melissa katsakos

Bringing invisible symptoms to light

Understanding CIRS

Chronic Inflammatory Response Syndrome

Invisible symptoms, real biology

Some of us keep a running list on our phones: the headache that starts in one particular room, the candle aisle we now take the long way around, and labs that come back normal anyway.

This is the lived experience of many of us with Chronic Inflammatory Response Syndrome (CIRS) and environmental sensitivities. CIRS is measurable, and the tests that show it are within reach.

CIRS is one part of environmental health: how our spaces, products, and exposures shape how we feel. And when seen clearly, it’s treatable.

What it can feel like

CIRS tends to show up as a cluster of signs that can seem unrelated:

  • Fatigue and energy crashes
  • Brain fog or trouble finding words
  • Muscle and joint pain
  • Headaches or sinus congestion
  • Digestive changes and new food sensitivities
  • Sleep that doesn’t refresh
  • Light, sound, or smell landing harder than it used to
  • Tingling or buzzing skin

Because the symptoms range so widely, many of us are diagnosed with something else first:

  • Chronic fatigue syndrome
  • Fibromyalgia
  • An autoimmune condition
  • Depression or early-onset dementia
  • Or we’re told nothing is wrong

Even the symptoms that seem strange or disconnected often fit a larger, recognizable pattern.

What CIRS is

CIRS is a multi-system inflammatory illness that can follow exposure to biotoxins. Water-damaged buildings are the most common source, and for many of us that exposure lands on a load that has built for years. In people with a genetic susceptibility, the immune system can stay switched on, and inflammation spreads across several systems.

That susceptibility runs through the HLA-DR genes. In Dr. Shoemaker’s data, about 24% of the general population carries it.

The load can come from several directions:

  • Actinomycetes (bacteria found in damp buildings and dust)
  • Endotoxins from Gram-negative bacteria
  • Mold and mycotoxins
  • Lyme disease and its co-infections
  • COVID-19 and long COVID, which may add to the load
  • Cyanobacteria (blue-green algae)
  • Ciguatera (from toxins in certain reef fish)
  • Other environmental toxins
  • EMFs, which may add to the total load (studied separately from biotoxin illness)

How it’s found

In the late 1990s, Dr. Ritchie Shoemaker, a family physician on Maryland’s Eastern Shore, began treating fishermen sickened by Pfiesteria piscicida, a toxic organism in local waterways.

What others dismissed, he investigated. What conventional medicine couldn’t explain, he measured.

He later found the same patterns in people exposed to water-damaged buildings. His work described CIRS as a measurable, treatable condition and gave clinicians a way to look for it.

One of the simplest screening tools is the Visual Contrast Sensitivity (VCS) test, which measures neurological function affected by biotoxin exposure. It’s quick, free on the BeyondMold website, taken at home, and paired with Dr. Shoemaker’s Symptom Cluster Analysis.

In Dr. Shoemaker’s clinical data, a multi-system symptom pattern plus a failed VCS puts the likelihood of CIRS at 98.5%. His data also show that about 8% of people with CIRS pass the VCS, so when the symptom pattern fits, a pass is a reason to keep looking.

Some of the tests that help with diagnosis:

  • GENIE (Gene Expression: Inflammation Explained): a newer blood test that shows how our genes are expressing across the domains involved in CIRS. Dr. Shoemaker’s group also uses it when long COVID or Lyme is part of the picture, and it can be especially useful when it’s unclear what’s driving symptoms.
  • C4a: a complement marker of innate immune activation, one of the hallmark CIRS signals.
  • TGF-beta1: a marker of chronic inflammation and immune dysregulation.
  • MSH (melanocyte-stimulating hormone): in Dr. Shoemaker’s data, it runs low in more than 9 in 10 people with CIRS from water-damaged buildings. His work links low MSH with poor sleep, a disrupted circadian rhythm, pain, and shifts in other hormones, including cortisol, sex hormones, and ADH, which balances water and salt.
  • MARCoNS: a deep nasal swab for a biofilm-forming staph that settles in the sinuses, found most often in people whose MSH is low.
  • NeuroQuant: an FDA-cleared analysis of a brain MRI that measures the size of brain structures against a normal range. It’s used in evaluating memory loss, Alzheimer’s and head injury, and it can show changes linked with CIRS and long COVID. CIRS clinicians also use it when Lyme is part of the picture.

Together, they offer a map.

A 2024 review of the published research found that the Shoemaker Protocol was the only CIRS treatment with documented clinical efficacy.

What recovery rests on

Recovery rests on four pillars, and the environment comes first:

  • Environmental remediation: finding and removing the sources of exposure, such as mold, actinomycetes, mycotoxins, and endotoxins.
  • Detoxification support: binders, nutrients, and gentle supports for the body’s own detox process, at a pace it can sustain.
  • Immune system rebalancing: addressing infections and bringing inflammation down.
  • Nervous system regulation support: whatever helps the limbic and nervous systems settle, including brain retraining, breathwork, somatic work, time outdoors, a choir, a garden.

Dr. Shoemaker’s treatment protocol reports that by its final step, most patients have already seen at least 75% of their baseline symptoms reduced or resolved.

Biology can evolve. Your body is adapting, responding to what it’s been exposed to, and given the chance, it can recalibrate, step by step.

Your biology is wise. It’s communicating. And when we learn how to listen, healing becomes possible.

Some of us feel CIRS most in the brain: wired, inflamed, or shut down. This is neuroinflammation, a real, measurable response to biotoxins. With treatment and a home that stops adding to the load, it can improve, sometimes a great deal.

Finding a practitioner

For CIRS, Surviving Mold keeps the list of practitioners certified in the Shoemaker Protocol, and for wider environmental medicine, ISEAI keeps directories of practitioners.

The whole picture

Your labs are one part of the picture. What you notice is another, and it’s worth trusting. Many of us are walking this with you.

There is a path forward, grounded in science, guided by self-trust.

If it helps to have everything in one place, the free guide gathers the symptom clusters, the tests, and one low-cost first step.