Chronic Inflammatory Response Syndrome (CIRS): The Initial Screen


Chronic Inflammatory Response Syndrome (CIRS) describes a group of symptoms and specific lab findings associated with biotoxin exposure in genetically susceptible individuals. When your doctor suspects you have CIRS, this is based initially on an eye test (Visual Contrast Sensitivity or VSC) and a set of specific symptoms.


The set of specific symptoms are outlined in something called the “CIRS Symptom Cluster Questionnaire” that is usually done on intake and during the first visit – it is that important!  Alongside a skilled medical history, this questionnaire statistically separates CIRS from all other diseases. No other illness to date will have a finding of 8/13 clusters of symptoms present! The likelihood of having a CIRS illness with a score of 8/13 or higher, is 95%!


The CIRS Symptom Cluster Questionnaire:

If one symptom or all symptoms are checked off in a category, this counts for one point for the category.

  1. Fatigue, weakness
  2. Headaches
  3. Joint aches, muscle aches, muscle cramps
  4. Unusual sharp, claw, electrical pain or ice pick pain
  5. Light sensitivity, eye redness, blurring of vision, tearing
  6. Shortness of breath, cough, sinus congestion or nasal drainage
  7. Abdominal tenderness or pain, secretory diarrhea
  8. Joint pain, morning stiffness
  9. Executive function difficulty, memory difficulty, poor concentration, difficulty with finding words, confusion, disorientation, difficulty assimilating new knowledge
  10. Mood changes; appetite swings, sweats, poor regulation of temperature
  11. Excessive thirst, frequent urination, static electric shocks
  12. Numbness, tingling, taste disturbance (metallic taste) 
  13. Vertigo, tremor, unusual skin sensations


When we add a failed VCS test to a positive Symptom Cluster Questionnaire (8/13 or greater), the likelihood that we are dealing with a CIRS illness is 98.5%. The VCS test tells us if there are visual deficits from biotoxin exposure. Biotoxins are a dangerous mix of chemicals, mold, bacteria, and inflammation provoking compounds in water damaged buildings.


Additionally, CIRS can have other triggers such as tick bites (with Lyme disease), brown recluse spider bites, and ingestion of contaminated reef fish. Biotoxins stir up inflammation by provoking immune cells to release cytokines that reduce blood flow to the retina and the optic nerve. The retina is the part of the eyes that enables vision, and the optic nerve is the nerve that carries impulses from the retina to the brain for visual information to be interpreted. With decreased blood flow to these areas, the ability to discriminate contrast is reduced. Contrast is the ability to see an edge/detect a visual pattern. 92% of CIRS patients will have a difficult time distinguishing contrast and will fail the VCS test.


There are additional tests that are important to run not only to confirm the diagnosis of CIRS but also for tracking the success of treatments. Clinically, we want you to be symptom free and living your best life, and, from a pathology perspective, we want certain lab markers – proteomics, GENIE, and NeuroQuant- to come back into a normal range. When these lab markers are dysregulated, the organs that get injured from uncontrolled inflammation are the brain, heart, and lungs.


At Linden & Arc Vitality Institute, we can help you figure out your diagnosis and determine the best courses of action based on your health needs and case. To book an appointment or for more information, contact [email protected].



Berndtson, K., McMahon, S., Ackerley, M., Rapaport, S., Gupta, S., & Shoemaker, R.C., (2008). Medically sound investigation and remediation of water-damaged buildings in cases of CIRS-WDB. Retrieved from


Shoemaker, R.C. (2010). Surviving mold: Life in the era of dangerous buildings. Otter Bay Books.


Shoemaker, R.C., Andrew, H., Annalaura, M., Ryan, J. (2017). Inflammation induced chronic fatiguing illnesses: A steady march towards understanding mechanisms and identifying new biomarkers and therapies. Internal Medicine Review (3)11, 1-29. 


Shoemaker, R.C., Johnson, K., Lysander, J., Berry, Y., Dooley, M., Ryan, J., & McMahon, S. (2018). Diagnostic process for CIRS: A consensus statement report of the Consensus Committee of Surviving Mold. Internal Medicine Review, 4(5), 1-47.


Shoemaker, R.C., Mark, L., McMahon, S., Thrasher, J., Grimes, C. (2010). Research Committee Report on diagnosis and treatment of chronic inflammatory response syndrome caused by exposure to the interior environment of water-damaged buildings. Policyholders of America. Retrieved from


Shoemaker, R.C., McMahon, S., & Heyman, A. (2020). The art and science of CIRS medicine. Ebook retrieved from 


Shoemaker, R.C., Neil, V., Heyman, A., van der Westhuizen, M., McMahon, S., & Lark, D. (2001). Newer molecular methods bring new insights into human- and building- health risk assessments from water-damaged buildings: Defining exposure and reactivity, the two sides of causation of CIRS-WDB illness. Medical Research Archives (9)3, 1-36. DOI:   


For more information, go to:



Dr. Ayla Lester, ND