What test will diagnose me with CIRS/Mould Illness?

Diagnosis should first and foremost be made by a CIRS/mould-aware health practitioner looking at a patient’s symptoms and diagnoses, health history, and environmental history in conjunction with biomarker testing. No one test, or even a panel, can diagnose CIRS with 100% accuracy.

How many of the tests below need to be abnormal for a CIRS diagnosis?
Short answer

In 2003 Dr. Shoemaker said at least 3 of  6 of biomarkers (known at that time) if symptom and environmental criteria were met. Speaking on the Low Tox Life podcast (#55, 50m02s) Dr. Sandeep Gupta said “Once you have around 3 abnormal markers, that should be sufficient.”

Other doctors will diagnose on other testing such as a positive urinary mycotoxin test. Whether this means the patients has CIRS, mycotoxicosis or mycotoxins coming from a normal diet is matter of some debate.

Long answer

From Dr. Shoemaker’s original Sick Building Syndrome (SBS) criteria from 2003 (note, this was before the discovery of C4a and TGF-b1 being elevated, and VIP being lowered, in CIRS):

1. We propose that a definition of a case of SBS include each of the following elements
– potential for exposure to buildings with a documented toxigenic fungi, evident fungal growth or a history of water intrusion with musty smells;
– presence of multiple symptoms in at least 4 of 8 system categories
– absence of confounders
2. At least 3 of the following 6
– VCS deficits
– MSH deficiency
– MMP9 elevation
– HLA genotype
– ADH/osmolarity dysregulation
– ACTH/cortisol dysregulation
3. Final criteria for case management
– Response to CSM, with abatement of symptoms and resolution of VCS deficit to control levels
– Reduction of leptin, if elevated, with treatment
– Reduction of MMP9, if elevated, with treatment
4. Clinical note needs to be made of
– Presence of MARCoNS in deep nasal spaces
– Elevated levels of myelin basic protein antibodies”

From a more recent (2020) paper:

…The difference is that CIRS literature has data on many recognized biomarkers and a published treatment protocol [7], but PICS does not. These biomarkers include symptom clusters for CIRS acquired following environmental exposures to biotoxins and inflammagens in water-damaged buildings (WDB), finding at least 8 of 13 clusters present.
Proteomic biomarkers compared to controls [4] include
(i) increased relative risk for specific HLA haplotypes;
(ii) presence of a distinctive deficit seen in visual contrast sensitivity (VCS);
(iii) reduction of mean levels of melanocyte-stimulating hormone (MSH);
(iv) dysregulation of ACTH to cortisol and
(v) ADH to osmolality;
(vi) elevated C4a,
(vii) TGF beta-1, and
(viii) MMP9;
(ix) suppression of vascular endothelial growth factor (VEGF);
(x) increased incidence of antigliadin and
(xi) anticardiolipin antibodies [7].
Functional CIRS WDB biomarkers include
(a) a distinctive “fingerprint” of volumetric abnormalities [22-24] seen on NeuroQuant™;
(b) reduction of VO2 max and
(c) anaerobic threshold shown by pulmonary stress testing;
(d) elevated pulmonary artery pressures at rest, or (e) after exercise on echocardiogram;
(f) transcriptomics.

Tests 1-5 are the classic Dr. Shoemaker CIRS biomarkers for screening and diagnosis of CIRS

1. Visual Contrast Sensitivity (VCS) (Free or low cost)

A contrast sensitivity test measures your ability to distinguish between finer and finer increments of light versus dark (contrast).  Inflammation from CIRS can cause loss of this contrast sensitivity. Dr. Shoemaker claims an accuracy of 92% (8% false negatives, 2% false positives) for the handheld kit, which is the gold standard. Accuracy of the online versions has never been formally studied but, anecdotally, practitioners find it less that those numbers. TMSA advises to try both the Surviving Mold ($15 USD) and VCSTest (free or contribution) and stick with the test that you find most accurate, usually the one where you get more fails.

Surviving Mold

2. Blood tests (Medicare rebateable)

The following are blood tests with Medicare item numbers. To have these bulk billed will depend on the willingness of your physician to tick the direct bill (DB) box on a test requisition form. VIP and Leptin are the only two tests that fasting is required.

HLA DR/DQ Gene Test
The HLA DR/DQ gene test show haplotypes (gene combinations) of susceptibility to CIRS-WDB/mould illness, Post Lyme Syndrome (PLS) and multi-susceptible (susceptibility to mould, PLS and dinoflagellates/ciguatera/toxic algae). Being positive does not mean you’re destined to develop CIRS. Interpretation can be done by a CIRS aware health professional or the HLA calculator. If you are still unsure please post your results in the TMSA Facebook group.

Correct laboratory group — Sonic Pathology

Sonic Pathology Australia are a network of pathology laboratories in every Australian state. See their website or the picture below for locations in your state.

Test information: HLA Panel Screen (DR and DQ)

Test name: Ask the GP to request “HLA DR-DQ typing” (Do NOT write coeliac)

Medicare rebate

It can be fully or partly Medicare rebateable depending on your practitioner and laboratory. Medicare item number 71151. No rebate is available via NutriPATH.

Price varies from lab to lab but ranges from $119 to $180.


NutriPATH do report the HLA DR/DQ test in the correct format also.

Test name: HLA DQ/DR Genetic Studies
Test number: 3401
Test cost: $180

Vasoactive Intestinal Polypeptide (VIP)

About: VIP is produced in many tissues including the gut, pancreas, and suprachiasmatic nuclei of the hypothalamus in the brain. VIP stimulates contractility in the heart, causes vasodilation, increases glycogenolysis, lowers arterial blood pressure and relaxes the smooth muscle of trachea, stomach and gallbladder.

Significance in CIRS: VIP is  often, but not always, low in CIRS. Low levels can lead to inflammation, immune dysregulation, post-exertional malaise/exercise intolerance and, according to Dr. Shoemaker, multiple chemical sensitivity (MCS). Replacement via VIP nasal spray is the last step in CIRS therapy.

Collection: Most Australian pathology labs can collect and send to Royal Prince Alfred/Sydney Southwest Pathology. A special collection tube is required and will usually have to be ordered in before the blood draw. Consult with your local path lab to arrange. VIP collection and information page.

Medicare: Medicare item number 66695.
Normal Range:  6.81-18.65 pmol/L (23-63 pg/mL, conversion ref).

Osmolality (serum)
About: Serum (or plasma) osmolality measures the body’s electrolyte–water balance.

Significance in CIRS: Dr. Shoemaker has found 60% of biotoxin illness patients have dysregulated ADH/osmolality — seen as low ADH with high serum osmolality. Such patients have excessive thirst and may need to urinate every 30 minutes, or more, due to low ADH causing an inability to retain the water that has been drunk. As the salt level in blood rises, due to the lack of free water, some salt is released on the skin creating a battery like effect leading to frequent static shocks. Additionally migraine-like headaches due to dehydration may occur.

Notes: This should be drawn at the same time as Copeptin (see below).

Medicare: Medicare item number 66563.
Normal Range: 280-295-297 mmol/kg.

Testosterone & Oestradiol
Testosterone is often low while Oestradiol is often elevated in CIRS due to upregulation of the aromatase enzyme. Testosterone replacement is not generally recommended in CIRS as it will just convert to Oestradiol.
ACTH & Cortisol AM
Adrenocorticotropic Hormone (ACTH) is a hormone made by the pituitary gland and controls the production of another hormone called cortisol. Cortisol is made by the adrenal glands, two small glands located above the kidneys and helps to respond to stress among other functions. ACTH and cortisol are often high early in the disease while later they may drop to low-normal or below normal levels. Ideally measure these in blood, as opposed to saliva or urine, in the morning.
Dehydroepiandrosterone (DHEA) is a hormone that your body naturally produces in the adrenal gland. DHEA helps produce other hormones, including testosterone and estrogen. Natural DHEA levels peak in early adulthood and then slowly fall as you age. DHEA is often low in CIRS. Ideally test blood levels of DHEA-sulphate (DHEA-S).
Antigliadin antibodies IgA/IgG
Sometimes elevated in CIRS due to low MSH and not coeliac disease.

Normal Range: 0-19

Cardiolipin antibodies IgA/IgG/IgM
Cardiolipin antibodies are autoantibodies produced by the immune system that mistakenly target the body’s own cardiolipins, substances found in the outermost layer of cells (cell membranes) and platelets. These autoantibodies can affect the body’s ability to regulate blood clotting. These are sometimes elevated in CIRS due to its dysregulation of the immune system.

Normal Range: IgA – 0-12; IgG 0-10; IgM 0-9

3. Blood tests (Out-of-pocket)


About: Leptin is an adipokine, a cytokine released by adipose (fat) tissue. High levels can lead to persistent weight gain that is unresponsive to diet and lifestyle interventions.

Significance in CIRS: It is frequently, but not always, elevated in cases of CIRS. It is hypothesised by Dr. Shoemaker that inflammatory cytokines damage the leptin receptor in the hypothalamus thus not allowing leptin to dock and instead recirculate.

Collection: Most Australian pathology labs can collect and send to Royal Prince Alfred/Sydney Southwest Pathology, but total cost (collection plus test) varies from lab to lab. Prices for collection vary so check with your local pathology centres for the best price. In Queensland QML are the cheapest ($60). Leptin collection and information page from SSWP.

Normal range: Depends on age, sex and BMI. Dr. Shoemaker gives the following normal range: Male: 0.5-13.8 ng/mL; Female: 1.1-27.5 ng/mL.

Copeptin (was ADH)

About: Antidiuretic Hormone (ADH) or vasopressin is a neuroimmune peptide hormone made by the hypothalamus in the brain and stored in the posterior pituitary gland. It tells your kidneys how much water to conserve. ADH constantly regulates and balances the amount of water in your blood.

Significance in CIRS: Dr. Shoemaker has found 60% of biotoxin illness patients have dysregulated ADH/osmolality — low ADH with high serum osmolality. Such patients have excessive thirst and may need to urinate every 30 minutes, or more, due to low ADH causing an inability to retain the water that has been drunk. As the salt level in blood rises, due to the lack of free water, some salt is released on the skin creating a battery like effect leading to frequent static shocks. Additionally migraine-like headaches due to dehydration may occur.

Notes: Most labs including the one below now offer the precursor C-Terminal Pro Arginine Vasopressin (copeptin) as a marker which has 1:1 compatibility with ADH.

Collection: Most Australian pathology labs can collect and send to Royal Prince Alfred Hospital via Sydney Southwest Pathology. Prices for collection vary so check with your local pathology centres for the best price. Copeptin collection and information page.

Normal range: 1.0-13.3 pg/ml.


4. Blood tests (Not currently available from an NATA accredited Australian lab)

TGF-b1, C4a, VEGF, MMP-9, MSH
Many of Dr. Shoemaker’s core CIRS tests — the inflammatory markers Transforming Growth Factor Beta-1 (TGF-b1), Complement C4a (C4a), and Matrix Metalloproteinase 9 (MMP-9), plus Vascular Endothelial Growth Factor (VEGF) and the protective neuropeptide hormone alpha-Melanocyte Stimulating Hormone (MSH) — are not currently available via any NATA accredited Australian laboratories.

Dr. Gupta is working with an Australian laboratory to collect and then send them to LabCorp in the US.

More details on these tests, including normal ranges, can be found on Surviving Mold’s Lab Tests for Mold Illness.

The GENIE transcriptomic test looks at the RNA expression of 215 genes and is the latest test created by Dr. Shoemaker and Jimmy Ryan, PhD to diagnose, track, and enable subtyping of, CIRS. It is not currently available outside the US.

5. NutriPATH biotoxin/mould panels (Out-of-pocket)

NutriPATH’s blood tests and mould panel (apart from HLA DR/DQ and MARCoNS) cannot be recommended at this time due to inaccuracies compared to Quest Diagnostics. Ref: Mold Illness in Children webinar (35m) and Low Tox Life #55 (39m22s).


Tests 6-7 are not endorsed by Dr. Shoemaker for CIRS diagnosis but are used by a number of health practitioners in the mould illness realm

6. Urinary Mycotoxin tests (Out-of-pocket)

Urinary mycotoxin testing has proven an increasingly popular biomarker test in mould illness. There are three main laboratories in the US doing this testing; Great Plains Laboratory (GPL), Realtime Labs (RTL) and Vibrant. The first two are available in Australia.

Great Plains
MycoTOX Profile [info page] Australian distributor: RN Labs
Cost: AUD$515 plus $20 postage
Client ordering: Yes, but the results will be sent to one of RN Lab’s listed health practitioners.
Mycotoxins tested: Aflatoxin M1, Ochratoxin A, Sterigmatocystin, Zearalenone, Roridin E, Verrucarin A, Enniatin B, Gliotoxin, Mycophenolic acid, Citrinin, Chaetoglobosin A
RealTime Labs
Mycotoxin Testing [info page] Australian distributor: NutriPATH
Cost: Initial #3413 AUD$630 / Review #3414 $350 / Extensive #3419 AUD$770
Client ordering: Maybe, contact NutriPATH for details.
Mycotoxins tested: Ochratoxin A, Aflatoxin group, Trichothecene group, Chaetoglobosin A, Gliotoxins (only in extensive)
Science supporting urinary mycotoxin testing

Data on mycotoxins due to inhalation or colonization:

  • Brewer, J., Hooper, D. & Muralidhar, S. (2015). Intranasal antifungal therapy in patients with chronic illness associated with mold and mycotoxins: an observational analysis. Global journal of medical research: K interdisciplinary, 15(1). PDF
  • Brewer, J., Thrasher, J. & Hooper, D. (2013). Chronic illness associated with mold and mycotoxins: is naso-sinus fungal biofilm the culprit? Toxins, 24, 6(1), 66-80. doi: 10.3390/toxins6010066  PMID 24368325
  • Brewer, J., Thrasher, J., Straus, D., Madison, R. & Hooper, D. (2013). Detection of mycotoxins in patients with chronic fatigue syndrome. Toxins, 11, 5(4), 605-17. doi: 10.3390/toxins5040605 PMID 23580077
  • Shaw, W. & Pratt-Hyatt, M. (2019). Biochemical Markers in the Urine Associated with Gastrointestinal Mold-Overgrowth Are Linked with Elevated Urinary Mycotoxins in Patients with Suspected Mold Illness. Townsend Letter, 436.
Dr. Shoemaker's view
Dr. Shoemaker’s perspective from 2019:

Even if we are presented with impeccable lab results from ELISA and thorough use of standard differential diagnosis (we aren’t), based on world-wide control data, and a robust literature on CIRS, there is no basis to ascribe any diagnostic significance to urine mycotoxin testing. ref

7. Serum Mycotoxin antibodies (Out-of-pocket)

Serum antibody testing for mycotoxins [FAQ page] Cost: USD$380
Client ordering: Yes. Have to arrange shipping via FedEx.
Info: Dr. Andrew Campbell’s laboratory in Florida, US performs serum IgE and IgG mycotoxin antibody testing for 12 different mycotoxins (24 results when combined). From the FAQ:

IgG antibodies to mycotoxins indicate that currently the immune system is reacting to mycotoxins. It is not an indicator of past exposure. IgG to a toxin such as mycotoxins, mercury, pesticides is current exposure; IgG to viruses, bacteria, molds, and parasite is an indication of past exposure. IgE is an indication that mycotoxins are stimulating mast cells, causing an inflammatory reaction and can result in Mast Cell Activation Syndrome (MCAS).

Science supporting serum mycotoxin antibody testing
  • Vojdani et al. (2003). Saliva secretory IgA antibodies against molds and mycotoxins in patients exposed to toxigenic fungi. Immunopharmacol Immunotoxicol. 25(4):595-614. https://doi.org/10.1081/iph-120026444
  • Vojdani et al. (2003). Antibodies against molds and mycotoxins following exposure to toxigenic fungi in a water-damaged building. Arch Environ Health. 58(6):324-36. PMID 14992307
  • Campbell et al. (2003). Neural autoantibodies and neurophysiologic abnormalities in patients exposed to molds in water-damaged buildings. Arch Environ Health, 58(8):464-74. https://doi.org/10.3200/aeoh.58.8.464-474
  • Brasel et al. (2004). Detection of trichothecene mycotoxins in sera from individuals exposed to Stachybotrys chartarum in indoor environments. Arch Environ Health, 59(6):317-23. https://doi.org/10.3200/aeoh.58.6.317-323
  • Campbell et al. (2004). Mold and mycotoxins: effects on the neurological and immune systems in humans. Adv Appl Microbiol, 55:375-406. https://doi.org/10.1016/s0065-2164(04)55015-3

Tests 8-9 are endorsed by Dr. Shoemaker for aiding in diagnosis

8. Nasal Swab for MARCoNS and Fungi (Out-of-pocket)

Multiple Antibiotic Resistant Coagulase Negative Staphylococci are organisms that colonise in the nasal areas due to low MSH. They produce toxins and deplete MSH further.

Microbiology Dx (USA)NutriPATH (Aus)
Microbiology DX
19A Crosby Drive
Bedford MA 01730, USA
P: +1 (781) 265 4956
W: microbiologydx.com

Ordering: Microbiology DX will FedEx collection kits free worldwide, visit the Order Kits page (add Australia to the “City, State, Zip” field) . You don’t have to use FedEx to send the sample back, simple Australia Post Airmail letter ($2.75) is usually fine. Requisition form (PDF).

Add on tests including a biofilm test which will rate the strength of the biofilm from 0 to +3 (only done if MARCoNS is present) and a fungal culture test.

Instructions: Nasopharyngeal Culture Collection Procedure


MARCoNS/bacterial culture: USD $85  (main one to get)

Fungal culture: USD$80
Biofilm analysis: USD$100

Melbourne based NutriPATH can also be used.

Test name: MARCoNS culture
Test code: 3404
Cost: AUD$150

Test name: MARCoNS & Fungal culture
Test code: 3418
Cost: AUD$300

9. Volumetric MRI Brain Imaging (NeuroQuant) (Partly rebateable)

NeuroQuant by Cortech Labs is a software program that can map brain regions for microscopic changes via an MRI scan. NeuroQuant is not used for diagnosis per se but more for tracking neuroinflammatory and atrophic changes.

Sunshine CoastSydneyMelbournePerthNZMedicareInterpretation
Pacific Radiology
49 Baden Powell Street
Maroochydore QLD 4558
P: 07 5409 2800

Note: Primarily only for the patients of Drs. Sandeep Gupta, Rashmi Cabena and Georgina Hale.

St Vincent’s Hospital
Level 3, Xavier Building
360 Victoria Street
Darlinghurst NSW 2010
P: 02 8382 3495

I-Med Network Radiology
Suite 3, Level 1
38B Albert Ave
Chatswood NSW 2067
P: 02 8440 3100

Note: This clinic is not recommended as they use a different type of MRI (Phillips Portal) to others that results in incompatible reports.

Imaging Associates Box Hill
Ekera Medical
Level 1, 116-118 Thames St
Box Hill VIC 3128
P: 03 8843 7999
F: 03 8843 7988
W: www.imagingassociates.net.au

Envision Medical Imaging
178-190 Cambridge St
P: 08 6382 3888
W: www.envisionmi.com.au
Auckland Radiology Group
101 Remuera Road
New Zealand
P: 09 529 4850
W: arg.co.nz
The MRI portion can be covered by Medicare if you fulfill the criteria for “unexplained seizure(s)” or “chronic headaches with suspected intracranial pathology” item number 63551 if referred by a General Practitioner.  Although this ultimately rests with the requesting practitioner.

There will usually be an additional charge for NeuroQuant processing by Cortechs labs ($$200 AUD).

Surviving Mold now have an online NeuroQuant analysis available that you can enter your General Morphology report and be given a mold and/or Lyme score and also looks at multi-nuclear atrophy, traumatic brain injury and asymmetry. Cost is $25 USD.

The author has no financial interest in any of the diagnostic testing companies or methods mentioned above. Being listed here does not guarantee the tests are 100% accurate or appropriate for each particular patient.
  • Lab tests for mold illness. n.d. SurivingMold.com
  • Berry, Y. (2014). The physician’s guide to understanding and treating biotoxin illness. SurvivingMold.com. Link.