Naturopathic Diagnosis of CIRS (Mold Illness)

I wrote this blog for Dr Sandeep Gupta and his Mould Illness made Simple Course. It is reproduced here with permission.

I highly recommend anyone who has Mould Illness take his course. It’s informative, simple to understand and you’ll have more knowledge and capacity to heal from CIRS than most doctors. Use code CLARITY10 for 10% off your course fee.

Naturopathic medicine has a lot to offer patients with Chronic Inflammatory Response Syndrome (CIRS)/mold illness, which is a disease characterized by widespread inflammation, toxicity and chaotic immune system responses after exposure to toxic molds in water-damaged buildings and vehicles.

Like all medical syndromes, CIRS is characterized by a cluster of symptoms. CIRS symptoms may include visual disturbances, fatigue, cognitive decline, body aches, mood changes, unusual pains or skin sensations and sinus or breathing difficulties. Fortunately, CIRS responds very well to Naturopathic treatments such as targeted herbal, nutritional and detoxification therapies.

CIRS vs Mold allergy

It’s important to understand that CIRS is not mold allergy. A mold allergy activates a mast cell reaction that results in typical allergic symptoms such as red swollen eyes with profuse watery discharge, sneezing and itchy skin or hives. A mold allergy  results in symptoms similar to allergic rhinitis after mold exposure. It’s usually short lived and quite sudden in onset after exposure to the mold allergen.

Mold allergy rarely occurs with CIRS, as they affect different branches of the immune system. Therefore, if you have seen a non CIRS-literate practitioner who dismissed your concerns when an allergy test for mold returned a negative result, you may still have CIRS as CIRS is not an IgE, IgG or IgA classical allergic reaction.

Instead CIRS is a long term, debilitating condition that affects multiple organs and body systems. (1)

How to Diagnose CIRS

Unfortunately the symptoms of CIRS aren’t exclusive to toxic mold exposure and can occur in a number of other conditions as well, making it difficult to diagnose CIRS based on symptoms alone. To add to this complexity, there is currently no definitive test or one blood marker that can diagnose CIRS, so we rely on a combination of symptoms and laboratory tests based on the pioneering work of Dr. Ritchie Shoemaker to confirm whether a person is likely to have CIRS.

For US readers a full list of Dr Shoemakers recommended lab tests and reference ranges are available from Surviving Mold. Australian readers may like to refer to the Toxic Mould Support Australia FAQ Parts 2-3 (2), to see which tests are currently available there.

If you are unable do any blood biomarker testing there are other criteria I use to determine whether my clients might have CIRS.

  1. Past or present water-damaged building/vehicle exposure: Has there been exposure to water damaged buildings or vehicles? This can be homes, workplaces, schools or any other building that time is spent in. The exposure may have been many years ago as toxins may recirculate indefinitely until treatment is undertaken.
  2. Fluctuating symptoms: Are your symptoms worse in certain environments such as musty smelling places or where there is visible mold or water damage? Or are they better in a dry climate, away from water-damaged building or on holidays?
  3. Shoemaker symptom clusters: How many clusters are you positive for? A score greater than 8 is indicative of CIRS although anything above 6 should be investigated further. Note: you only need to have one symptom in a cluster for that cluster to be positive.
  4. Visual Contrast Sensitivity (VCS): Ideally do both the Surviving Mold and the version, if your practitioner does not have a handheld kit. Which ever version you do that has the most fails, keep tracking that.
  5. Horowitz questionnaire: Take Dr. Horowitz’ online questionnaire to determine whether tick borne infections might be playing a role as there is significant symptom overlap between the diseases as they are both biotoxin illnesses. (3. Horowitz, pg 24-27)

A note about Tick-borne and stealth infections

If it is possible that tick borne bacteria such as Borrelia (Lyme), Bartonella, Babesia (a parasite), Rickettsia, and stealth infections such as EBV and other viruses, Mycoplasma and C.pneumonaie, are also contributing to your symptoms, testing may be warranted. Labs such as Australian Biologics (Australia), ArminLabs in Germany or Galaxy DiagnosticsDNA Connexions and IGeneX in the USA, can be helpful to better understand the infectious load. Due to the intelligent and adaptable nature of these infections, a herbal provocation and sauna protocol prior to having the blood drawn increases the chances of accuracy.

Further Investigation

If one or more these initial investigations are positive, CIRS diagnosis is probable, and there is value in doing the following:

  1. Human Leukocyte Antigen (HLA): This is a genetic test through Sonic Labs or NutriPATH for Australians or LabCorp and Quest in the USA. HLA genes are a useful way of determining whether a person has healthy genes that can identify mold as a pathogen and allow the immune system to cope with it in an optimal manner, or whether they are one of the 24% of people who have HLA genes that can’t recognize mold as a problem. If the immune system can’t see and remember mould as a pathogen, there is significant risk of developing CIRS after a mold exposure.
  2. Urinary mycotoxin test: If budget allows, consider a urinary mycotoxin test through Great Plains (via RN Labs in Australia) or Realtime (via NutriPATH in Australia) to assess whether there are mold toxins within the body. Dr Neil Nathan suggest a provocation with 500mg oral glutathione twice daily for 7 days before taking the test and having an infra red sauna to assist in elimination of molds from the body to improve test sensitivity. (3. Nathan, 2018 p61)

Those tests, investigations and questions are generally able to determine whether a person is likely suffering from CIRS and the next step is to find the source of the mold exposure and cease exposure to it, or remediate the issues, before starting treatment. Dr Gupta has an excellent module (module 7) in the Mold Illness Made Simple course covering remediation for further information about this step.

There are other Shoemaker recommended tests which can be useful to determine which body systems and organs are also affected but I don’t generally run them unless the information gained would directly influence the next step of the treatment process.

For example, if there is ongoing sinus pain or frontal headaches and mucous issues with the nose and throat it can be useful to conduct a MARCoNS nasal swab with fungal culture as the results contain information that determines which treatments will be most useful to combat the specific infections found.

Regardless of whether there are also tick borne diseases present, the first line of treatment is always to clear the body of mold toxins and limit mold exposure before addressing other infections. Managing mold first reduces the total inflammatory load and allows the immune system to function more appropriately.

Stay tuned for the second part: Naturopathic Treatment of CIRS / Mold Illness, coming soon


  1. Shoemaker, R. (accessed 10/6/2019)
  2. Nathan, N. Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities, and Chronic Environmental Illness. Victory Belt Publishing (October 9, 2018)
  3. Rudd, C. (accessed 10/6/2019)
  4. Horowitz, R. How Can I Get Better?: An Action Plan for Treating Resistant Lyme & Chronic Disease St Martin’s Griffin (February 14, 2017)

Briana Gunn is an Australian Naturopath who specialises in using natural solutions to rebuild your health from CIRS and tick-borne diseases. In practice since 2009, Briana has seen over 1000 clients per year as a Naturopath and expert in CIRS, Lyme and nutritional bypasses for methylation disorders. Briana sees patients all over Australia via Skype.