Screening and Diagnostic Testing

Part 2: Screening for Chronic Inflammatory Response Syndrome (CIRS)

2.1 Visual Contrast Sensitivity (VCS) test

The VCS is a simple online visual test as a handheld version (preferrably) at a doctor’s office or at the Surviving Mold website. It can be used to screen patients to see if they are affected by biotoxins and also used to track treatment progress. It works because biotoxins cause hypoperfusion (lack of blood flow) throughout the optic nerve.

2.2 How much does it cost? Are there free ones?

The cost is $15 USD although there are discounts for bulk purchasing which are handy if continue with the CIRS protocol. There is a free one VCStest.com although it may not correlate that well with the handheld or Surviving Mold version.

2.3 How accurate is the VCS test?

Dr. Shoemaker’s original research showed a sensitivity of 92% with only 8% false negative results, although this was done with a handheld device. False positive were even less (2.5%) and mainly seen in those who had been exposed to occupational solvents, heavy metals, hydrocarbons and petrochemicals. In layman’s terms if you are positive via the Surviving Mold test it is very likely you have a biotoxin illness; VCS can be used to track your treatment.

If you are negative you should go onto other screening and diagnostic testing to confirm or rule CIRS out and you also won’t be able to rely on VCS to track treatment. The handheld VCS test performed by Dr. Shoemaker-approved physicians is considered to be more accurate than the online VCS tests and is recommended for tracking progress.

Part 3: Biomarker Testing

3.1 Genetic testing – HLA genes

In research conducted by Dr. Shoemaker approximately 25% of the general population have Human Leukocyte Antigen (HLA) genes that are mould, Lyme or multi-susceptible. When these genes are expressed and a person is exposed to biotoxins the immune system does not make the appropriate antibodies to clear the biotoxins due to a defect in antigen presentation. This results in a chaotic and ineffective inflammatory response. These people will not clear biotoxins that instead recirculate in the body for years, if not indefinitely, unless binding compounds are used.

3.2 How do I get tested for and interpret mould and Lyme susceptible genes?

Any GP can request “HLA DR/DQ for Coeliac Disease” or “HLA Panel Screen (DR and DQ)” but it must be performed at a Sonic Healthcare laboratory for the results to be formatted correctly. See the Resources page (“HLA DR/DQ Gene Test” section) for the Sonic Healthcare division in your state.

3.3 Is the HLA DR/DQ test Medicare rebateable?

It can be if your doctor checks the bulk bill box. The MBS schedule number is 71151. The full fee cost is $118.85 but some pathology labs will charge more.

3.4 How do I interpret the HLA gene results?

If your doctor is unable to interpret you can put your numbers into the Australian HLA-DR calculator and/or post in the TMSA Facebook group.

3.5 Does 23andme show the HLA genes?

No. 23andme does not show all the HLA haplotypes and not in a format that correlates to Dr. Shoemaker’s table.

3.6 What CIRS related hormone tests are available in Australia?

Medicare rebateable (although this depends on referring doctor)

  • Vasoactive Intestinal Peptide (VIP) – A hormone which has far reaching effects throughout the body especially in the brain, gut and lungs. It is often low. Every MCS patient that Dr. Shoemaker has seen has had low VIP. Can be covered Medicare (schedule 66695). Special EDTA/trasylol tube needs to be ordered by the pathology lab. Also note that the range (0-50 pmol/L) is too broad and should be 8-21 as per Shoemaker’s research. This is a fasting test.
  • Osmolality (serum) – Tends to be high but interpret with ADH level (see below).
  • ACTH & Cortisol AM – Hormones which are affected by low MSH. ACTH is often low while cortisol is often high, although this can be reversed.
  • DHEA-S & Testosterone – Androgen hormones often low.
  • Estradiol – The main form of estrogen in the body. Often high, especially in males.
  • Anti-gliadin antibodies – Can be present either due to coeliac disease or low MSH.

Non-Medicare rebateable (out of pocket)

  • Leptin – A hormone which is most well-known for fat storage but has more profound effects. Tends to be high especially in overweight CIRS patients. Fasting.
  • Anti-Diuretic Hormone (ADH) / vasopressin – ADH is a hormone which retains water in the body and constricts blood vessels. Often low but interpret with osmolality.

Note 1: VIP, Leptin and ADH can be collected at any pathology centre but must be forwarded to Sydney Southwest Pathology/Royal Prince Alfred Hospital Sydney.
Note 2: Costs can vary form one pathology lab to another, so ask around.

3.7 Which CIRS tests are not available in Australia?

Although NutriPATH have a panel that include the biomarkers below, to date they have not been accurate when compared to the gold standard (Quest Diagnostics USA). We cannot endorse NutriPATH until we see accurate side-by-side blood draw comparisons to Quest.

  • alpha-Melanocyte Stimulating Hormone (MSH) – A master hormone secreted by the pituitary gland which is involved in regulating inflammatory responses throughout the body. Low levels allow MARCoNS to flourish which reduce MSH further.
  • Transforming growth factor beta 1 (TGF-b1) – A multifunctional cytokine and marker of inflammation which has profound inflammatory effects. Usually elevated.
  • C3a – An inflammatory protein used in the complementary arm of the immune system. complement immune system component. Can be high in active Lyme but usually normal or low in mould illness. NOT the same as C3 routinely performed by Australian laboratories.
  • C4a – Another complement protein. Usually elevated in CIRS. NOT the same as C4 routinely performed by Australian laboratories.
  • Matrix metallopeptidase 9 (MMP-9) – An enzyme/inflammatory cytokine. Often high in CIRS. Can rise with intensification.
  • Vascular endothelial growth factor (VEGF) – Low levels cause capillary hypoperfusion which results in cells and organs not getting sufficient blood flow. Often low, although occasionally high early in the illness. Contributes to exercise intolerance/PENE symptoms.

See Surviving Mold for more detailed information and ranges.

3.8 What is the NeuroQuant MRI brain scan?

NeuroQuant (NQ) is a software program that measures microscopic volumetric changes in defined areas of the brain from a magnetic resonance imaging (MRI) scan. It be helpful in establishing a diagnosis and for tracking atrophy changes.

3.9 How can I get a NeuroQuant scan?

At present in Australia both the CIRS certified doctors and the majority of the mould literate physicians are requesting these (see Health professionals). See Diagnostic testing for locations and more information.

3.10 What about urine mycotoxin testing (Realtime labs/Biosign labs)?

Dr. Shoemaker does not recommend this test for a number of reasons.

  1. Mycotoxins only make up 1-2% of the burden of inflammagens in a WDB.
  2. These tests only look for three mycotoxins (aflatoxin, ochratoxin, trichothecene) when there have been four hundred discovered so far.
  3. These tests are polyclonal and have never had specificity of their antibodies confirmed.

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