Due to the complexity and severity of symptoms in this condition, a systematic approach needs to be taken to evaluate and treat mold and biotoxin illness. For diagnosis, this commonly includes some combination of the following:

• Direct testing for mycotoxins utilizing Real-Time Labs or Great Plains Laboratory
• Performing a swab of the sinuses for culture and/or PCR testing to determine if there is the fungal presence of certain bacteria (MARCONS) which are characteristic of ongoing mold exposure.
• Visual Contrast Sensitivity – this test is a very inexpensive and effective method for understanding the severity of mold illness as well as tracking the effectiveness of therapy.
  Indirect testing to ensure no particular mold/biotoxin was missed as well as to determine the severity of illness and how best to initiate and progress through treatment. This testing can include markers such as MSH, VIP, TGF-b1, ADH with osmolality, testosterone, DHEA, VEGF, MMP-9, and cortisol.
• Once the diagnosis of mold/biotoxin illness has been made, a similarly integrative approach is used to help eliminate toxins from the body. Depending on the individual diagnosis, this includes some combination of the following:

The first and most essential starting point is ensuring that the patient is no longer being exposed to a sick/water-damaged building. Testing for mold spores (and toxin levels) using an ERMI, EMMA, HERTSMI, canister test or other method is critical, as ongoing exposure will surely sabotage recovery. Until you clean or move out of the toxic environment, it’s a bit like using a bucket to bail out a leaking boat.

Binders to sequester toxins and promote elimination, primarily through stool. These medications are chosen based on the specific toxins identified as well as gauging which substances are most likely to be individually tolerated. Common binders include cholestyramine, charcoal, clay, chlorella, propolmannan, and modified citrus pectin. Cholagogues to stimulate bile flow are often utilized prior to taking these binders and can be provided either orally or intravenously.

Nasal-sinus sprays or washes to eliminate abnormal fungi/bacteria associated with mold illness. This can range from prescription antibiotics and antifungals to essential oil formulas or patented colloidal silver sprays with EDTA.

Mobilizers to promote the elimination of mycotoxins/biotoxins from fatty tissues such as cell membranes. This ‘lipid-exchange’ method can be done orally or, if needed, intravenously and involves the use of true phosphatidylcholine, fatty acids in a specific ratio, folinic acid, glutathione, and other nutrients needed for cell membrane and mitochondrial membrane repair and remodeling.

Medications, either naturally or pharmaceutically, to help repair the damaged systems in the body. This is done in a very targeted and systematic way as established by Dr. Shoemaker. Commonly the goal is to eventually use VIP (vasoactive intestinal peptide) spray to repair atrophied neuroendocrine regions of the brain.
In certain cases of CIRS, the offending biotoxin comes from an implanted material or a resident commensal or opportunistic organism living in the body. This could be virtually any organism that has found a way to survive in the human body including herpes, Candida, Klebsiella, Strep, Epstein-Barr, a dental filler or implant, a stool parasite, or a tick-borne infection such as Borrelia (the organism that causes Lyme).

In these cases, since it is not always possible to eliminate the source of inflammation, the goal is to re-establish immune tolerance. This is commonly done using thymic peptide injections, immune-based therapies, and/or Low Dose Immunotherapy.

1. Hypersensitivity- The allergic effect from repeated exposure to the mold spores or particles that are released into the environment. This reaction may be IgE (histamine) mediated or inflammatory causing problems such as pneumonitis.
2. Infective – This includes mild to severe growth of the mold/fungus in the body, generally in the sinuses or lungs.
3. Toxic – The toxic black molds produce chemicals that are airborne and toxic to the human body. They are absorbed by breathing the air that is contaminated and may stay in the body for an unknown length of time, possibly months.

1. Hypersensitivity
   Immune status evaluation by blood work and allergy hypersensitivity.
   Individual skin testing with preservative-free antigens to avoid false-positive reactions.
2. Infective
   Blood antibody specific testing for the body’s immune response to the infection.
   Direct cultures of the infective site.
   Blood tests to detect genetic particles of the fungus that may be circulating in the bloodstream.
3. Toxic
   1. Urine evaluation for the toxin (mycotoxin) if present.
   2. Blood tests for the genetic ability of the exposed individual to metabolize the toxin.

1. Hypersensitivity
   Allergy immunotherapy desensitization.
   Immune enhancement with nutrients and natural substances.
   Medication when indicated to treat acute situations.
2. Infective
   The antifungal medication, oral or intravenous.
   Antifungal nutrients and natural substances.
3. Toxic
   1. Nutrients to enhance the toxin metabolism both by the oral and intravenous routes.
   2. Bile binders to hinder re-absorption of the toxic metabolites for the intestinal tract that the liver secrets in the body’s natural detoxification process.
   3. Hyperbaric Oxygen Therapy to enhance the body’s ability to mobilize and metabolize the mycotoxin (mold toxin) from the body’s cells and tissue.