Diagnosing Mold Related Illness

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Past History Of Exposure To A Water Damaged Building

Identify if the person has a past history of exposure to mold and a precipitating incident. Were they exposed to mold/water damaged buildings or other biotoxins. Do they remember some type of stressful incident that precipitated their illness. Many of these folks remember a specific incident such as a car wreck or acute illness or some type of emotional event that took place while they were living, doing business or going to school in a water-damaged environment.

Identify Sings And Symptoms

Identify signs and symptoms of reacting to a water-damaged building.

Look For All Factors That May Be Causative Or Add To The Signs And Symptoms

A look at the full toxin load, not just biotoxins is necessary as biotoxins are just one type of toxin category. All toxins together create a toxic load level that the body may or may not be able to handle. Various biotoxins can have similar symptom pictures, so ask your patient questions to ascertain if they have possibly had a history of  biotoxin exposures other than a water-damaged environment.

Identify if the person has any heavy metal issues, microbial, parasite or viral issues that can add to the drain on their health. Additionally, look at their home/work/school environment to see if they are around any toxic chemicals that could add to their toxin load. Examine their daily habits including what they eat and drink, exercise or lack, rest/restorative activities or lack, as well as the prescription and non-prescription drugs. These are all possible layers of toxicity. Realize that stress adds to this load, so you need to examine all sources of mental, emotional, spiritual and physical stress.

Besides knowing what their toxin load is, it is important to know how they are able to biotransform these toxins. It is important to examine their biotransformational capability.

While examining all the things that are not working in their life, be sure to identify what is working well in their life and what makes them happy and feel better.

A full examination of all body systems is necessary and a full physical exam can be helpful. Most of these people have "leaky gut" due to gut inflammation leading to inflammation all over the body. Keep this in mind.


The first test to help identify a possible biotoxin illness is the screening test called a visual contrast sensitivity test (VCS) that can be taken in a physicians office or you can find tests available online.

Testing for identifying biomarkers that are altered in CIRS - due to water damaged buildings is often necessary.

Genomic Analysis can help identify where inadequacies may exist in how the person's biotransformational/detoxification system is working. Nutrigenomics can be used to assist these people.

One of the most useful tests for me has been using a 24 hour urine test to ID  mycotoxins being removed from the person's body. This tells me which mycotoxins they are dealing with and I can see if they are in large or small amounts. This needs to be done as a challange test to be sure sequested mycotoxins show up in the urine.

There is additionally testing that can be done to find allergenic reactions (IgE) reactions to mold that is accomplished through blood testing or even testing offered by one lab for blood testing of IgE, IgG antibodies to the mycotoxins. I don't know how useful this test is yet. So, I can't yet recommend it.

The Usual Order Of Things

The physician will usually use a list of signs and symptoms that they look for. They will also ask the patient if they have been exposed to a water damaged building at home, work or school etc. Additionally they will see if the patient has been exposed to poisoned seafood, spider/scorpion bites, may have or had Lyme Borreliosis, may have been exposed to blue green algae or other cyanobacteria. Most patients will also have some sort of precipitating incident that starts their illness off. They may have been living in a moldy environment and it was not noticeably bothering them until some big stressor effected them. I am talking about major life stressors such as a car accident. If a patient has any of these exposures and if the patient has signs and symptoms that are seen with biotoxin disease, they may suspect CIRS. The most common type of biotoxin illness seen is that due to water damaged buildings (mold).

Next they may ask the patient to use a Visual Contrast Sensitivity test. Many physicians that treat patients for mold exposure or other biotoxin illness use the Visual Contrast Sensitivity test as an easy to take test that helps them screen their patients. If positive, more tests are undertaken. There are a variety of places patients can take this test on line or you can purchase the test to use in office. One place that offers on-lines tests is survivingmold.com They also sell a kit for your office. Dr. Ritchie Shoemaker who is the owner of the Surviving Mold website has done tremendous research on mold related illness. He has greatly contributed to the knowledge of biotoxin illness. His website is worth while to visit.

If the Visual Contrast Sensitivity test is positive, there are a variety of additional tests that can be run depending on the signs and symptoms the patient is displaying.

If the patient has a past history of exposure to a biotoxin, has signs and symptoms of biotoxin illness and tests positive for a number of lab tests used to identify CIRS patients, the physician at that point will move forward with the diagnosis. The most common biotoxin illness is CIRS - due to water damaged buildings (mold).


In 2008 the following list of diagnostic procedures were made available at the Government Accountability Office by Dr. Shoemaker.

Dr. Shoemaker may not be the first practitioner to treat mold related illness, but he certainly made many people in the United States aware of it, and I think I would be remiss to leave out his quick and dirty list he shared with everyone.

Tier 1 - exposure & symptoms

  • see it, smell it, measure it.
  • Need to have sufficient symptoms in 4 of 8 body systems. (He is talking about a list of symptoms often seen with CIRS)

Tier 2 - labs. Need to have 3 of 6 labs from

  • HLA DR - this may not be the issue - maybe we need to test for antigen presenting and receiving proteins in HLA DR/DQ system - sorry to confuse you but the new evidence appears that although there is an HLA DR/DQ issue, the type may not be important. The amount may be the issue.
  • Abnormal VCS
  • Abnormal ADH/osmo
  • Abnormal ACTH/cortisol
  • Elevated MMP9
  • Low MSH

Tier 3 - improvement. Symptoms and VCS should improve with treatment. Labs should improve.

For more information on symptoms and clusters of symptoms, see this article by Dr. Shoemaker or see my list of symptoms here.

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