Chronic Inflammatory Response Syndrome (CIRS) was first used as a term in the 1990s to describe a multi-symptom, multi-system chronic illness. Exposure to certain environmental ‘inflammagens’ and pathogenic organisms (which can collectively be termed ‘biotoxins’) is understood to trigger this chronic inflammatory response in the body. The work of Dr. Shoemaker, who applied the term CIRS in 1997 to an illness specific to the human response to exposure to Pfiesteria in the Pocomoke river, specifies the following as being key considerations for triggering a chronic inflammatory response:
- Post Lyme syndrome (CIRS-PLS) which occurs beyond the acute phase of Lyme disease in around 20% of Lyme patients.
- Ciguatera poisoning (CIRS-Ciguatera) which is a fish-borne dinoflagellate that can trigger neurologic and gastrointestinal symptoms when consumed. Around 5% of cases can become chronic.
- Possible estuarine-associated syndrome (PEAS) relating to Pfiesteria exposure. It was understanding the health effects of Pfiesteria that laid the foundation for CIRS as Dr Shoemaker investigated fish kills in the Pokomoke river and the resulting human illness.
- Cyanobacteria (CIRS-Cyanobacteria) which is a blue-green algae that can produce toxic substances, that can have hepato and neuro-toxic effects.
- A bite from a brown recluse spider is also known to be a trigger of the same chronic immune response.
Whilst mould and exposure to water-damaged buildings (CIRS-WDB) are probably the most well-known in Europe, it is important to understand that the toxic soup found in a water damaged building may not be the only trigger.
Dr. Shoemaker’s work is intimately connected with Dr. Dale Bredesen’s work on cognitive decline and both indicate that exposure to biotoxins can be part of the pathway that leads to this condition. Both doctors also agree that resulting inflammation and eventual metabolic changes are the net result of inflammatory exposures, contributing to changes in brain function. CIRS can therefore be seen as very much part of the cognitive decline jigsaw.
Many of those who may have a chronic environmental exposure impacting on their health may have a diagnosis of fibromyalgia, depression/stress/anxiety, POTS or chronic fatigue to name just a few conditions.
Specific symptoms may include long term sinus or neurologic symptoms, both of which can be associated with coag. neg. staph infection (if antibiotic resistance is present this is called multiple antibiotic resistant coag. neg. staph - MARCoNS). MARCoNS can be ruled in or out by nasal swab testing. Some people have no symptoms at all relating to MARCoNS, which highlights the importance of testing.
There are 37 common CIRS symptoms that are split into symptom clusters. A score of above 8/13 clusters is 95% associated with positive test results and consideration of CIRS, but diagnosis cannot be made on symptoms alone, lab tests and improvement with appropriate therapeutic interventions complete the picture.
The 37 Symptoms
Once CIRS has been identified, the Shoemaker protocol can be considered. The first step, and the most important, is the removal of exposure to the biotoxin. Whether the water-damaged building exposure is school, home, work, a frequently visited service or gym, it is important to prevent exposure to inhaled contaminants. If this is not achieved, the inflammatory cycle may not be arrested. To check an environment, the most commonly used tests are the Environmental Relative Moldiness Index (ERMI) and Health Effects Roster of Type Specific Formers of Mycotoxins and Inflammagens (HERTSMI 2) utilising dust sample collection. Eradicating MARCoNs comes next and re-balancing all other out of normal range markers follows until all re-tests are normal. The twelve step programme is best undertaken with a suitably certified practitioner.
Until testing became available, CIRS was deemed by many to be “all in the head”. To some extent there is an irony that the volumetric MRI tests we now have access to can show changes consistent with exposure to CIRS-PLS and CIRS-WDB. Different parts of the brain can show swelling or shrinkage consistent with lab work. Improvements can also therefore be tracked.
The future of CIRS is now expanding into transcriptomics, new tests such as the genomic expression by Nanostring: inflammation explained (GENIE) reveal changes in gene expression, protein production and cellular activity. From this testing, we are able to see that activities such as how we produce energy are down-regulated in CIRS, so fatigue is more likely to be seen along with changes in vascular and brain health. Ultimately, the simple equation of pathogen exposure, immune response and eradication still has a very personal element to it, with around 20-25% of people being at risk of symptoms consistent with exposure, but by tracking blood work, scans and genomics, CIRS is a concept that is also leading the way in personalised therapeutics.
Author: Louise Carder
