From the Guidelines
Chronic Inflammatory Response Syndrome (CIRS) from black mold exposure should be treated by removing the patient from the mold-contaminated environment and following a comprehensive treatment approach that prioritizes binding toxins, reducing inflammation, and supporting detoxification pathways, rather than relying on antifungal therapy, which has been shown to be ineffective in treating Chronic Rhinosinusitis (CRS) 1. The treatment approach for CIRS typically follows the Shoemaker Protocol, which begins with binding toxins using cholestyramine (4 grams, 2-4 times daily) or Welchol (625mg, 2 tablets twice daily) for 1-2 months.
- Next, address inflammation with medications like VIP nasal spray or low-dose naltrexone (4.5mg daily)
- Support detoxification with glutathione (500-1000mg daily), N-acetylcysteine (600mg twice daily), and activated charcoal (1-2 capsules between meals)
- Improve immune function with vitamin D (2000-5000 IU daily), zinc (30mg daily), and vitamin C (1000mg twice daily). Recent research has shifted the focus from identifying the causative factors of CRS to understanding the resulting inflammation and identifying molecular pathways or endotypes that have been activated 1.
- This approach has led to the development of biologic agents that target specific aspects of type 2 inflammation, which may be effective in treating CRS patients with a pure or mixed type 2 endotype.
- The use of biologic agents that suppress type 2 inflammation may also reverse remodeling patterns, such as polyp formation and goblet cell hyperplasia, and limit recurrence of CRS. Throughout treatment, it is essential to maintain proper hydration, follow an anti-inflammatory diet avoiding sugar, gluten, and processed foods, and get adequate rest.
- Recovery from CIRS is typically slow, taking months to years, as the body gradually clears biotoxins and repairs damaged systems.
- The treatment works by binding mycotoxins in the gut, reducing inflammation, supporting detoxification pathways, and restoring normal immune function. It is crucial to note that antifungal treatments like fluconazole or itraconazole may not be necessary unless fungal colonization has occurred, and their use should be guided by the latest evidence and clinical judgment 1.
From the Research
CIRS from Black Mold
- There is no scientific evidence that exposure to visible black mold in apartments and buildings can lead to the vague and subjective symptoms of memory loss, inability to focus, fatigue, and headaches that were reported by people who erroneously believed that they were suffering from "mycotoxicosis" 2.
- The concept of toxic mold syndrome has been disproven, despite the numerous disreputable practices such as testing homes for mold spores, measuring "mycotoxins" in the urine, and testing patients for IgG to mold 3.
- Molds can cause allergies and can be a trigger for asthma, and certain specific molds such as Aspergillus can be a cause of hypersensitivity pneumonitis 2, 3.
- In immunocompromised hosts, both dermatologic and systemic infections can result from various fungi and can be associated with significant morbidity or even mortality 2, 3.
- Recent observations indicate a particular importance of mold/mycotoxin exposure in individuals with pre-existing dysregulation of the immune system, due to exacerbation of underlying pathophysiology including allergic and non-allergic chronic inflammatory diseases, autoimmune disorders, and even human immunodeficiency virus (HIV) disease progression 4.
Health Effects of Mold Exposure
- The induction of allergic immune responses by molds is generally acknowledged 4.
- Other direct health effects like the toxic mold syndrome are controversially discussed 4.
- Mold and mycotoxins can have an impact on disease progression in pre-existing immune dysregulation, and experimental in vivo and in vitro findings can present cellular and molecular modes of action 4.