, multisymptom illness it would make sense to observe and not initiate treatment. Having said that, if the visual contrast sensitivity (VCS) test is positive at this date, the likelihood that this finding will resolve without 14 treatment is quite low. Having a VCS test done now provides a reasonable basis to look back 2 weeks from now to see whether this is developing into an ongoing syndrome. I do not object to you having baseline labs done, including C4a and TGF beta-1, together with MMP-9, as the acute exposure is not likely to have enough time to lower MSH and VIP but did have enough time to drive up inflammatory responses.


7/ Acute illness after exposure.


QUESTION: My Mom’s house flooded when she was away and it sat soaking for weeks. I went in for six hours scrubbing mold from walls in the home. I now am ill with sinus problems, sore throat and lung congestion. I now am irritable and moody with red eyes and temperature intolerance. Is this serious?


ANSWER: Certainly you have met the requirement for the potential for exposure and you have multiple health systems represented with multiple health symptoms. I would suggest that you take a look at the online visual contrast sensitivity (VCS) test to gain a better idea of what all symptoms you might actually have and then to correlate those symptoms with an objective screening test. It is a first diagnostic test that indicates CIRS.


At some time it would make sense for your physician to evaluate you with the Shoemaker Protocol™ labs on the physician order sheet in the diagnosis section of this website. You need to have the labs present to secure the diagnosis and initiate treatment. Do not ignore your illness. I think that you have made a good start by contacting us. I hope you will follow through.


8/ Air sampling, spore trap method


QUESTION: Can you please discuss the spore trap method in detecting mold in a building? Is it reliable and how does it compare to ERMI?


ANSWER: Air sampling for spores was the industry standard for years. Attempts to determine if a building was moldy or not using air sampling, however, is so fundamentally illogical I cannot understand why people still consider these tests to be reliable. They are not. In this approach to sampling a vacuum device is attached to a filter and then turned on for either five or ten minutes such that air above the sampling device (usually placed in the middle of the room) would be pulled through the filter. Particles smaller then the pore size of the filter would go right through but particles bigger then the pore size would be retained. The pore size was established at 3 microns which made it an effective device to measure large, intact spores. The problem is that for every intact spore, ranging in size from 3 to 8 microns, there will be 99 fragments of spores that sail right through the device, right back into the room to continue to make people sick by inhalation. An additional problem with spore trapping is that the spores are identified by using light microscopy, often at a mere 200 power. Such microscope work will not distinguish any of the species of the Aspergillus genus; similarly the Penicillium species could not be sorted out. Even worse all Aspergillus itself could not be separated from all Penicillium. What we see in spore trap reports with be ‘Asp/Pen,’ a classification that wholly ignores the vastly more important role for A. versicolor and A. penicilloides, for example. If particular spores were particularly sticky, as those of Stachybotrys are supposed to be, air samples would often not show any spores of this important mold as spores would not be released from their “stuck on” habitat easily.


Further, Wallemia has never been reported in any spore trap I have seen. Using ERMI, a DNA analysis of dust collected not from the air but from areas where dust is settled in a given room, has the opportunity to identify up to 136 species with remarkable accuracy using QPCR. As opposed to guessing about Aspergillus and Penicillium and never even knowing about Wallemia, the QPCR tells us about these very important organisms specifically, inexpensively and rapidly.

Spore trapping has been exposed as inadequate in countless discussions including the World Health Organization report of 2009. WHO suggested that if spore trapping is to be used then multiple samples should be taken from multiple locations in each given room throughout a given day with multiple days per week and multiple weeks per month. The cost of such sampling is prohibitive. Let’s not forget that by using ERMI or HERTSMI-2 you can obtain health information from building information. Such correlation has never been done from air sampling and frankly never can be done reliably given the limitations discussed briefly above. If you are a landlord and want to hide evidence of a moldy building, use a single 5-minute spore trap taken from the middle of a room with the windows open. If you are concerned about health effects of WDB, use ERMI or even better, use HERTSMI-2.