CIRS

One in four people in Australia have a genetic susceptibility towards Chronic Inflammatory Response Syndrome (CIRS). The most common trigger for CIRS is mould and mycotoxins from buildings with water damage. The ongoing inflammation can affect virtually any organ system of the body and if left untreated becomes debilitating.

What is CIRS?

CIRS stands for Chronic Inflammatory Response Syndrome. It is also called Mould Biotoxin Illness. CIRS is an inflammatory response in the body that may affect multiple systems—like digestive, respiratory, nervous, musculoskeletal, pulmonary—and is generally brought on by environmental exposure or infection. [1] The most common trigger for CIRS is mould, biotoxins and mycotoxins from buildings with water damage. If you see health changes after a water leak, moving to a new home or workplace, or even after a brief exposure at a hotel, then CIRS could be a possibility.

There are three common ways to get CIRS:

• Water-damaged building (home or office)
• Tick bite-related diseases, such as Lyme disease
• Exposure to dinoflagellates (waterborne toxin producers) like Ciguatera or Pfiesteria

[2]

What are Mycotoxins and Biotoxins?

Mycotoxins are toxic secondary metabolites produced by fungi. Several hundred substances are known. Biotoxins or natural plant toxins are secondary metabolic products, formed by plants to protect against herbivores by many plant species worldwide. Both mycotoxins and biotoxins can show acute or chronic toxic effects towards humans and animals even in low concentrations. [3]

Science has long recognised the dangers of eating mouldy food. Mycotoxins are the toxins produced by certain moulds, some of which can be so toxic to humans as to pose serious health risks and even cause death. Because of this, food standards include limits on mycotoxin contamination in grains and other foods.

However, the health effects of mould and the mycotoxins they form have been somewhat under-recognised. In this context, some people view all mould as harmless to humans, and it’s true that most species are harmless. In the end, mould spores and their fragments are found almost everywhere on our planet, and we are constantly exposed to them. [4]

For example, the biggest CIRS trigger for most people is mould and mycotoxin exposure from water-damaged buildings. And in a certain group of genetically-susceptible people, this will trigger an inflammatory response that affects many different systems in the body, from the GI tract, brain, and nervous system, to pulmonary and respiratory tracts, and inflammation in the musculoskeletal system. We call this CIRS.

CIRS: Signs and Symptoms

Reported symptoms associated with CIRS include combinations of [5]

• Fatigue
• Weakness
• Aches
• Muscle cramps
• Sharp pain
• Headache
• Light sensitivity
• Red eyes
• Blurred vision
• Tearing
• Sinus problems
• Cough
• Shortness of breath
• Joint pain
• Morning stiffness
• Memory issues
• Difficulty with focus/concentration
• Word finding difficulties
• Decreased assimilation of new knowledge
• Confusion
• Disorientation
• Skin sensitivity
• Mood swings
• Sweats (especially night sweats)
• Temperature regulation or dysregulation problems
• Excessive thirst despite frequent water intake
• Static shocks
• Numbness
• Tingling
• Vertigo/Dizziness
• Metallic taste
• Abdominal pain
• Diarrhoea
• Tremors
• Unusual pain
• Migraine/facial pain
• Appetite swings
• Increased urination/nocturia

Why is CIRS often misdiagnosed?

Often, patients present with so many bizarre symptoms that practitioners (or even family members) believe it’s all in their heads. Other times, practitioners misdiagnose mould illness. According to a 2013 study of 112 patients with chronic fatigue syndrome, 104 (93%) tested positive for at least one mycotoxin. Researchers found that mycotoxin levels in chronic fatigue syndrome patients were significantly higher than those in healthy control subjects. If you’re looking for a root cause in a complex patient case, mould should be considered. [6]

Why do some people become more ill than others?

With exposure to water-damaged buildings, some people are better able to clear the toxins out than others. The body flags the mould as an unfriendly antigen and creates antibodies to rid the body of it in subsequent exposures.

About 25% of the population has the HLA-DR gene and is genetically susceptible to mould. For these people, the foreign substances, or antigens, have defences that are ineffective at clearing the mould. This causes widespread inflammation throughout the body.

This constant fight and inflammatory response can then lead to chronic illness. [7]

“One in four Americans (adults and children) have a genetic susceptibility towards Chronic Inflammatory Response Syndrome.”

[8]

What are common misdiagnoses of CIRS?

Biotoxin exposure suppresses the immune system. Clinicians and patients have routinely noted that CIRS may be an underlying cause or a co-factor in:

• Chronic fatigue syndrome (CFS) / myalgic encephalomyelitis (ME);
• Fibromyalgia;
• Multiple sclerosis;
• Somatisation (i.e., hypochondria);
• Attention deficit hyperactivity disorder (ADD/ADHD);
• Depression, stress, and anxiety;
• Allergies;
• Irritable bowel syndrome (IBS);
• Post-traumatic stress disorder (PTSD); and
• Other autoimmune disorders.

[9]

Testing for CIRS

Testing should include: [10]

• Mycotoxin testing – These tests can identify biotoxins in your blood created by mold.
• Human Leukocyte Antigen (HLA) genetic test – An estimated 25 percent of the population have a genetic variation that makes their immune system bad at identifying and ridding the body of biotoxins. Sometimes when mold is an issue in a home, the rest of the family only notices the problem after a person with the HLA gene becomes sick.
• MARCoNS – Multiple Antibiotic Resistant Coagulase Negative Staphylococci (MARCoNS) live inside the nasal cavity. These can contribute to CIRS and need to be identified and treated.
• Mold CIRS Panel of laboratory markers. This panel tests for MMP9, TGF-beta1, MSH, ADH, and osmolality.

At our clinic of Advanced Functional Medicine we offer these Advanced testing options to our patients.

The following are biomarkers commonly associated with CIRS and may also be tested: [11]

• Vasoactive Intestinal Polypeptide (VIP) – Normal range is 23-63 pg/mL. CIRS patients usually have lower levels.
• Melanocyte Stimulating Hormone (MSH) – Normal range is 35-81 pg/mL. CIRS patients usually have lower levels.
• Transforming Growth Factor Beta–1 (TGF Beta-1) – Normal range is <2380 pg/ml.
• C4a – Normal range is 0-2830 ng/ml.
• Antigliadin (AGA IgA/IgG) – Normal range is 0-19.
• Adrenocorticotropic hormone (ACTH)/Cortisol – Normal range is ACTH 8-37 pg/mL. Cortisol in the a.m. 4.3-22.4 and p.m. 3.1-16.7 ug/dL. CIRS patients usually have higher levels.
• Vascular Endothelial Growth Factor (VEGF) – Normal range is 31-86 pg/mL. CIRS patients usually have lower levels.
• Antidiuretic hormone (ADH)/Osmolality – Normal range is ADH 1-13.3 pg/ml and Osmolality 280-300 mosmol.
• Matrix Metallopeptidase 9 (MMP-9) – Normal range is 85-332 ng/mL.
• Leptin – Normal range is 0.5-13.8 ng/mL for men and 1.1-27.5 ng/mL for women.

Case Studies – Finding Effective Treatment

The following case studies are personal accounts referred to by The Standing Committee on Health, Aged Care and Sport will inquire into and report on Biotoxin-related Illnesses in Australia to the Parliament of Australia.

Despite presenting with a range of symptoms, CIRS-affected individuals described having difficulty in gaining a diagnosis and treatment. Some individuals found there was a limited knowledge among GPs and specialists in relation to mould exposure and illness. As a consequence individuals did not always feel they were believed or understood by medical practitioners. Personal accounts of the difficulties that arose while seeking effective treatment included:

‘No practitioner in Australia was able to diagnose or treat me, or offer anything that gave me any relief until I undertook careful avoidance of all mould and found the doctor who treated me for CIRS in 2014. I suffered nine years of steadily deteriorating health and functionality despite consulting over 40 practitioners. Not one of them was aware that mould could have been the precipitating cause, or the factor that was keeping me ill.’ [11]

‘The attitude of doctors towards me when I told them I had a mould‑related illness was very unhelpful and sceptical. I was ostracised and the lack of consensus, understanding and support was extremely distressing, added to my expenses, exposed me to additional radiation unnecessarily, and prolonged my recovery time as I started to think maybe I had lost the plot … at a time in my life when I so desperately needed to be understood, nurtured and supported I felt completely alone.’ [12]

‘… I began suffering from a range of severe medical symptoms and spent many years seeing doctors, medical specialists (immunology, otolaryngology, toxicology, gastroenterology, psychiatry, etc.), going into hospital … but never resolving my conditions’.  [13]

‘I have been ignored; belittled, laughed at and dismissed … [some medical practitioners] are not aware of what this illness does so therefore [assume] I must be mentally ill. The ignorance and arrogance has prolonged my suffering and pain’. [14]

Unfortunately, these are also common stories we hear in clinic with patients that have been to multiple practitioners without being able to resolve their “mystery illness”

Treatment for CIRS

Clinical experience has shown that the most important aspects of treating CIRS to reduce symptoms and overcome immune dysfunction on a permanent basis include the following “Big Three” Interventions outlined below: [15]

1) Take Toxin Binders

Examples include Can utilise 1-3 binders from the list below
Cholestyramine
Welchol
Chlorella 5 tablets
Activated Charcoal

Bentonite Clay

When on toxin binders long term it is important to add in a mineral supplement to prevent depletion, and to monitor Magnesium, Zinc and iron levels to be sure that levels remain normal.

2) Treat Toxin-producing Infections – Lyme, Babesia, Candida
Lyme, Babesia and Candida will need to be tested and treated when positive. This can be tested from a range of tests including Organic Acids testing and Advanced Stool testing.

3) Reverse Immune Dysfunction

Supporting the immune system and mitochondria is vital in recovery from mould related illness

Lifestyle Changes

Diet

In many circumstances, functional medicine encourages patients to go on a gluten-free diet for a few months. In others, patients may need to adhere to a low amylose diet.

The No-Amylose Diet can yield great results in CIRS patients. The No-Amylose Diet eliminates:

• Bananas
• Grains
• Sugars
• Processed foods
• Foods grown underground, such as potatoes, carrots, and peanuts

[16]

Anti-inflammation diet

Foods to eat

A variety of foods are known to have anti-inflammatory properties. These include foods that are high in antioxidants and polyphenols, like:

• olive oil
• leafy greens, like kale and spinach
• tomatoes
• fatty fish, like salmon, sardines, and mackerel
• nuts
• fruits, especially cherries, blueberries, and oranges

If your doctor or dietician has recommended you change your eating habits, consider talking with them about the Mediterranean diet. A 2018 study found that participants following this diet had lower markers of inflammation.

Foods to avoid

The following foods have been known to increase inflammation in some people:

• refined carbohydrates, like white bread and pastries
• fried foods, like French fries
• processed meat, like hot dogs and sausage

If you’re trying to reduce chronic inflammation, your doctor may recommend you reduce your intake of these foods.

Other Lifestyle Changes

The following may also help with CIRS

• Sauna
• Coffee enemas or colonics
• Personal air purifier

To Summarise,

• CIRS (Chronic Inflammatory Response Syndrome) is a mould biotoxin illness when the biotoxins are not swiftly removed by your immune system, usually due to a genetic disposition common in a quarter of USA and Australia. (The gene is named HLA-DR.) [16]
• CIRS is too often misdiagnosed as something else.
• The symptoms of CIRS are mainly inflammation-related
• Treatment of CIRS involves supplements, medication and lifestyle changes.

The above support considerations will provide assistance for someone suffering CIRS. If you think you or someone you know may have CIRS, contact us as we may be able to help.