Symptoms of CIRS as described by Dr. Ritchie Shoemaker

According to Dr. Shoemaker to be diagnosed with Chronic Inflammatory Response Syndrome (CIRS) patients need to have a multi-system, multi-symptom illness.

In research Dr. Shoemaker found that 35 health symptoms reached statistical significance in CIRS patients, compared to healthy controls, and these could be categorised into 13 clusters (Shoemaker et al., 2006). If a patient is confirmed to have 8 or more clusters of symptoms the likelihood of presence of CIRS exceeds 95%. A cluster is positive if you have one or more symptoms in each group. When combined with VCS deficits, symptom clusters can yield an accuracy of 98.5%, with false negatives < 2% (Shoemaker et al, 2017). [Note clusters and VCS cannot differentiate CIRS-WDB from other CIRS causes such as CIRS-PLS (Post Lyme Syndrome)].

Dr. Shoemaker says that it’s reasonable to do further testing if you are positive for 6+ symptom clusters  (Berry, 2014).

Caveat: Children

Dr. McMahon says that in children < 11 years they’ll often have only 6+ symptom clusters while children 11+ years will have 8+ symptom clusters, as per adults. Very young children, < 5 years may present with only one symptom (e.g. chronic headaches, chronic fatigue, chronic abdominal pains, inability to potty train, ADHD) that will, if not treated, develop into the full CIRS multisystem, multi-symptom illness. (Mold Illness and Children Webinar, 2017).

CIRS Symptom Clusters

Cluster 1: Fatigue Related
Chronic fatigue
Do not recover after a night’s sleep. Crash for days after doing what is normal for others before gathering enough energy to make another push to get work done.
Cluster 2: Muscle & Cognitive
Physical muscle weakness. Can’t remove twist-off lids, or lift that heavy bag of groceries.
Decreased assimilation of knowledge
Often have to re-read and read again to retain just a fraction of what would normally be retained.
Body aches
Some days are better than others, but it’s hurting all over for no apparent reason.
Can last for days of varying intensity but may be severe.
Light sensitivity
Bright light is very discomforting and may be overwhelming.
Cluster 3: Cognitive
Memory impairment
Can’t remember more than one or two items in a list without making a serious effort. It may get so bad that within minutes you forget you were even trying to remember something. Forget mid-sentence what you were about to say. Forgetting why you got up and went into another part of the house by the time you get there. Make a lot of lists.
Word recall
Frequently find yourself looking for relatively common words mid-sentence and often having to rephrase the sentence because you’re unable to recall the missing word. Generally worse when tired or stressed.
Cluster 4: Concentration
Difficulty concentrating
Unable to stay focused. More easily distracted and lose track of what was being worked on more easily. May bounce from one task to the next without any direction. Mindlessly visit the same websites or click through Facebook and YouTube pages.
Cluster 5: Pain
Joint Pain
Some days are worse than others but pain is bad enough that you limit activity or can’t sleep. May frequently take anti-inflammatory drugs like aspirin, ibuprofen, or naproxen sodium.
AM Stiffness
Waking up with stiffness in small and large joints that takes more than 15 minutes of movement to work out the kinks.
Tend to get muscle spasms without exertion and may occur even during sleep.
Cluster 6: Nerve/Skin
Unusual skin sensations
Feelings of itching, burning, and skin crawling without any visible rash or skin abnormality.
Prickly, tingling feelings often on the head but can be anywhere.
Cluster 7: Respiratory
Shortness of Breath
Even minor exertion leads to shortness of breath – carrying light objects, climbing stairs.
Sinus congestion
Thick post-nasal drip, sinusitis, or feeling stuffed up that reoccurs shortly after varying treatments.
Cluster 8: Various
Persistent/chronic cough for no apparent reason.
Unable to think as quickly or with the usual level of clarity. May have difficulty following in-depth conversations or juggling as many variables or thoughts.
Excessive Thirst
Can’t drink enough to ever feel quenched even after drinking a lot. Often feel parched and may take a water bottle everywhere. Related to low ADH.
Cluster 9: Various
Appetite swings
Hungry one day followed by disinterest in food or nausea the next.
Difficulty regulating temperature
Frequently having to add or remove clothing to keep from sweating or getting chilled. For examples, starting out with heavy bedding at bedtime that is removed later in the evening or being unable to step outside even briefly in the cold without experiencing deep chills.
Frequent urination
Drinking even as little as a cup of water results in a restroom stop shortly after. Wake up to go to the toilet several times during the night.
Cluster 10: Various
Red eyes
Eyes that appear irritated for no apparent reason.
Blurred vision
Unable to focus to the same level of sharpness or unable to see fine details that may vary from day to day. May include worse depth perception resulting in misstepping onto a curb.
Mood swings
Intolerant and quick to anger, depressed and weepy, joyful and loving, all in the same day or from one day to the next.
Ice pick pain
Brief, intense, sharp, stabbing pain that last for a few seconds occurs several or more times on a daily basis. The frequency and intensity may vary.
Night sweats
Sweating at any time of the day without exertion and frequently includes night sweats during sleep.
Cluster 11: GI & Nerve
Commonly affecting the hands, feet, and face but may be anywhere.
Watery or looser stools that may last for days or longer at a time.
Abdominal pain
Chronic nagging abdominal pain that varies in intensity. Can vary from pain over the entire abdomen to a persistent knot at the solar plexus to a dull ache over the kidneys.
Cluster 12: Various
Persistent watery eyes as if welling up to cry with tears that may be thicker. May wake up with eyes crusted over.
Losing your bearings that may vary from not being able to remember how to make the daily commute home to being unsure where you are within a shopping center. Forgetting which way to turn at the end of the drive to get to a frequented destination.
Metallic taste
Tastes like there is a copper cent or silver twenty cent in your mouth.
Cluster 13: Various
Static Shocks
Constantly getting static shocks. Have developed strategies like always closing the car door with your sleeve protected arm to prevent getting shocked. May also include causing reception to drop out when walking by a radio.
Experience motion (usually spinning) when there is none. For example, feeling as if the car is moving when stopped at a red light.

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  • Shoemaker, R.C., & House, D.E. (2006). Sick building syndrome (SBS) and exposure to water-damaged buildings: time series study, clinical trial and mechanisms. Neurotoxicology and teratology, 28(5), 573-88. PMID 17010568  | Full text
  • Shoemaker, R.C., Johnson, K., Lysander, J., Berry, Y., Dooley, M., Ryan, J. & McMahon, S. (2018). Diagnostic process for chronic inflammatory response syndrome (CIRS): A consensus statement report of the consensus committee of surviving mold. Internal medicine review, (6)5 May 2018. Full text.