Ask the doctors: Mold can pose serious health risks
Q: My 31-year-old daughter has leg cramps, fatigue and brain fog. Her apartment tested positive for mold, and she was told she has CIRS. She started a treatment called the Shoemaker protocol. Are either of those medically recognized? Might other causes or cures be overlooked?
A: Your daughter has been diagnosed with what some clinicians refer to as chronic inflammatory response syndrome, often called CIRS. Proponents of the diagnosis describe it as a systemic inflammation that involves multiple organ systems.
They believe it's an immune system response to exposure to mold, fungi or other toxins in the environment. This exposure can often occur in water-damaged buildings. However, CIRS is not widely seen as an established medical diagnosis. Almost everything about it remains the subject of research and ongoing debate. This includes the criteria for diagnosis, biomarkers and ways to treat it.
There is clear agreement on one point: Molds and other forms of fungal growth can pose serious health risks. This is particularly true when their growth is extensive or there's long-standing exposure. Symptoms often vary a lot from person to person. This can make it hard to identify a mold-related illness.
Symptoms can include nasal congestion; sore throat; and red, watery or itchy eyes. Respiratory symptoms include tight chest, wheezing and difficulty breathing. Skin symptoms include irritation like a rash or dermatitis. Even headache and fatigue can be symptoms.
Another challenge with mold-related illness is effective treatment. Fungi are more closely related to humans than bacteria. That makes it hard to develop drugs that can eliminate fungi without harming human cells. A few antifungal medications do exist. Often their use is limited to specific fungal infections. Many chronic or environmental illnesses from mold exposure rely on removing the source of exposure. Then it's about managing symptoms, usually not relying solely on antifungal medications.
This gap in available treatments has opened the door to treatments like the Shoemaker protocol. It's a multi-step approach that starts with testing for mold or moisture problems. Test results may signal exposure to fungal toxins. Then, it focuses on removing sources of exposure. The patient can be tested for certain biomarkers that are believed to signal the presence of CIRS. Then there's a course of off-label treatment with medications. The idea is the medications bind to toxins so they can be excreted in the stool.
The Shoemaker protocol is as disputed as the syndrome it is meant to treat. One concern is that a focus on CIRS may delay other diagnoses. Other causes could be missed. In a more conventional medical path, a doctor would explore other causes for your daughter's symptoms. These could include endocrine disorders, vitamin deficiencies, electrolyte imbalance, central nervous system disorders and peripheral neuropathies.
Undiagnosed asthma, Lyme disease, sleep disorder and autoimmune conditions could also be checked. If your daughter's current approach doesn't bring relief, consider encouraging her to seek a broader medical evaluation.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.
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