What is CIRS? Part 1

Chronic Inflammatory Response Syndrome- Water damaged buildings (CIRS- WDB)

Chronic Inflammatory Response Syndrome (CIRS) is an environmentally acquired illness related to mould exposure or stealth pathogens and the immune response that occurs with such exposures. It is possible to acquire CIRS due to mould exposures, stealth pathogens (such as Borrelia, Bartonella, Ehrlichia, Babesia etc) or a mixture of both, which I most commonly see in practice.

There is often a level of dysregulation of detoxification and the flagging and tagging of immune allergens, which causes an error within the innate immune system, pathogen byproduct reactivity and an increase in chronic inflammation in the body (Berndtson et al., 2015). The patients immune system and body is unable to properly identify and eliminate several by products such as biotoxins, endotoxins, fumitoxins and mycotoxins (Berndtson et al., 2015). This causes an overwhelming inflammatory response within the body, with many symptoms being seen, within many systems of the body and with varying levels of intensity. Patients can often find themselves being sent to several medical specialists, each trying to manage the symptoms and mounting diagnoses.

Unfortunately the wide spanning reactivity and sensitivity that CIRS patients experience and lack of practitioner and public knowledge and education often results in medical, familial and social neglect and abandonment. CIRS patients have often been labelled as hypochondriacs, accused of faking their illnesses or exaggerating their symptoms, many present to clinic with several forms of trauma and Post Traumatic Stress Disorder (PTSD). People who are fortunate enough not to be affected by (or seemingly unaffected by) water damaged buildings (WDB) or tick bites etc. will often downplay the side effects of CIRS patients. This has a devastating effect not only on patients mental health but on their relationships. I always advise family and friends of CIRS patients to practice kindness and compassion, as we all should, especially when navigating things that require greater understanding.

What are CIRS symptoms?

A CIRS patient may have neurological effects such as migraine headaches, brain fog, visual floaters, forgetting their own children’s names, births or important dates and routes they regularly drive, such as the way to work, directions can become exceedingly hard to follow. There can be involvement of both the central nervous system [CNS] and the peripheral nervous system [PNS] (Garcia-Monco & Benach, 2019).

The following symptoms can be seen in both mould toxicity and certain stealth pathogens:
- Fatigue, weakness, headaches, confusion and cognitive impairment (e.g. brain fog)
- Muscle aches and cramps, joint stiffness, strange pains or sensations in the body such as electric shocks
- Skin sensitivity, rashes, numbness and tingling
- dizziness, excess thirst, frequent urination and a metallic taste in the mouth
- changes in digestion, menstrual cycle, mood and intolerance to lights, foods, changes in heat
- Night sweats
- impotence
- tics, seizures or seizure like events
(Nathan, 2018).

I would also add migratory pain is something often seen with clients, I have seen several fibromyalgia diagnoses where the person actually had mould or stealth pathogens (or both) as a causative factor.

The assessment of several biomarkers is often done to confirm the clinical picture of CIRS (such as HLA genotyping, MMP9, MSH, VCS, MARCoNS etc.) however as with stealth pathogens such as borrelia and bartonella, good clinical case taking and physical assessment also makes up a large portion of individual assessment (Shoemaker et al., 2006).

Environmental factors and influences of illness are becoming more widely known and understood, especially with natural disasters like rising flood waters and storm damage. This does not however mean that all affected buildings, even those obviously affected by water damage, are correctly remediated or remediated to the extent a highly reactive CIRS patient needs.

It is 100% my recommendation should you suspect your house has structural damage, a water leak or any sort of environmental issue that you seek out a qualified building biologist trained by Nicole Bijlsma (Nicole’s information can be found here). It is necessary that building assessors and remediators are aware of sick building syndrome and the steps involved to make a safer environment.

The first thing to do in the case of CIRS- WDB is to eliminate exposure. This is probably the hardest one I see for people, especially if they have already been through this process before as it is an expensive one.

What do I do if I live in a WDB?

The safest answer is to leave the building and not return, however this is often the hardest thing to achieve. We are currently in a housing crisis, and this may be impossible or feel impossible for sick individuals and families. Some may feel it is unnecessary and won’t have a significant impact on their recovery from ill health.

In my experience as both a CIRS patient and practitioner CIRS patients will be placing their health and potentially their lives at risk living, working or entering into a water damaged and mould affected building. For some people this may mean they don’t progress in treatment, they don’t get better despite doing all the right things- taking supplements, taking herbals, taking binders, eating a good quality diet with reduced inflammatory foods etc. If this occurs and for most people I would say if you experience zero improvements after 3 months of treatment you are still being affected by mould or an allergen and likely a current source.

If you have CIRS it is important that you also dispose of all contaminated belongings- if this makes you uncomfortable please consider sealing items in tubs and storing these away from the new house (so not to cross contaminate them), until you can manage this. Anyone who has tried to remediate clothing that is beyond saving can attest it will literally break down in the wash. All porous items- books, furniture, wooden shelving etc will need to be replaced. This in itself is an expensive and often heartbreaking experience; however it is often needed for recovery. It may sound excessive however this is necessary for many people. I have repeatedly seen CIRS patients who keep books, furniture, ignore roof leaks and active mould, not get better. It is frustrating for the patient and the practitioner.

People often ask me why they can’t just treat themselves, you can but it’s likely you will be guessing at treatment and if you are like one of the commonly seen cases, brain fog, confusion and memory issues will often affect reading, comprehension and application of information. Additionally, I think it is important to see someone who has read and assessed the often conflicting information and is ready to support you on your path towards healing in a tailored approach and specific protocol for you. Some patients I have seen have tried water fasting, juice fasting, enemas, saunas, binders, herbs and supplements all without results, often due to missed precautions, not sticking to a protocol or using poorly indicated specific therapies.

What do I do if I suspect I have CIRS?

Where there is a suspected CIRS case my advice is to please see a health practitioner well versed in both mould illness and stealth pathogens (borrelia, babesia, bartonella, Ehrlichia, mycoplasma etc). I often see mould illness in conjunction with several diagnosed health conditions such as chronic fatigue syndrome (CFS/ ME), lyme-like disease or borreliosis and coinfections, Mast cell activation syndrome (MCAS) and histamine intolerance, mental health issues and trauma (depression, schizophrenia, bipolar type 1 and 2, PTSD and C-PTSD), Irritable Bowel Syndrome (IBS), Irritable Bowel Disorders (IBDs) and several chronic pain and autoimmune disorder presentations.

Several of the stealth pathogens have what is known as symptom clusters, with several strains again having particular affinity to certain systems within the body. A well-known example of elevated liver enzymes and associated issues is Epstein Barr Virus infection, which loves the liver cells, whereas certain European strains of Borrelia can present with more of the neurological based symptoms (Zhang et al., 2020; Squires, 2008; Schwenkenbecher et al., 2017). A practitioner who primarily works in this area will be well aware of these issues.

Fresh air, calm clean spaces, allergen reduction, supportive eating habits and supportive environments all go a long way to support the recovery process.

References:

Berndtson et al. (2015). Medically sound investigation and remediation of water-damaged buildings in cases of CIRSWDB – Consensus statement – Pt 1. Center for Research on Biotoxin Associated Illnesses.

Garcia-Monco, J. C., & Benach, J. L. (2019). Lyme Neuroborreliosis: Clinical Outcomes, Controversy, Pathogenesis, and Polymicrobial Infections. Annals of neurology, 85(1), 21–31. https://doi.org/10.1002/ana.25389

Nathan, N. (2018). Toxic heal your body from mold toxicity, Lyme Disease, Multiple Chemical Sensitivities, and Chronic Environmental Illnesses. Victory Belt Publishing Inc. Las Vegas.

Squires, R. H. (2008, May). Acute liver failure in children. In Seminars in liver disease (Vol. 28, No. 02, pp. 153-166). Thieme Medical Publishers.

Schwenkenbecher, P., Pul, R., Wurster, U., Conzen, J., Pars, K., Hartmann, H., Sühs, K. W., Sedlacek, L., Stangel, M., Trebst, C., & Skripuletz, T. (2017). Common and uncommon neurological manifestations of neuroborreliosis leading to hospitalization. BMC infectious diseases, 17(1), 90. https://doi.org/10.1186/s12879-016-2112-z

Shoemaker et al. (2006). Sick building syndrome (SBS) and exposure to water-damaged buildings: time series study, clinical trial and mechanisms. Neurotoxicology and Teratology, 28(5), 573-88. PMID 17010568

Zhang, Y., Zhao, Y., Jiang, Y., & Wang, H. (2020). Effects of Epstein–Barr virus infection on liver function in children. Journal of Infection and Public Health, 13(2), 260-265.