SECTION 1: INTRODUCTION TO MOULD ILLNESS / CHRONIC INFLAMMATORY RESPONSE SYNDROME
TMSA is a website and facebook group which provides information and support for Australians who have health issues associated with toxins from a biological source, otherwise known as biotoxins specifically from mould and bacteria due to water damaged buildings and/or Lyme disease. We discuss the health effects of these biotoxins on our health and also the impact of water damage to our buildings where we live and work.
Mould is a microorganism, omnipresent in nature, which breaks down organic matter. It is nature’s great decomposer. Mould has been a cause of health problems for thousands of years even being referenced in the Old Testament (Leviticus 14:43). It is theorised that it has become an issue in modern times due to building practices and materials which have provided conditions for toxigenic mould and bacteria to flourish in buildings after they have experienced water damage. Mould are multi-celled fungi, while yeast such as candida albicans are single celled fungi.
The British English spelling is mould and is the one used throughout this FAQ. American English spelling omits the u.
Chronic Inflammatory Response Syndrome acquired following exposure to the interior environment of Water-Damaged Buildings (CIRS-WDB).
Mould illness is the common name for CIRS-WDB. The two terms will be used interchangeably throughout this document. CIRS is a condition caused by biotoxins (chronic neurotoxins) produced by microorganisms such as mould and bacteria such as Borrelia (Lyme). These conditions are also called biotoxin illnesses.
No! CIRS is caused by the toxigenic microbial soup found in water damaged buildings and includes mycotoxins from mould, beta-glucans from mould, endotoxins and exotoxins from bacteria (including gram positive and gram negative bacteria, mycobacteria and actinomycetes) microbial volatile organic compounds (mVOCs) from bacteria and mould, VOCs from building materials that are broken down through microbial activity and many more compounds. Mould is just the most visible, most researched and easiest microbe to test for.
There are three main schools of thought about mould causing health problems.
The traditional viewpoint is known as the allergy theory. This theory views mould as causing an allergic response that results in upper respiratory symptoms, such as asthma and rhinitis. The typical medical practitioner generally views mould as a minor ailment only. Doctors will usually test for mould allergy via IgE/IgG blood tests or skin prick tests (IgE aka immediate allergy response). Treatment is centered on exposure reduction and/or immunotherapy.
The second viewpoint is the colonisation theory. This theory views mould as mostly a problem when found growing in the body, either in the gastrointestinal tract (yeast overgrowth), nasal and sinus cavities, skin and/or bloodstream. Stool tests, culture of sinus/nasal cavity or urine mycotoxin testing are usually the way this is diagnosed. This is treated with anti-fungal medications and/or supplements and diet. Binders and other supplements such as glutathione are often used by proponents of this philosophy. Detoxification methods such as far infrared saunas and coffee enemas can be recommended as well.
The third viewpoint is the Chronic Inflammatory Response theory. This theory views mould and other microbes in water damaged buildings as being able to cause a chronic inflammatory response and a host of symptoms that can persist for years and decades even if removed from exposure, especially in a genetically predisposed subset of the population. This is due to those with impaired HLA genetics are not able to mount an effective antibody response to mould (or other) biotoxins that the host is exposed to. As a result, a chaotic and ineffective inflammatory cascade occurs which includes lowering of the regulatory hormones and increase in inflammatory cytokines. There are a number of other aberrations however these are the most important.
Note: One or a combination of the three may be an issue for a patient. TMSA and this document primarily focuses on the CIRS theory.
Dr. Ritchie Shoemaker from Pocomoke, Maryland, USA is the leading physician and researcher in regards to the CIRS theory. He has published 30 papers, mostly peer-reviewed, on the mechanisms, diagnosis and treatment of mould illness, Lyme and CIRS. See references section for links. Dr. Shoemaker has certified physicians in the USA and in Australia. Out of these Dr. Scott McMahon is a pediatrician and recommended for children under 10. Dr. Mary Ackerley is a psychiatrist and recommended for those with severe psychiatric issues.
For the colonization theory Dr. Joseph Brewer and Dr. Janette Hope are the leading proponents. See references section for papers.
Mycotoxins are the toxins produced by mould spores, both alive and dead, that are inhaled, ingested or absorbed through the skin. Although mycotoxins are potentially deadly inhaled or ingested in large enough amounts it is thought they are only 2% of the toxic load found in WDB with beta-glucans, microbial and building VOCs and bacterial toxins providing the remainder. Types of mycotoxins include aflatoxin (known to be associated with liver cancer), ochratoxin A (known to be neurotoxic and carcinogenic) and tricothecene (which is mainly produced by the black mould species known as stachybotrys).
Yes, however there is debate whether ingested biotoxins (usually mycotoxins) are as problematic as inhaled ones. Dr. Shoemaker downplays the role of food borne mycotoxins while Dave Asprey (Bulletproof Executive), Doug Kaufmann and Dr. Gabriel Cousens and others have developed diets emphasising reduction of them.
In susceptible individuals that develop CIRS biotoxins can affect every organ and every bodily system. Common symptoms include upper respiratory complaints (rhinitis, sinusitis, asthma, blood noses), cognitive issues (brain fog), flu-like symptoms, frequent colds/flus, muscle pain (myalgia), joint pain, ice pick pain, static shocks, frequent urination and thirst, neurological pain, headaches, vision problems, insomnia, malsomnia, “tired but wired” feeling and psychological issues (depression, anxiety, OCD, ADD and emotional dysregulation) etc.
Diseases associated with CIRS are usually autoimmune and neuroimmune in nature such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia, multiple chemical sensitivity (MCS), atypical multiple sclerosis (MS), post/chronic Lyme disease, irritable bowel syndrome, irritable bowel disease, POTS, rheumatoid arthritis and more.
The oil crisis of the 1970s led to the demand for energy efficient airtight homes with reduced airflow. Faster and cheaper construction methods and modern building materials were introduced such as gypsum board (plasterboard/drywall) in walls and particleboard (chipboard) for kitchen and cupboard construction which provide perfect food for mould once wet either via a water leak or humidity.
Other factors such as the switch from copper piping to plastic piping, tight deadlines in building projects which often result in insufficient time for house slabs to dry properly, subfloor areas in buildings and insufficient drainage and less than optimal sealing of walls. Additionally anti-fungal paints in buildings and fungicides in the environment meant mould mutated into more toxic strains.
The Borrelia bacteria of Lyme disease release biotoxins in their host. Even if the Lyme bacteria are killed by antibiotics the biotoxins remain, perpetuating post-Lyme syndrome, aka chronic Lyme, in susceptible individuals i.e. those with HLA genes that are post-Lyme or multi-susceptible.
In contrast to many Lyme literate doctors Dr. Shoemaker treats confirmed Lyme disease with a three week course of antibiotics (Doxycycline or Amoxicillin) and then uses his CIRS protocol to clear their biotoxins. Chronic Lyme syndrome sufferers have intensification (“herx”) reactions on his protocol. Lyme patients may have exposure to both Lyme and mould biotoxins, so removal from WDB is still critical.
Dr. Shoemaker tends to believe that co-infections such as Bartonella and Babesia are much rarer than most ILADS-trained Lyme treating doctors tend to diagnose. He believes that Lyme disease and mould illness cannot be easily differentiated on the basis of symptoms alone and that careful testing is the only way to solve this diagnostic conundrum.
NeuroQuant (volumetric MRI) can help show a fingerprint of Lyme damage for both active and chronic Lyme. Additionally Dr. Shoemaker recommends Quest Laboratory Western Blot only for Lyme diagnosis.