CIRS Protocol

What is CIRS?

Chronic Inflammatory Response Syndrome (CIRS) is a multi-system, multi-symptom illness first described by Dr. Ritchie Shoemaker. It occurs in genetically susceptible individuals who are exposed to certain biotoxins or inflammagens, such as mold from water-damaged buildings, cyanobacteria, or dinoflagellates. The body’s immune system fails to recognize and eliminate these biotoxins effectively, leading to persistent inflammation and a wide array of symptoms that can affect the brain, lungs, endocrine system, and other organs.

Common Symptoms

• Chronic fatigue and brain fog
• Headaches and light sensitivity
• Joint or muscle pain
• Digestive issues
• Mood swings or anxiety
• Shortness of breath or chronic cough

How CIRS Develops

In CIRS, exposure to biotoxins triggers the innate immune system but fails to activate an adequate adaptive immune response. As a result, inflammatory mediators like TGF-β1, MMP-9, C4a, and C3a remain elevated, causing systemic inflammation. Genetic factors—especially certain HLA-DR haplotypes—play a major role in susceptibility.

Diagnosis Criteria

1. Documented exposure to a water-damaged or toxin-producing environment
2. Multiple organ system symptoms (at least six systems affected)
3. Abnormal laboratory markers (MSH, TGF-β1, C4a, C3a, MMP-9, VIP, VEGF)
4. Improvement with appropriate treatment following the Shoemaker Protocol

The Shoemaker Protocol

The Shoemaker Protocol is a stepwise treatment plan designed to identify, remove, and correct the inflammatory consequences of biotoxin exposure. It remains one of the few structured approaches supported by peer-reviewed clinical evidence for CIRS management.

Core Steps of the Shoemaker Protocol

5. Remove exposure: Identify and leave the contaminated environment.
6. Bind biotoxins: Use Cholestyramine or Welchol to interrupt enterohepatic recirculation.
7. Treat MARCoNS: Address Multiple Antibiotic-Resistant Coagulase-Negative Staphylococci in the sinuses.
8. Correct anti-gliadin antibodies: Manage gluten sensitivity if present.
9. Correct hormone imbalances: Address low MSH and VIP levels, and normalize ADH/osmolality.
10. Manage inflammation: Reduce MMP-9 levels through a low-amylose diet and omega-3 supplementation.
11. Restore neuroendocrine balance: Use VIP nasal spray once all other steps are completed and exposure is controlled.

Clinical Outcomes

Studies have shown that patients who complete the Shoemaker Protocol experience measurable improvements in inflammatory markers and symptom resolution. However, the process requires strict environmental control and collaboration with a trained practitioner familiar with CIRS and biotoxin-related illness.

Key Takeaways

• CIRS is a chronic, multi-system illness triggered by exposure to biotoxins.
• Proper diagnosis requires both clinical and laboratory evaluation.
• The Shoemaker Protocol provides a structured and evidence-based treatment path.
• Removing exposure is the most critical and often the most challenging step.
• Monitoring biomarkers helps confirm recovery and prevent relapse.