Week of June 3, 2024

1/ HLA DR 16-5-51, Mold illness and Lyme susceptibility

Q: My son has HLA DR 16-5-51. Does that mean he is not reactive to mold as someone else? Each of us has two separate HLA haplotypes.

A: If both of your son’s haplotypes are 16-5- 51, he is called a homozygous 16-5-51. We know individuals who have dual HLA haplotypes that are not susceptible to mold (16-5-51 is not mold susceptible), if they are sickened by exposure to interior environments of water-damaged buildings (of course that can happen), the illness is less severe and more easily treated then those with exposure and mold susceptible haplotypes.

Should your son be bitten by a tick and acquire Lyme disease, the likelihood that he will respond to antibiotics alone is very small given his HLA. As such, careful avoidance of tick habitat and use of permethrin on clothing is mandatory.

2/ Multi-susceptible HLA 13-3-52B

Q: I have a 13-3-52B (LabCorp) which my doctor says is multi-susceptible. Can you discuss?

A: The Rosetta Stone roster of HLA types does not include all 54 of the known HLA (there are so many subsets of HLA now that the main 54 haplotypes are expanded to number in the hundreds). It includes only the HLA where we have enough patients with a given HLA type to determine “relative risk.”

What we look at is incidence of a given HLA in cases divided by the incidence of the same HLA in controls. If the number is greater then 2.0 then the relative risk criterion is met. We have HLA < 13-3-52B in over 10,000 HLA haplotypes on file. These haplotypes are more likely to be due to 13-3-52A with a lab reporting that arouses some suspicion in me. 13-3-52A is also rare; we have less than 200 of these in our data sets. This HLA appears to be a multi-susceptible haplotype that does not confer the same magnitude of abnormalities we usually see in 4-3-53 and 11-3-52B. I would suggest double checking the reliability of the lab assay by sending a DRB3, 4 and 5 to Quest to see if this can be verified at some time in the future but in the meantime your physician will certainly be able to treat the underlying illness and help you return to health.

3/ HLA HLA 17-2-52B

Q: I have 3 patients with HLA 17-2-52B that seem to have biotoxin illness. Is this considered the same as 17-2-52A? Also, can I assume in a post Lyme patient who has biotoxin illness and is homozygous for just the post-Lyme genotype (15-6-51) that mold is not part of the problem? Is the genotype that specific? Or do we still have to check the ERMI, etc.?

A: Yes, HLA 17-2-52B and 52A are equivalent. No one can assume that absence of the mold susceptible genotype rules out mold illness. As MSH falls, the role of mold as a sequential problem of post Lyme patients must be always considered. ERMI testing remains mandatory. We have looked at the per cent of non-HLA susceptible patients with confirmed mold illness. It runs about 5%.

4/ HLA labs

Q: Would the basic screening labs for adults be the list of labs mentioned on your web page: "Secrets of Survival"?

A: Yes, HLA typing, C4a (Not LabCorp), TGF beta-1, MSH (Not Quest), VIP (Not LabCorp), MMP-9, Leptin, ADH/Osmolality, ACTH/Cortisol, ACLA /IgG/IgA/IgM, AGA lgA/IgG, VEGF, von Willebrand's profile (not LabCorp). Be sure to include the

CD4+CD25++CD1271ow- assay as well. In a few days we hope to hear good news from the Institutional Review Board regarding our genomics testing (after 5 years of development!), so it is possible that we will be bringing the genomics testing to clinical use. Confirmed!!

A PAXgene tube will be added as well. Stay tuned on this one.

5/ HLA 1-5 and 17-2-52B

Q: My HLA is 1-5 and 17-2-52B. It does not fit any row of your Rosetta Stone. I feel that I have been exposed to mold with an illness that is 3 years in duration. My physician thinks I have Lyme.

A: Please look again at the Rosetta Stone. Your HLA types are well represented there.

Acquisition of Lyme disease is independent of HLA. In patients with Post Lyme Syndrome, however, those in which symptoms persist despite reasonable use of antibiotics for a reasonable period of time, having an HLA-based susceptibility (including 15-6-51, 16-5-51, 11-3-52B and 4-3-53) essentially guarantees that antibiotics alone will

not correct your illness. Don’t assume anything about co-infections: follow the inflammatory treatment protocols. The HLA types that you have are 1-5, a non-specific haplotype associated with low MSH and 17-2-52B which is mold susceptible.

6/ HLA, 4-3-53 and CSM

Q: I have heard that the people who have the 4-3-53 HLA DR gene can not take cholestyramine. Is this true?

A: Intolerance to cholestyramine is not impacted by genetic disposition. Aldous Huxley told us the key to understanding is casting out false knowledge. I suggest you cast out knowledge that 4-3-53 means you can’t take cholestyramine.

7/ HLA, 11-5-52B

Q: Does the 11-5-52B genotype cause immune system to not clear toxigenic mold spores in addition to toxins? Or do genotypes kill spores?

A: The HLA is neither involved in killing spores nor clearing mycotoxins. The HLA is simply associated with processing of antigens. We have seen repeatedly in multiple cohorts that the 11-3-52B shows up disproportionately in those who have the worst

outcomes and the greatest elevations (statistically) of TGF beta-1.

The killing of mold spores is accomplished by alveolar macrophages. The illness is not

related to spores themselves as a general rule only as there will be 500 fragments of spores for every single spore with each fragment able to set off inflammatory responses.

8/ HLA, texts

Q: Are there published text book references for use on HLA?

Yes. Academic Press has two books of interest. The first by Lechler and Warrens is entitled HLA in Health and Disease, 2nd edition. The other book from Academic Press is the HLA Facts Book by authors, Marsh, Parham and Barber.

Given the fact that the field of HLA is moving so rapidly, comments in published books will often be out of date by the time that the book is in print. Pay careful attention to detail. References found in the bibliographies found on the Surviving Mold website will be of benefit.

9/ HLA, mechanism

Q: What are the mechanisms immune systems that cause mold illness in mold susceptible genotypes?

A: The HLA haplotype 4-3-53 is the best studied showing the presence of seven separate amino acids that are “permissive,” in that a variety of chemical structures, call epitopes, are not recognized by this series of seven amino acids. What this means is that if these epitopes are antigens, presentation to an HLA will no result in antibody formation.

10/ Crawl space and illness

Q: We had ERMI testing on our crawl space and air conditioning system confirming presence of Cladosporium cladosporioides 1 and Epicoccum nigrum. We have discarded porous material, put in all new ductwork and put a new carpet in. We feel somewhat better. Is there a reduced panel of lab tests that we can do at this time

as funds are quite tight?

A: Historically, the two organisms that you mentioned are not players of concern in evaluation of a water-damaged building (WDB). They are in ERMI Group II and are not in HERTSMI-2. The HERTSMI-2 is the shorter version of the test, and is less expensive. It assesses the top offending bacterias and toxins in the environment. It can be used after the initial ERMI is done as a follow up test, or you can use the HERTSMI-2 scorecard on the site to check the key “players” in a WDB.

I am glad you are feeling better with the changes you have made but there is insufficient information in your question to get to the

next step of laboratory testing.

Also, while it is a first step to determine if you’ve been exposed to a Water Damaged Building, to get started quickly, and most affordably, before actually doing the actual building lab testing, do your own inspection and detective work. You can often get enough information to get started. Here are a few basics to keep in mind:

Do the initial detective work – when did your symptoms start, and what new building (or even automobile – especially used from flood states) did you frequent at that time? Then, look, smell, ask… Look for signs of water damage (visible mold growth, stained ceiling tiles, buckled floors or rippled, discolored paint or wall paper. Check under sinks, near water systems, celings, basements, crawl spaces and attics, and bathrooms. If it has a musty or moldy smell, chances are it has the biotoxin and bacterial offenders that inhabit water-damaged buildings. If you don’t own the building, ask a building owner or maintenance manager or worker the age of the building and if it’s had any water damage. If the building is over 20 years old, often less, chances are, it has had water damage.

Also before doing the actual building testing, first determine whether or not you physically meet the first diagnostic test steps of the case definition. You can take the Protocol’s first diagnostic test, the online Visual Contrast Sensitivity test (VCS), for minimal cost from home. If the VCS is normal and you do not have a multisystem, multi-symptom illness, I would not suggest doing any home/building lab testing at all. Keep in mind, while the VCS points to being afflicted with CIRS, yet further testing will need to pinpoint if it’s actually due to water-damaged building toxin load, and if you have the gene susceptibility as well.

If your symptoms are new or have been developing for under a month and you pass the VCS test, but with some abnormalities, then take it again 2 weeks later to see if the symptoms are developing into full-blown CIRS, or not. 

If you fail the VCS and you do have a multi-symptom, multisystem illness, then the testing that confirms each of the 11 steps of the sequential Shoemaker Protocol™ are included, because they all are important. Certainly the first several steps would include these Protocol diagnostic tests: HLA DR by PCR; MSH (done at LabCorp, not at Quest) C4a (done at Quest not at LabCorp) MMP-9, TGF beta-1, anti-gliadin antibodies (done on serum not on saliva or stool), VEGF and a nasal culture. I would further recommend testing of ADH and osmolality as a pair (done simultaneously). The balance of the tests can be done once we see what parameters are needed to go further.

There are lab order sheets provided on the Surviving Mold website to assist your attending physician or specialist, or even better, find a Shoemaker Protocol™ practitioner to manage your case.

You may also be interested in the free downloadable Shoemaker Protocol™ “Got Mold?” Guide.

11/ Crawl space and flooding

Q: Our crawl space smells moldy. I have fixed the water intrusion problem and now I am trying to get rid of mold. How can I accomplish this removal?

A: I would suggest that you take a look on this site at the reviews and the opinions of well respected experts (Michael Pinto and Greg Weatherman) regarding proper industrial hygiene in approaches to wet basements and wet crawl spaces. There are numerous

discussions in both of my books, Surviving Mold and Mold Warriors that may also be of benefit. I will also refer you to the Consensus Statement on Remediation available on this site.

Simply stated, you must stop the water intrusion first. Second, you must remove any contaminated building materials such as insulation and then expose structural elements (rafters, joists and rim joists) to look for evidence of microbial growth. This growth must be treated with biocides and then followed by removal of all residual contamination. Structural elements need to be encapsulated if they can not be removed.

Most people are looking at crawl spaces differently now then they did 15 years ago in which increasing ventilation seemed to be a good idea. Now people are encapsulating crawl spaces with thick plastic (30-40 mils). They are preventing intrusion of warm, moist air by sealing air vents. All penetrations through the subfloor into the floor above are closed off with expandable foam. The idea is that while there may be ground water as source of moisture in the soils of your crawl, it will not penetrate the plastic and thereby get into the crawl space or into the crawl space air.

My suggestion is to review proper clearance of the crawl by speaking with people with prior experience in clearing crawl spaces. You must use DNA testing, either ERMI or HERTSMI-2 testing before and after to confirm efficacy. If a contractor does not use ERMI and is unfamiliar with it I would stay away from that provider. I see absolutely no reason to rely on air sampling when we have massive amounts of data confirming human health risks are unveiled with DNA testing but not by air sampling. I understand that there are people that disagree with my emphasis on use of accurate fungal DNA testing.

All I ask is that they withhold their opinions until they present their prospective data showing how their sampling correlates with subsequent illness or not. I would expect that proper IRB approval of their study design would be obtained.