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FAQ
CIRS
Chronic Inflammation Response Syndrome
(Mould Illness)
CIRS is a multi- symptom, multi-system illness that typically involves symptoms from at least six clusters and is triggered by a bio toxin exposure – most commonly mould.
CIRS Symptom Clusters
CIRS Explained
CIRS, short for Chronic Inflammation Response Syndrome, is a biotoxin driven illness that affects multiple systems and produces multiple symptoms, seemingly unrelated.
People develop CIRS as a result of exposure to biotoxins, most usually from a water damaged building (WDB), but also as a result of tick bites, contaminated water (blue-green algae), contaminated fish, or spider bites. Lyme disease is a key trigger for CIRS.
95% of people with CIRS have a genetic susceptibility where they lack the normal immune response gene that is required to form antibodies to biotoxins, such as those created in a water damaged building.
24% of the population have been found to have this genetic susceptibility in their HLA DQ/DR genes, meaning they do not have the immune response genes that are required to form an antibody to biotoxins.
Not everyone with this genetic susceptibility will react to a water damaged building, as there is usually an inflammatory event such as glandular fever, viral infections, Lyme disease, surgery or extreme stress that has switched on the HLA genes.
Regardless of the initial cause these people will usually react to the biotoxins present in a water damaged building.
As a result, in simplified terms, these biotoxins circulate indefinitely (unless removed by a binder – which is part of the Shoemaker Protocol to treat CIRS) throughout the body, causing a cascade of chaotic inflammation.
This explains why the majority of the population may not experience adverse health effects living in a water damaged building, the remaining 24% can potentially experience adverse health effects.
Dr Shoemaker has named this bio toxin driven, multisystem and multisymptomatic illness Chronic Inflammation Response Syndrome, or CIRS.
CIRS typically involves symptoms from at least six symptom clusters and commonly up to 10 symptom clusters.
The cornerstone symptoms are fatigue, memory and concentration problems.
Taking the online VCS test is the first step and is used as an indicator for those suffering from Biotoxin or volatile organic compound (VOC’s) exposure.
ERMI: Environmental Relative Mouldiness Index
Performing an ERMI is a way to determine if the environment in a home or other building, which has been subject to water intrusion (WDB), has suffered from mould amplification likely to cause deleterious health consequences to occupants.
Samples for ERMI are analysed using Mould Specific Polymerase Chain Reaction (MSQPCR) methods. Data obtained from this is assessed and interpreted by reference to a database of similar ERMI data acquired normal homes. The test is an objective, sensitive and standardised method that can identify and quantify selected mould species.
The usual sample is settled dust collected in homes and buildings to determine the concentrations of the DNA of the different species of mould. While there is a wide spectrum of moulds that can be analysed in this way, 36 species of mould are detected. The research on which the procedure is based selected 26 of those moulds as being associated with WDB (the Group 1 moulds) and 10 common species (Group 2) that were not found to be associated with WDB. The first step to calculate the ERMI is to total the individual log10 of the Group 1 moulds and then total the individual log10 of the Group 2 moulds. The ERMI is then the difference between these two totals. Simply put a home or building with a high ERMI value has a greater chance of causing a mould problem for its occupants than those with lower ERMI.
1. Take the 'How do I know if I need a mould assessment' questionnaire.
2. Have a look around your home in the areas that mould often lurks such as the subfloor, under beds, behind mirrored sliding doors, behind hanging art work or framed photos, in undersink cabinets, at the back of wardrobes and the side of timber furniture. Use an LED torch, or even just the torch on your phone. You may be surprised to pick up mould in places that you had not noticed it before.
If you have chronic health issues or suspect that you are mould affected then please do not disturb carpets as when you lift a carpet that is mould affected it will send thousands of spores into your breathing zone. You should have full face protection of the eyes and airways before lifting a carpet that is supected to be mould affected.
Mould is commonly found on the back and sides of timber furniture - particularly on the lower level of a house located above a soil subfloor that is poorly drained or poorly ventilated.
Mould is often found under beds. This was a metal bed frame and the mould grew on the collected dust. Metal frames can reach dew point due to poor insulative properties, resulting in condensation. This home was unoccupied for an extended period of time and therefore lack of heating, lack of ventialtion and settled dust resulted in unchecked mould gorwth.
Carpets can often harbour hidden mould. If the timber strip (smooth edge) is blackened then this means it has suffered moisture ingress. Please do not disturb carpets if you are chronically ill or suspect to be mould affected. Carpets that back onto wet areas, at the entrance to wet areas and under doors and windows are more likely to have suffered moisture ingress.
Dampness in the subfloor can result in efflorescence and fungal / bacterial growth. This can be caused by poor drainage (if the soil is wet then this may be your issue), broken plumbing and / or inadequate ventilation.
Being aware of the huge crossover of diseases and symptoms associated with environmental sensitives is vastly important. It is not enough to just look at one potential trigger as there is usually a synergistic effect. Those who become sensitive to allergens such as mould are then more likely to become chemically and / or electrically sensitive. Those suffering from CIRS are also likely to be affected by exposure to chemicals and EMF’s. As Building Biologists we are trained to look at the whole home and multiple exposures. Tables sourced from Nicole Bijlsma’s latest book which I highly recommend.
This will depend on the size of your home and if you have a subfloor or ceiling cavity. A small unit will take less than 2 hours, a moderate sized home 2 to 3.5 hours and a large home with multiple levels will take 3 to 4 plus hours. Please make sure you leave enough time for a full assessment to take place. It is better to leave more time and therefore not be rushed.
This will depend on whether we take samples as these do need to be sent to the lab for anlaysis. All reports should be with you within 2 weeks of the assessment as long as the invoice has been paid in full. If you need a report for a health appointment or to make a purchasing or leasing decision then please make us aware of this at the time of booking and we will let you know if the time frame is workable.
If you suspect that you are suffering from a mould / water damaged related illness such as CIRS and there is visible mould then it is recommended that air and surface samples are taken. This gives vital information to a professional remediator and your health care provider.
When you combine air and surface samples with moisture mapping and a visual inspection you can pass this information to a mould remediator. In the absence of samples a mould remediator may recommend that the whole residence is remediated and this may not in fact be necessary. It is also highly recommended to have a base line so that you can confirm that professional remediation has been successful. Without before samples you have nothing to compare a post remediation sample with.
If you suspect that you are suffering from a mould / water damaged related illness such as CIRS and there is no visible mould or moisture then air samples may be taken to eliminate mould as a possible trigger for your illness. Sometimes mould is hidden in wall cavities such as behind bathroom tiles or kitchen cabinets and taking air samples may be a precursor to destructive sampling. It may be that your heating / cooling system is the underlying issue and therefore sampling may eliminate or confirm this as a possible trigger for your illness.
We always need to take at least one outdoor air sample to compare the indoor samples to.
There are pros and cons with all types of mould sampling and it is important that samples are not the only information used to assess a property. Moisture mapping, a visual inspection, a thorough history of any water ingress and condensation and noting the presence or absence of odour are important aspects of a mould and moisture assessment. As a Building Biologist we use many tools to assist us in such an investigation and we must weigh the strength and weaknesses of each tool and put them in context of the environment being assessed.
Surface samples and air trap spore sampling look at total counts of both viable (live) and non-viable (dead) spores as dead mould can still have health impacts. Because there is no culturing of the sample the lab can only identify to the genera and not to the species. This is however an affordable method of testing that will allow you to assess room by room, therefore helping to identify which areas are most affected and therefore require remediation. The identification of Hyphal Fragments may also assist in identifying if the sample was taken close to an active mould colony. There are certain genera that require high levels of water to support growth and therefore the identification of these genera may indicate a serious water ingress issue. The limitation is that mould spores are not always airborne and therefore disturbing the room a little (such as folding back the bed covers to simulate getting into bed) will give a better indication of what moulds you may be exposed to.
ERMI sampling analyses the DNA in settled dust and therefore will give you an overview of the extent that a home or building is affected by mould. It looks at the history of the site assessed as mould spores settle into the dust. This analysis will analyse viable (live) and non-viable (dead) spores and fragments to the species level. The HERTSMI-2 analysis that is then calculated from the ERMI can help people suffering from CIRS (due to exposure to a water damaged building) identify if the building will support their health or if it requires remediation. Due to the higher cost of ERMI analysis it is often not viable to test each room in the home and therefore you cannot use it to locate the source of the mould contamination. A professional remediator cannot complete a scope of works based on a single ERMI. It is also an assessment that was formulated in the USA for research purposes and therefore there is some controversy around how applicable it is to test Australian homes. We do find this test useful when assessing the environment of a CIRS sufferer, however it should be taken in context of a full assessment involving moisture mapping, visual inspection, building history, client health history and the detection of odour.
We do not recommend DIY culture plate sampling as this only assesses viable mould and dead mould can also have health implications. There are also many ways that a DIY cultured sample may become compromised.
PREPARATION:
Please email copy of most up to date floor plan (can often be found on real estate listings)
Complete and return the questionnaire by email at least 24 hours prior to assessment
Please do the following online VCS Test before our appointment and email results.
http://www.survivingmold.com/diagnosis/visual-contrast-sensitivity-vcs
(USD$15 tracks results)
https://www.vcstest.com/ (1st test is free)
Building Biology Assessment:
24 hours prior to assessment:
Please close doors and windows
Do not dust or vacuum
Turn off dehumidifiers / humidifiers
Turn off air purifiers
Please be prepared to turn off your wireless modem
Please keep dogs on a leash if they are likely to investigate equipment
For VOC / Formaldehyde sampling:
24 hours prior to assessment:
Please close doors and windows
Do not dust or vacuum
Do not cook by frying
Do not clean with bleach or other chemical products
Do not use aerosol deodorants / hair sprays / air fresheners / perfumes
Discard perfumed air fresheners
Turn off air purifiers
Please keep dogs outside if they are likely to investigate equipment
PAYMENT:
Deposit: Deposit of $150 upon confirmation of appointment
Cancellation: 24 hours is required to cancel or change appointment times. Otherwise a $150 fee will be charged
Final Payment: Required before results and report are forwarded
Form of payment: Electronic Bank Transfer
Payment by Direct Deposit:
Bank: Commonwealth Bank Australia
BSB: 06 2287
Account #: 1035 4074
Account Name: Jeanette Williams
Here are 21 things to consider to reduce the risk of moving into a home that will not support your health. Remember that the cost of moving into a home with mould problems is not just your health but all your belongings may become contaminated. If you are moving from a mould contaminated environment then be careful of what you take to a new home.
Try to visit the property when it is raining or after a heavy rain – you can see if water pools around the property or if it smells damp inside.
Homes located on a slope can be challenging – check the subfloor for dampness and look for drainage. If there is a strong damp odour you may want to give this one a miss.
Use the torch on your mobile phone to discreetly check the bottom, sides and back of furniture and skirting boards for mould – it shows up under the LED light. (See photos of skirting board in natural light and skirting boards under LED torch light).
Discreetly check the backs of curtains, blinds, window frames, the back of wardrobe doors and the back corners of wardrobes – these areas are less likely to have been cleaned and are common places for mould growth due to condensation.
Does the linen cupboard smell fresh or musty?
Make sure the property has good northerly exposure, units and town homes with a shared northern wall are more likely to have condensation problems.
A flat roof is often problematic as they eventually tend to leak and condensation will collect and drop onto the ceiling rather than running down to the eves.
In my experience those suffering from CIRS do not do well in a home with a soil subfloor.
Plants close to the foundations are ill advised as they can block sub floor ventilation and also create high moisture in the foundations.
Check for an exhaust fan in the bathroom – older properties often do not have them. Also look on the outside of the bathroom for an external vent as the majority of bathroom exhaust fans vent directly into the ceiling cavity creating elevated moisture.
Check the gutters and down pipes to ensure they are not blocked or rusted. High foliage cover over a roof is ill advised as leaves block gutters and drains causing back flow into the ceiling.
Check the outside for visible mould, moss or lichen as this indicates if there is dampness in the exteral environment.
Check for peeling paint, swelling and bubbling on lower walls, cornices and ceilings, especially areas bordering or below bathrooms and laundries as well as walls built into the earth and above sandstone foundations. Look out for efflorescence on bricks and concrete. These are signs of potentially high moisture content in the structure of the building.
Is the meter box on the otherside of the wall to a bed, desk or sofa?
When looking at units check to see if the meter boxes / smart meters are on the wall of the unit you are inspecting. This can create high levels of electromagnetic fields, especially at times of high power use.
Are there powerlines running outside bedroom windows? This increases your risk for exposure to elevated electromagnetic fields while you sleep.
Are there high voltage powerlines within 600m of the property? This increases your risk for exposure to elevated electromagnetic fields througout the property.
Are there mobile phone transmission towers within 400m of the property? The closer to mobile phone transmission towers the higher your potential exposure to high frequency electromagnetic radiation.
Is it within 500m of a busy road? This increases your risk for traffic related air pollution.
Is it within 2km of a golf course, farm, timber plantation or garden centre? This increases the risk for pesticide drift.
Has it recently been painted or is there new carpet? If it has that new paint smell then it can be problematic for those with chemical sensitivities.
If in doubt or you still love the place, then book a pre-lease / pre-purchase inspection. The investment of an assessment can save much heartache, expense and potential poor health in the future.