What is CIRS (chronic inflammatory response syndrome)?
Chronic Inflammatory Response Syndrome, also called biotoxin illness, is a diagnostic framework that conventional medicine doesn’t yet recognize. It describes a group of symptoms making up a chronic illness in people affected by water-damaged buildings, including exposure to mold, actinomycetes and endotoxins. Dr. Ritchie Shoemaker, MD developed this framework, and the work of Dr. Neil Nathan, MD and Dr. Jill Crista, ND also informs how Dr. Madeira cares for people with mold-related illness.
Exposure can go beyond visible mold. Dr. Madeira also looks at other sources, such as endotoxins from dried-up P-traps in plumbing.
Researchers believe some people are more susceptible because their immune systems don’t clear these compounds efficiently, so inflammation continues long after the exposure began. That helps explain why one family member may become very ill while others feel fine.
Why CIRS is often missed
CIRS symptoms are broad and fluctuate, and they often overlap with chronic fatigue, fibromyalgia, anxiety or long COVID. Standard labs are frequently normal. Without asking about water damage and testing more specifically, it’s easy to overlook.
CIRS treatment: how the Shoemaker protocol works
Dr. Shoemaker describes his protocol as a series of steps taken in a set order, like climbing a pyramid. The first step is getting out of exposure, and a few people need nothing more. The next step is a binder, and later steps each address a specific abnormality found on testing.[8] A 2024 review of published treatment studies found that the Shoemaker protocol was the only CIRS treatment with documented clinical evidence; it was described in 11 of the 13 CIRS treatment articles the review found.[7]
Dr. Madeira’s step-by-step approach below draws on this framework, adapted to you and paced to what you tolerate. Not everyone needs every step.
How Dr. Madeira evaluates CIRS
- A detailed exposure history covering homes, workplaces, schools and vehicles
- A thorough symptom review across body systems
- Testing chosen for your history and read as a whole (see “How is CIRS evaluated?” below)
- Screening for related issues such as mast cell activation
A step-by-step treatment approach
- Get out of exposure. Identify and address water damage with qualified professionals. This is the foundation of recovery.
- Lower the biotoxin burden. Detoxification therapies, which may include binders, introduced at a pace you tolerate.
- Address what CIRS disrupted. Inflammation, gut health, hormones, sleep and the nervous system, with personalized nutritional and botanical medicine.
- Rebuild resilience. Mindfulness practices and lifestyle foundations to support lasting recovery.
Dr. Madeira coordinates with your other doctors and with indoor environmental professionals when your situation calls for it.