Chronic Inflammatory Response Syndrome
Explore the CIRS framework, the stepwise protocol developed by Dr. Ritchie Shoemaker, and published research related to water-damaged buildings, environmental exposure, biomarkers and inflammatory response.
What is Chronic Inflammatory Response Syndrome?
CIRS is a term used to describe a chronic, multi-system inflammatory illness associated in the Shoemaker framework with exposure to certain environmental biotoxins or inflammagens. Water-damaged buildings are one of the environments frequently discussed in this research literature.
Environmental Exposure
Research has examined exposures associated with water-damaged buildings, microbial growth, endotoxins, actinobacteria and other environmental inflammagens.
Inflammatory Response
The CIRS framework evaluates a pattern of symptoms, laboratory markers and physiologic findings associated with persistent inflammatory response.
Individual Susceptibility
Genetic susceptibility, including selected HLA-DR patterns, has been investigated as one factor that may influence individual response to environmental exposure.
Symptoms discussed within the CIRS framework
Published CIRS literature describes a broad pattern of symptoms that may affect multiple systems. These symptoms are not specific to CIRS and require appropriate clinical evaluation.
The CIRS Protocol
The Shoemaker Protocol is described as a sequential framework for addressing exposure and related physiologic abnormalities. Medical treatment decisions should be made by a qualified healthcare professional.
Address exposure
Identify and address ongoing exposure to a potentially problematic environment.
Biotoxin binding
The published protocol discusses use of binding agents under professional medical supervision.
Nasal colonization
Selected protocols evaluate organisms or resistance patterns associated with nasal colonization, including MARCoNS.
Evaluate biomarkers
Laboratory markers described in the literature may be assessed as part of a broader clinical evaluation.
Address inflammation
The framework includes additional steps intended to address persistent inflammatory physiology.
Monitor progress
Clinical response and selected biomarkers may be followed over time by an experienced practitioner.
Understanding the indoor environment
Environmental laboratory testing can provide information about mold, actinobacteria, endotoxin and other environmental markers discussed in water-damaged building research.
Explore published CIRS and environmental health research
The following publications and research documents are provided for educational review. Select any study to open the complete document.
Inflammation Induced Chronic Fatiguing Illnesses
Mechanisms, biomarkers and therapies related to chronic inflammatory illness and persistent fatigue.
View Research PDF → TranscriptomicsTranscriptomic Signatures in Ciguatera-Associated CIRS
Whole-blood transcriptomic research following exposure to the marine toxin ciguatoxin.
View Research PDF → Human HealthThirty Years of Research on Water-Damaged Buildings
Review of published research concerning human health effects associated with water-damaged built environments.
View Research PDF → IEP ConsensusIndoor Environmental Professional Consensus
Guidance concerning investigation and remediation of water-damaged buildings in the context of CIRS.
View Research PDF → ComplementComplement Split Products C3a and C4a
Research evaluating complement activation markers in acute Lyme disease.
View Research PDF → ProtocolThe CIRS Protocol
Detailed discussion of the sequential framework used in published CIRS treatment literature.
View Research PDF → Brain & TranscriptomicsTranscriptomics and Brain Volumetrics in CIRS
Research examining cognitive impairment, transcriptomics, brain volumetrics and VIP treatment.
View Research PDF → Water-Damaged BuildingsNewer Molecular Methods for Building Health Risk
Research addressing exposure and reactivity in water-damaged building health assessments.
View Research PDF → MetabolismWater-Damaged Buildings, HIF-1A and Mitochondrial Metabolism
Research examining inflammatory physiology and metabolic changes associated with building exposure.
View Research PDF → TranscriptomicsParkinson's Disease Fingerprint in CIRS
Transcriptomic patterns investigated in CIRS patients in relation to Parkinson's disease.
View Research PDF → ActinobacteriaExposure to Actinobacteria in Water-Damaged Buildings
Research discussing actinobacteria exposure and immune injury within the CIRS framework.
View Research PDF → EndotoxinA Novel Therapeutic Approach to Parkinson's Disease
Transcriptomic investigation including patterns associated with endotoxin exposure.
View Research PDF → Post-COVIDTreatable Metabolic and Inflammatory Abnormalities in Post-COVID
Transcriptomic research exploring persistent symptoms through lessons derived from CIRS.
View Research PDF → ActinobacteriaScreening for Biomarkers of Actinobacteria
Research examining biomarkers associated with actinobacteria in water-damaged buildings.
View Research PDF → Neurologic ResearchTranscriptomic Fingerprint for Parkinson's Disease
Investigation of transcriptomic patterns found in patients with CIRS.
View Research PDF → Historical ResearchAtovaquone Plus Cholestyramine
Published research involving treatment of patients coinfected with Babesia microti and Borrelia burgdorferi.
View Research PDF →This page is provided for educational purposes and summarizes published research related to CIRS and environmental exposure. It is not intended to diagnose disease, provide individualized medical advice or recommend treatment. Clinical evaluation and treatment decisions should be made with a qualified healthcare professional.
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