What Is Mold Related Illness/
Chronic Inflammatory Response Syndrome

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Petri dishes with mold growing.

The Issue

For An Abbreviated Rendition of this, See "The Short Story"

Water-damaged buildings are not just stinky, they are a health problem. It is now quite apparent that people who have been diagnosed as having Chronic Fatigue Syndrome, Fibromylagia, Post Lyme Syndrome, Myalgic Encephalitis or any other similar inflammatory condition who are not being helped by their treatment, should take a look around them and see if they might be living, working or being educated in a water-damaged building.

How Mold Illness Presents

The person with Mold Associated Illness/Chronic Inflammatory Response Syndrome (CIRS) due to water-damaged buildings, does not usually awake refreshed. (Thought to be partly due to low MSH, however also related to lack of energy production in the cells by the mitochondria) They will have good days, and bad days, or at least better days and worse days. When they have a good day, and try to get extra work done or push themselves in some manner, they often pay for it by feeling worse. (This can be due to capillary hypoperfusion.) Usually they have achy muscles and migratory joint pain, stiffness in the morning, muscle cramping at night or even the daytime, poor memory, cognition issues, trouble with body temperature control, static shocks, resting tremor and many other symptoms.

For additional signs and symptoms, check out this page.

Mold Associated Illness or chronic Inflammatory Response Syndrome (CIRS) due to water-damaged buildings is the term used to describe an illness that is a response to unhealthy buildings with water damage. Although, there are other biotoxin illnesses that can cause a CIRS reaction, the reaction caused by moldy/bacterial ridden buildings made with toxic materials is the most common due to the type of materials used in construction in the United States, as well as what I would call lazy or uneducated construction practices. CIRS is an inflammatory response of the innate immune system when a person is exposed to the air and dust in water-damaged buildings.


It Is More Than Mold In The Buildings Causing The Illness

On this website, I talk about CIRS due to water-damaged buildings or "mold illness" a lot without mentioning the microbes and toxic chemicals that accompany it. You should know there is more than mold in water-damaged buildings that cause this biotoxin response. This is also why it is technically more appropriate to call it CIRS due to water-damaged building, rather than Mold Illness. Water-damaged buildings have a variety of nasties growing in them and releasing biotoxins as well as toxins. They contain a variety of pathogens inflammagens and toxigens. Secondary metabolites of mold and bacteria have been found in carpeting, heating, ventilation and air-conditioning systems, wallpaper and dust. Some of the nasties you can find in a water-damaged building are mold, bacteria, amoebas, actinomycetes and mycobacteria. Additionally, the chemicals in the building materials can create an environment that alters these organisms into a more pathogenic manner, as well as add to the release of toxins from the building materials themselves. You can have a release of mycotoxins, bacterial endotoxins, beta glucans, mannans, proteinases, hemolysins, c-type lectins, spirocyclic drimanes, and volatile organic compounds. It is thought that the combination of these various toxins from a variety of organisms is what causes the illness. As more is learned about this illness and the toxins causing it, the focus will grow broader to include toxic building materials and other pathogenic organisms. Indeed, mycotoxins have been identified in body fluids as well as tissue samples of people exposed to water-damaged buildings. In one clinical study Ochratoxin A (a mycotoxin) was found in 83% of over 100 individuals tested with chronic illness and a history of water-damaged building exposure. Since it is so hard to test for all of the offending organisms and their biotoxins they release into the environemnt and there are not tests to test for many of them in body fluids, it is easier to test for the inflammatory reaction to these toxic elements. Just in the last ten years, I have seen much change in this field as tests have become available to test for toxin metabolites in blood and urine. There is even testing for allergic reactions to many of the mycotoxins now.

How Does Mold Associated Illness Or CIRS Start

Chronic Inflammatory Response Syndrome (CIRS) starts when a person is exposed to a biotoxin and the body is unable to remove it. CIRS is most often found in people sickened by exposure to the interior environment of water-damaged buildings (WDB). These people are exposed to a mixture of molds and bacteria as well as the toxins they produce and chemicals in the building materials. This exposure to mycotoxins and chemicals is the main reason for CIRS. Many of these people live in a moldy environment without noticing major issues until a precipitating incident takes place. The incident can be anything that causes severe physical, mental, and or emotional stress. The stressful incident ends up pusing their body over the edge as they were probably barely keeping up with the toxins in the moldy building and now the stressful incident is too much on top of the current stress already on the body. There are other causes of biotoxin illness besides exposure to water damage buildings. Some people have more than one biotoxin illness going on at one time. it is not uncommon for someone to have both Lymes disease and Mold Illness.  There are also additional factors that can muddy the picture or make it worse such as heavy metal accumulation, bacterial or viral illness, exposure to herbicides, pesticides and other chemicals. Here are a few examples of other known biotoxin illnesses.

  • Borrellia (Lymes) - May create a toxin that creates signs and symptoms very similar to CIRS.
  • Post Lyme Syndrome - The Borrelia spirochete creates biotoxins such as Bbtox1 that causes a chronic inflammatory response syndrome. However in many cases the person may have a reaction to mold that was stirred up from the stress of the Lymes illness in addition to the Borrelia infection and the Borrelia biotoxins. If a person has been treated with antibiotics appropriately and early on, yet continues to be sick, consider either an additional CIRS due to water-damaged buildings, which has the same symptoms and chronicity of Lymes or that the bacteria Borrelia has been killed (or they could be encysted or otherwise hiding out) and the person is still reacting to Borrelia biotoxins that they can not remove from their body. See Lyme Disease.

Examples Of Less Common Biotoxin Reactions

  • dinoflagellate Ciguatera causing Chronic Ciguatera Seafood Poisoning
  • dinoflagellates such as Pfiesteria piscidia
  • Gulf War toxins
  • Spiders such as Brown Recluse
  • Scorpian bites
  • Cyanobacteria (Blue Green Algae) Exposure

See my biotoxin write-up for more details on biotoxins.

What If You Are Ill From A Water-damaged Building

These water-damaged buildings contain mycotoxins, endotoxins and volatile organic compounds that are released from the mold and bacteria. Additionally, there may be release of toxic chemicals from the building materials. Depending on the types of building materials and the type of molds and bacteria as well as their stage of growth, the toxins in the air can vary greatly. Volatile organic compounds are released in water-damaged buildings by all three of these troublemakers. So, the person living in a water-damaged building may be living in an environment where tiny bits of microscopic structural toxins as well as toxic, volatile organic compounds are floating around in the air getting in their lungs and landing on their skin.

For many people, removing themselves from these buildings will remedy their condition. For others, they can recover faster with treatment. However, for 25% of these people they may have a genetic susceptibility to the mycotoxins, endotoxins and volatile organic compounds found in these buildings that keeps them from removing these toxins from their bodies adequately. This group of people may not recover fully after removing themselves from the water-damaged building and they usually need treatment to recover.

How Does This Happen

Almost all modern buildings experience minor to more serious water damage during their life time. Any time a building has a moisture issue that is unattended or is not remediated appropriately it can lead to increased levels of microbial, and fungal agents along with the toxins and volatile organic compounds that they release into the air. This exposes those living, working or going to school in these buildings to unhealthy levels of inflammatory toxins. This exposure can lead to minor respiratory  issues as well as major body system complaints. The symptoms are quite diverse and you can find a list of them at this link.


Details on Mold/Bacteria And Their Toxins

Molds make both mycotoxins and volatile organic compounds (VOCs). VOCs are also released by toxic building materials. The VOCs are chemicals with low molecular weights  (don’t weigh much compared to other molecules), a high vapor pressure (will vaporize easily like essential oils) and are not very water soluble. This means they will evaporate into the air easily. These volatile compounds that fungi release are alcohols, aldehydes, amines, ketones, terpenes, aromatic, chlorinated hydrocarbons and sulfur-based compounds. They are all variations of carbon based molecules. They usually have some sort of odor.

Fungal VOCs come both from their primary and secondary metabolism. In primary metabolism, they are breaking food down from their environment to use nutrients needed to maintain themselves. This creates fungal VOCs in the process. In secondary metabolism the VOCs are due to competition for resources in a nutrient-poor environment.

In studies, the greatest production of VOC production seems to happen during spore formation (especially terpenes and sesquiterpenes) and mycotoxin production. Mycotoxins are different from VOCs in that mycotoxins are relatively large molecules that are not volatile and do not easily evaporate or “off-gas” into the air. This means what you smell in a “musty” house is the VOCs from mold, bacteria or chemicals and not the actual mycotoxins. However, if you smell fungal/microbial VOCs there are also mycotoxins/endotoxins there and the fungus may be actively making spores. Remember that bacteria and many chemicals in building materials also give off VOCs, it is not just mold. Each of these organisms affect each other as they compete for nutrients in the environment. Additionally, the building materials they are growing on can make a difference in which VOCs or how much VOCs are released. The building material itself gives off VOCs. Additionally, building materials that have some type of antifungal and/or antibacterial chemicals built into them will kill off many of the fungus and bacteria and select for only the strongest to live. Thus creating super bacteria and fungi that end up populating the building when it becomes water-damaged and is not properly remediated.


What These Toxins Do

Anyone can be bothered by these toxins, but some people have a genetic susceptibility that causes them to build up toxins in their body due to a decreased genetic ability to remove them. They have multiple body system dysregulation that can appear in many different forms depending on types of molds/bacteria and mycotoxins they are exposed to as well as the individual genetics/predispositions of the individual. The mycotoxins and bacterial toxins can get on their skin and cause skin inflammation and irritation that leads to various "disease processes". The toxins can be breathed into the mouth and respiratory tract and cause reactions in the mouth such as sores, or nasal congestion, sinus congestion, and asthma. The toxins can get into their gut lining and cause inflammation and discomfort as well a leaky gut and intestinal dysbiosis.  These toxins can cause metabolic changes, immune system dysregulation, neuroendocrine dysregulation, brain fog, migratory pains through-out the body, headaches, anxiety, depression and the list goes on and on. It may seem hard to believe a person can have so many symptoms from being exposed to a water-damaged building, but they can. Some symptoms are from immediate irritation and inflammation from mycotoxins but there is also dysregulation of many body systems that can be acute or chronic and effect any organ system in the body. Some people have even died or committed suicide from water-damaged building exposure that has been inadequately treated.


What Else Is Involved In This Illness

Many of these people who have biotoxin illness such as from moldy buildings, also have additional problems with envionmental chemcials, drugs, viral/bacterial disease, heavy metals, polluted water, soil, air and, stress. Just because these things are so ubiquitous and an issue for us all, do not dismiss them.

These bacteria,and fungi in water-damaged buildings also react to each other when they come across each other in the environment. They also react to chemicals in buildings. This can ramp up the amount of biotoxins they are putting out into the environment. Chemicals in building materials or chemicals used as fungicides can add to the problem. Not only can the cause a person to become sick upon contact with the volatile organic compounds from these chemicals or other exposures, but they can create super fungi and bacterial communities in the building materials. Beaware that fungicides do not usually kill all the fungus off. Some fungus will remain and become immune to the fungicide. The fungicide basically kills off the weakest and only the strongest fungus remains.

There is also the fact that multiple exposures to different things can effect the person who is exposed. For example, mouse research has shown that a bacterial toxin such as lipopolysaccharide can amplify the reaction a mouse will have to a mycotoxin such as deoxynivalenol. So, it is quite possible that a person with a viral or bacterial infection will have an increased reaction when exposed to both a bacterial toxin and a mycotoxin. It is also possible the person with a bacterial infection in their body may react more intensely to a water-damaged building.

Usually when a person is exposed to a biotoxin the bodies immune system will identify the toxin as an antigen and it will be removed from the body by a mix of the immune systems tagging it and with the help of the biotransformational system transporting it out of the body via the urine or the feces. However, some people do not have fully functioning immune system response genes (HLA-DR haplotypes) required to remove these foreign items or they have issues with their biotranformational system due to genetics or environmental causes/other toxin causes and the lack of necessary enzymes means toxins remain in the body to circulate. This causes an over-reaction of the innate immune system without a full reaction of the adaptive immune system which leads to various over-reactive inflammatory responses. In this case these biotoxins need to be removed with some additional assistance which can include nutrition, supplements, lifestyle changes, herbs, exercise etc. The fact is some peoples biotransformational systems do not work as well as other peoples due to genetic differences, or due to their biotransformational system becoming overwhelmed by a toxic environment that their body can't keep up with. This is always a factor that needs to be observed as there are supportive measures that can be undertaken.


More Details On The Immune System Reaction

As you can see CIRS due to water-damaged buildings is a reaction of an immune system and biotransformational system that is under attack and may not have all the genetic and nutritional resources it needs. There is a reaction in a broad and non-specific sense to viruses, bacteria and fungi and there is broad inflammation and damage.  We are not talking about an allergic reaction which is a more precise response of the adaptive immune system.

The person with CIRS is unable to remove the biotoxins properly and therefore these circulating biotoxins are able to bind to surface receptors of most of the cells of the body or gain entrance to the cell, with no relief in site. There is constant upregulation of the inflammatory pathways, including cytokine production, split product of complement and TGF Beta-1. Cytokines bind to receptors causing release of MMP9 into the blood. They also bind to leptin receptors in the brain, blocking the leptin receptor from working. This keeps alpha melanocyte stimulatilng hormone from being produced.

To make this even more complicated, the mycotoxins can additionally harm or decrease the activity of the immune system and the biotranformational system of the body as well as other organs in the body. Some mycotoxins are more toxic to specific organs than others. A person in this situation can end up in a viscous circle, sensitive to everything around them and feeling like the world is caving in on them. They can have a wide range of symptoms and problems.

People who have immune systems that can not identify these antigens adequately and therefore can not properly remove the biotoxins, can be identified via testing of HLA DR genes. There are also some tests to identify low functioning biotransformational/detox systems with genetic testing or with biomarker tests more focused on how a specific detox system is working.

Testing And Taking Control Of Environmental Toxins

Tests can also be used to identify if a person is having a reaction to biotoxins such as mold. There are a variety of biotoxins that all create similar responses in susceptible people. Since these responses are similar, you can test in a similar manner for biotoxin illnesses and treat in a similar fashion. Special testing can be undertaken to diagnose biotoxin illness and CIRS.

Some people are overwhelmed by the idea that they have a varient in their HLA DR haplotypes that predisposes them to becoming sick from a "moldy" environment. However, I would like to point out that most health conditions in society today are multifactorial in nature. In essence, there is an underlying genetically determined risk that requires a significant infectious or environmental “trigger” to initiate the process. A certain threshold or body burden needs to be met for each of these factors in order for multifactorial disease to occur. Taking control of these environmental triggers and supporting your bodies biotransormation (detoxification) processes can go a long way in supporting a healthy and happy body and a healthy and happy person. I find the folks who get CIRS usually have multiple problems that need to be addressed and by addressing them, their body is stronger, more flexible and able to endure some of the assaults our environment can throw at us from time to time. Additionally, it goes without saying that we all have to persevere in cleaning up the environment and live in ways that does not include the use of toxins. You can best do this by simply refusing to buy and use toxic items. Additionally, you can refuse to purchase items grown or made with toxic growing/manufacturing processes. If you  are confused as to what is and is not toxic, check out this website of the Environmental Working Group.


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