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    Biotoxin Illnesses:

    Best overviews:

    CIRS: Overview, Diagnosis, and Treatment

    Very easy to understand super in-depth overview

    Maybe my favorite overview:


    Diagnostic Process for Chronic Inflammatory Response Syndrome (CIRS) – a TON of papers linked there about CIRS:

    CIRS Overview and Diagnosis and Treatment (not exactly the same as Shoemaker but pretty much):

    Review of Mold Literature from 2011-2018

    Scientific Papers:

    Alzheimer’s and Dementia:

    Inhalational Alzheimer’s disease: an unrecognized—and treatable—epidemic

    Chlamydophila (Chlamydia) pneumoniae in the Alzheimer’s brain

    Finland’s high rate of dementia mortality due to environmental toxins

    Why does Finland have the highest dementia mortality rate? Environmental factors may be generalizable

    Environmental toxins and Alzheimer’s disease progression

    Arsenic (not exactly a biotoxin but still environmental): Positive association between soil arsenic concentration and mortality from alzheimer’s disease in mainland China

    Asthma and viral infections:

    (note: asthma is a misdiagnosis. Tests for asthma won’t show pulmonary function failing on tests but the diagnosis is still given because physicians don’t know what else to call it and aren’t aware of CIRS or viral induced asthma)

    Remediating buildings damaged by dampness and mold for preventing or reducing respiratory tract symptoms, infections and asthma (Review)

    Asthma Risk Associated with Indoor Mold Contamination in Hispanic Communities in Eastern Coachella Valley, California

    Fungal and endotoxin measurements in dust associated with respiratory symptoms in a water-damaged office building

    Asthma and respiratory symptoms in hospital workers related to dampness and biological contaminants

    Identification of mold and dampness-associated respiratory morbidity in 2 schools: comparison of questionnaire survey responses to national data


    Effects of Mycotoxins on Neuropsychiatric Symptoms and Immune Processes

    Autoimmunity (MS, Lupus, Arthritis, UC):

    Major histocompatibility complex class II and C4 alleles in Mexican Americans with systemic lupus erythematosus

    (CIRS) Reversal of Refractory Ulcerative Colitis and Severe Chronic Fatigue Syndrome Symptoms Arising from Immune Disturbance in an HLADR/DQ Genetically Susceptible Individual with Multiple Biotoxin Exposures

    Mold Exposure and Mitochondrial Antibodies

    Serum Levels of Vasoactive Intestinal Peptide as a Prognostic Marker in Early Arthritis

    The Anti-Inflammatory Mediator, Vasoactive Intestinal Peptide, Modulates the Differentiation and Function of Th Subsets in Rheumatoid Arthritis

    Vasoactive intestinal peptide gene polymorphisms, associated with its serum levels, predict treatment requirements in early rheumatoid arthritis

    Vasoactive intestinal peptide alleviates osteoarthritis effectively via inhibiting NF-κB signaling pathway

    C4a levels before and after CIRS treatment:


    Chronic biotoxin-associated illness: multiple-system symptoms, a vision deficit, and effective treatment

    Chronic Fatigue:

    Inflammation Induced Chronic Fatiguing Illnesses Inflammation Induced Chronic Fatiguing Illnesses: A steady march towards understanding mechanisms and identifying new biomarkers and therapies

    (They used urine testing for mycotoxins and didn’t look for other bacteria, but it’s on the right track) Detection of Mycotoxins in Patients with Chronic Fatigue Syndrome

    Cognitive Deficits:

    Environmental Mold Exposure, Brain Inflammation, and Spatial Memory Deficits

    COVID (long Covid):

    Treatable metabolic and inflammatory abnormalities in Post COVID Syndrome (PCS) define the transcriptomic basis for persistent symptoms: Lessons from CIRS

    DMHS (CIRS under a different name):

    (Just for fun (these papers are on DMHS – Dampness and Mold Hypersensitivity Syndrome), but the authors haven’t identified the blood markers or treatment to cure it so right now they think it’s permanent. Like I said, CIRS is unknown and very new):

    2017: An Evolutionary-Based Framework for Analyzing Mold and Dampness-Associated Symptoms in DMHS

    2017: Clinical Diagnosis of the Dampness and Mold Hypersensitivity Syndrome: Review of the Literature and Suggested Diagnostic Criteria

    2020: The Roles of Autoimmunity and Biotoxicosis in Sick Building Syndrome as a “Starting Point” for Irreversible Dampness and Mold Hypersensitivity Syndrome

    2023: In Search of Clinical Markers: Indicators of Exposure in Dampness and Mold Hypersensitivity Syndrome (DMHS)


    Citric Acid (made from fermenting aspergillus niger): Potential role of the common food additive manufactured citric acid in eliciting significant inflammatory reactions contributing to serious disease states: A series of four case reports

    Agricultural fungicides leading to more deadly fungus: Azole fungicides – understanding resistance mechanisms in agricultural fungal pathogens

    Antifungal resistance from agriculture transferring to hospitals: Does the use of antifungal agents in agriculture and food foster polyene resistance development? A reason for concern

    Genetics and Lyme Disease Papers:

    Antibiotic-refractory Lyme arthritis is associated with HLA-DR molecules that bind a Borrelia burgdorferipeptide

    HLA-DR alleles determine responsiveness to Borrelia burgdorferi antigens in a mouse model of self-perpetuating arthritis


    RNA-Seq on patients with CIRS treated with vasoactive intestinal peptide (VIP) shows a shift in metabolic state and innate immune functions that coincide with healing

    Transcriptomic signatures in whole blood of patients who acquire a chronic inflammatory response syndrome (CIRS) following an exposure to the marine toxin ciguatoxin


    Non-Thyroidal Illness Syndrome in Patients Exposed to Indoor Air Dampness Microbiota Treated Successfully with Triiodothyronine

    Immune System Changes:

    Mixed mold mycotoxicosis: immunological changes in humans following exposure in water-damaged buildings

    Mold, Mycotoxins and a Dysregulated Immune System: A Combination of Concern?

    Lyme Disease:

    CIRS and Lyme causing gene changes: Longitudinal Transcriptome Analysis Reveals a Sustained Differential Gene Expression Signature in Patients Treated for Acute Lyme Disease


    Chronic Illness Associated with Mold and Mycotoxins: Is Naso-Sinus Fungal Biofilm the Culprit?

    Biofilm formation (warning do not treat with antifungals): The Interface between Fungal Biofilms and Innate Immunity

    Antibiotic resistant bacteria makes organisms more inflammatory to immune cells (this is one paper but there are tons of papers on this): Inflammatory properties of antibiotic-treated bacteria

    Antifungals show to breed resistance: 

    Mutations in the cyp51A gene and susceptibility to itraconazole in Aspergillus fumigatus serially isolated from a patient with lung aspergilloma

    cyp51A-Based Mechanisms of Aspergillus fumigatus Azole Drug Resistance Present in Clinical Samples from Germany

    This resistance happens quickly because fungi and plants, red algae, slime mold, bacteria and cyanobacteria can transfer genes between each other as soon as one of them makes a resistant gene.. Boom, they all have it. Pretty scary.


    Moist and Mold Exposure is Associated With High Prevalence of Neurological Symptoms and MCS in a Finnish Hospital Workers Cohort

    Multiple Chemical Sensitivity: 

    Severe Sequelae to Mold-Related Illness as Demonstrated in Two Finnish Cohorts


    Structural brain abnormalities in patients with inflammatory illness acquired following exposure to water-damaged buildings: a volumetric MRI study using NeuroQuant®

    Reduction in Forebrain Parenchymal and Cortical Grey Matter Swelling across Treatment Groups in Patients with Inflammatory Illness Acquired Following Exposure to Water-Damaged Buildings

    Other Treatments:

    A Large Case-series of Successful Treatment of Patients Exposed to Mold and Mycotoxin (85% success rate – didn’t take genetics into account so kind of useless info but shows desensitization and antigen exposure can help – not recommended for CIRS)

    Dr. Andrew Campbell uses a different treatment and doesn’t believe there’s evidence for the Shoemaker protocol (but does think mycotoxins are extremely toxic). This is silly because CIRS isn’t controversial once you read the papers, they even use it to treat long COVID. There are tons of studies so he’s wrong about that but maybe his treatment helps people with full on fungal infections. He suggests this instead:

    Sporanox: 100mg a day (anti-fungal – potentially linked to grey matter atrophy)

    Phosphatidyl serine: 500mg one daily

    Melatonin: 3mg at night (protect neurons from mycotoxin damage)

    B complex

    Nitric oxide: take one twice a day to help the neuronal networks to function (N1o1 has them)


    Vitamin D: 5000 iu

    Omega q plus max: omegas and some other anti inflammatories from squid

    Probiotic: from megaspore biotic

    There is evidence sporonox can help fungal infections that cause autoimmunity so I think it depends whether it’s an active infection or immune system changes from chronic exposure. Or both? 

    Antifungal itraconazole ameliorates experimental autoimmune encephalomyelitis through a novel mechanism of action 


    Inflammatory Responses Acquired Following Environmental Exposures Are Involved in Pathogenesis of Musculoskeletal Pain

    Recent progress in clinical applications and research in fibromyalgia

    Moist and Mold Exposure is Associated With High Prevalence of Neurological Symptoms and MCS in a Finnish Hospital Workers Cohort


    This is wild. Certain areas of the brain atrophy and get swollen from CIRS. One key area is the caudate (highly innervated by dopaminergic neurons that originate from the substantia nigra pars compacta (SNc). That’s the area that is impacted in Parkinson’s. People have no idea why.

    Shows what area of the brain is impacted

    Atrophy in that exact area

    Cyanobacteria Biotoxins in Canada and Guam. They found cyanobacteria in Alzheimer’s/Parkinson’s patients brain tissue!!!: Biomagnification of cyanobacterial neurotoxins and neurodegenerative disease among the Chamorro people of Guam:

    Pfiesteria Biotoxin:

    Treatment of persistent Pfiesteria-human illness syndrome

    Pfiesteria complex organisms and human illness

    Neurobehavioral effects of harmful algal bloom (HAB) toxins: a critical review

    POTS/PANDAS, Ehler Danlos:

    Dampness and mold hypersensitivity syndrome and vaccination as risk factors for chronic fatigue syndrome

    Psychiatric Illnesses (and pain):

    Reduction in Forebrain Parenchymal and Cortical Grey Matter Swelling across Treatment Groups in Patients with Inflammatory Illness Acquired Following Exposure to Water-Damaged Buildings

    Mold inhalation causes innate immune activation, neural, cognitive and emotional dysfunction

    Neurologic and neuropsychiatric syndrome features of mold and mycotoxin exposure

    Dampness and Mold in the Home and Depression: An Examination of Mold-Related Illness and Perceived Control of One’s Home as Possible Depression Pathways

    Psychological, Neuropsychological, and Electrocortical Effects of Mixed Mold Exposure 

    A Psychiatrist’s overview of what CIRS does to the brain

    Overexpression of schizophrenia susceptibility factor human complement C4A promotes excessive synaptic loss and behavioral changes in mice 


    Medically sound investigation and remediation of water-damaged buildings in cases of chronic inflammatory response syndrome

    Sick Building Syndrome:

    CIRS: Sick building syndrome (SBS) and exposure to water-damaged buildings: time series study, clinical trial and mechanisms

    Sick Building Syndrome in Water-damaged Buildings: Bioaerosols, Fungi, Bacteria, Mycotoxins and Human Health

    Stachybotrys chartarum, Trichothecene Mycotoxins, and Damp Building–Related Illness: New Insights into a Public Health Enigma

    VCS Testing:

    Chronic biotoxin-associated illness: Multiple-system symptoms, a vision deficit, and effective treatment

    At the bottom there’s a load of papers on visual contrast testing

    Comparison of work-related symptoms and visual contrast sensitivity between employees at a severely water-damaged school and a school without significant water damage

    Examples of biotoxin illnesses impacting VCS tests:

    Water Damaged Building and Sick Patients: International Marine Terminal in Portland Maine:

    Water Damaged Building and Sick Patients: Goddard High School:

    After Hurricane Katrina, newly homeless people who had been badly exposed to water damage were housed on cruise ships with crew that had not been exposed:


    Intranasal VIP safely restores volume to multiple grey matter nuclei in patients with CIRS

    Serum Levels of Vasoactive Intestinal Peptide as a Prognostic Marker in Early Arthritis

    The Anti-Inflammatory Mediator, Vasoactive Intestinal Peptide, Modulates the Differentiation and Function of Th Subsets in Rheumatoid Arthritis 

    Vasoactive intestinal peptide gene polymorphisms, associated with its serum levels, predict treatment requirements in early rheumatoid arthritis

    Vasoactive intestinal peptide alleviates osteoarthritis effectively via inhibiting NF-κB signaling pathway

    Pharmacodynamics and toxicity of vasoactive intestinal peptide for intranasal administration

    Martínez C, Juarranz Y, Gutiérrez-Cañas I, et al. A Clinical Approach for the Use of VIP Axis in Inflammatory and Autoimmune Diseases. Int J Mol Sci. 2019;21(1):65. Published 2019 Dec 20. doi:10.3390/ijms21010065 

    Dvoráková MC. Cardioprotective role of the VIP signaling system. Timely Top Med Cardiovasc Dis. 2005 Oct 3;9:E33. PMID: 16341283.

    Henning R, Sawmiller D. Vasoactive intestinal peptide: Cardiovascular effects. January 2001. Cardiovascular Research 49(1):27-37. DOI:10.1016/S0008-6363(00)00229-7

    Delgado M, Robledo G, Rueda B, et al. Genetic association of vasoactive intestinal peptide receptor with rheumatoid arthritis: altered expression and signal in immune cells. Arthritis Rheum. 2008;58(4):1010-1019. doi:10.1002/art.23482

    Delgado M, Abad C, Martinez C, et al. Vasoactive intestinal peptide in the immune system: potential therapeutic role in inflammatory and autoimmune diseases. J Mol Med (Berl). 2002;80(1):16-24. doi:10.1007/s00109-001-0291-5

    Carrión M, Ramos-Leví AM, Seoane IV, et al. Vasoactive intestinal peptide axis is dysfunctional in patients with Graves’ disease. Sci Rep. 2020;10(1):13018. Published 2020 Aug 3. doi:10.1038/s41598-020-70138-3

    Iwasaki M, Akiba Y, Kaunitz JD. Recent advances in vasoactive intestinal peptide physiology and pathophysiology: focus on the gastrointestinal system. F1000Res. 2019;8:F1000 Faculty Rev-1629. Published 2019 Sep 12. doi:10.12688/f1000research.18039.1

    Jiang, W., Wang, H., Li, Ys. et al. Role of vasoactive intestinal peptide in osteoarthritis. J Biomed Sci 23, 63 (2016).

    Michael C. Grimm, Rosie Newman, Zeenath Hassim, Natalia Cuan, Susan J. Connor, Yingying Le, Ji Ming Wang, Joost J. Oppenheim, Andrew R. Lloyd. Cutting Edge: Vasoactive Intestinal Peptide Acts as a Potent Suppressor of Inflammation In Vivo by Trans-Deactivating Chemokine Receptors. The Journal of Immunology November 15, 2003, 171 (10) 49904994; DOI:10.4049/jimmunol.171.10.4990 

    Dulari Jayawardena, Arivarasu N. Anbazhagan, Grace Guzman, Pradeep K. Dudeja, and Hayat Onyuksel. Vasoactive Intestinal Peptide Nanomedicine for the Management of Inflammatory Bowel Disease. Molecular Pharmaceutics 2017 14 (11), 3698-3708. DOI: 10.1021/acs.molpharmaceut.7b00452

    YouTube Videos:

    CIRS: Biotoxin Treatment Protocol – An Integrative Model

    CIRS: CIRS Evaluation & Toolkit (Chronic Inflammatory Response Syndrome):

    CIRS: Biotoxin Treatment Protocol – An Integrative Model (He adds in integrative medicine to assist in healing – I can’t tolerate most of the supplement recommendations and it’s not supported by Shoemaker but the supplements he lists if tolerated do seem to be supported by other scientific literature so you can decide for yourself):

    Dr. Scott McMahon on CIRS (very knowledgeable) 

    Videos from Surviving Mold/Dr. Shoemaker 

    VCS Tests:


    Bioaerosols, Fungi, Bacteria, Mycotoxins and Human Health 





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