What Cleaning and Restoration Contractors Need to Know About CIRS

What is a restoration contractor supposed to think when they show up in response to a water intrusion or mold call and are bombarded by the homeowner’s litany of health problems? When the conversation turns from complaints about respiratory irritation, headaches, and fatigue to static shocks, numbness, tingling, vertigo, metallic tastes, and tremors, many contractors politely excuse themselves from the work because they have learned the hard way that “mold crazies” are rarely satisfied.

Interestingly, the reason such people have been given that pejorative label is because those pro- professionals who were trying to serve them did not understand enough about their situation to know how to help. It reminds me of the water restoration contractor who says that a gypcrete floor that has been flooded must be torn out because they do not have knowledge of the latest equipment and techniques to dry it. In that case, using standard approaches that meet the current industry standard of care is just not good enough. And so it is for contractors trying to serve individuals who have become sensitized1 to contaminants from water-damaged buildings. We now understand that they need to go beyond the normal style of work in regards to remediation and cleaning.


Ten to 12 years ago, claims by people who believed that wide arrays of symptoms were caused by exposure to mold were battled in court. At that time, the legal system decided that there was no scientific proof that mold exposure caused symptoms beyond allergic responses and the occasional infection in immune-compromised individuals. Still, it was obvious from the collective wisdom of anecdotal data from thousands of contractors that all the occupants of water-damaged buildings who were reporting similar health challenges could not be liars, insurance cheats, or crazy, as they were often portrayed.

We are now entering the stage where the medical community is recognizing symptoms associated with water-damaged buildings as a specific illness and has a growing arsenal of diagnostic and treatment tools to deal with it. While having a name — chronic inflammatory response syndrome (CIRS)2 — is pushing the process forward, it is really the ability to evaluate conditions through objective measures and lab tests that are having the biggest impact. Not only can the symptoms be correlated with quantifiable tests, but an improvement in those medical indices tracks closely with a reduction in symptoms.

The concept of CIRS is clearly gaining credence in the medical community. This growing awareness is based on the fact that an understanding of CIRS is resulting in better diagnostic and healing methods. One physician who has been working for the past three years with patients who occupied water-damaged buildings confirmed the association between a gene variation and the presence of CIRS with a quick assessment of his own patient records.3

Of the 227 patients he was treating for severe symptoms associated with water-damaged buildings, 222 had one of the gene types connected with an immune system that cannot effectively deal with the contaminants from such buildings. Even the doctor was amazed by the correlation of 98 percent. His records

confirmed that nearly all of his patients come from only 25 percent of the population.

In layman’s terms, two different genes have been isolated, which keep some people’s immune systems from functioning properly when they have been exposed to contaminants from water-damaged buildings. Instead of properly identify- ing and eliminating the foreign invader, those body defense mechanisms increase the problem. When viewed from a basic understanding of genetic distributions, this research made it clear that up to a quarter of the population is at increased risk from exposure to water-damaged buildings.

From a business standpoint, if only one-tenth of one percent of susceptible individuals have their immune systems triggered by mold exposure, cleaning, and restoration contractors will be dealing with over 90,000 customers.


One of the continuing problems with connecting the medical aspects of occupants from water-damaged buildings to the environmental professionals that need to help them is that each side speaks its own language. In order to get true collaboration, someone must act as a translator to bridge the terminology gaps. Therefore, a simplified explanation of CIRS is crucial to move the process forward. This is offered as a layperson’s description of each word of the acronym.

We are now entering the stage where the medical community is recognizing symptoms associated with water-damaged buildings as a specific illness, and has a growing arsenal of diagnostic and treatment tools to deal with it.

CIRS is a chronic condition because it is an ongoing illness. Although caused in part by mold, it is not an allergy. It starts when a person is exposed to a biotoxin, the technical term for a poison produced by a living organism. While the remediation industry does not hear much about biotoxins other than mold, doctors know that many natural organisms such as Pfiesteria, cyanobacteria, fungi, and the Lyme virus are spread by ticks4 produce poisons when they invade a person.

If a body responds to these biotoxins in the standard way, the impacted person does not develop a chronic condition because the immune system responds to the poison by binding it with cells that allow the biotoxin to be filtered by the liver, kidneys, and other organs. For those with certain gene types, this binding does not happen, so the biotoxin continues to circulate within their bodies.

Another way to explain this condition is to realize that in about 25 percent of the population, specific immune response genes cause the process of building antibodies to the substances from a water-damaged building to fail. In these cases, the biotoxins are not tagged, and they remain in the body indefinitely, free to wreak havoc.

The “I” in CIRS stands for “inflammatory.” The lack of antibodies despite the presence of poisons creates a vicious cycle. When biotoxins continue to freely circulate in the body, the immune system constantly fights these toxins that it cannot properly identify by releasing substances that cause inflammation. So much inflammation leads to long-term (chronic) illness. Just as important, the debilitated person is also defenseless against new exposures. The sensitized individual falls into a pattern of suffering daily from inflammation, which, in essence, is caused by an immune system that has gone haywire. Like any well-designed system, the human body has redundant safety systems. CIRS also contains the word “response” because other internal control mechanisms are also affected, as well as the immune system. For example, numerous studies have shown that neuro-regulatory hormones that help the immune system respond properly are lowered by biotoxins associated with water-damaged buildings.5

The last word in the acronym is “syndrome” because the symptoms are a result of many factors, including external exposures and internal responses. The contaminants from water-damaged buildings should trigger the activation of an immune response, but some people’s genetic structure does not allow the proper recognition of the biotoxin. Since this combination of circumstances inhibits the clearance of the poison from the body, these harmful substances continue to circulate and create continual damage. With such individuals, there is no linear dose/response relationship, meaning that even trivial exposures can create severe problems.

For sensitized individuals, even if exposure to mold and other contaminants is stopped, some will continue to suffer symptoms until their runaway contaminant-fighting system is brought under control. In short, over time, constant inflammation damages many-body systems. This explains the wide range of symptoms and leads to the conclusion that CIRS is both multi-system and multi-symptom.


At this point, the details may have started to overwhelm the core concepts of this issue. Therefore, it is important to close with some straightforward ideas that will allow a cleaning and restoration contractor to step up and assist people suffering ill health effects from exposure to water-damaged buildings.

The first takeaway is to realize that credible science is changing the way we look at water-damaged buildings. A corollary is to understand that much of the available information about health effects related to mold is too narrow and out of date to be useful for sensitized individuals. It is too narrow because it only looks at fungal materials, not the myriad factors that are present in water-damaged buildings. It is archaic because it does not even mention CIRS6 or alert individuals to the fact that some symptoms do not follow a dose/response pattern.

A second key point is that professionals need to have a better understanding of and appreciation for the challenges faced by sensitized individuals. The attached diagram shows how complicated the challenges can be for those sensitized to water-damaged buildings.

In summary, cleaning and restoration contractors that want to expand their services by helping sensitized individuals suffering from CIRS must go beyond the traditional understanding of mold and health. Do not build future services on old data and outdated ways of understanding the problem, even if those concepts are still being promoted by government agencies. There is no restriction on going beyond the existing standard of care to assist those with special circumstances and vulnerabilities. CIRS sufferers deserve nothing less than the best that the industry has to offer, particularly when the motto is: “We make it right, we promise.”RIA

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