Diagnosing CIRS: Your Complete Guide to Testing

Diagnosing CIRS: Your Complete Guide to Testing

Chronic Inflammatory Response Syndrome (CIRS) is really an umbrella term of symptoms with a few different causes. It can be caused by tick borne illnesses, mold exposure, and more. Characterized by extreme exhaustion, weakness, and cognitive difficulties, CIRS is a debilitating condition that’s inherently complex.

The nature of CIRS makes it difficult to diagnose. Sometimes patients go years, even decades before a full diagnosis is made. Fortunately, our understanding of this disease and its diagnostic testing has gotten much better.

I’ve found that because the functional medicine approach examines the body as a whole, it’s better at diagnosing complex conditions such as CIRS. In my article How to Know if You Have Chronic Inflammatory Response Syndrome, I explored:

  • What is Chronic Inflammatory Response Syndrome?
  • Why waiting for a diagnosis might not be the answer.
  • Testing for mold exposure.

If you need more of an introductory to CIRS, I recommend you start there. In this article, you will find a comprehensive approach to diagnostic testing for CIRS. This is a guide you can use before you see a doctor, to help you determine if you possibly have CIRS – and what testing you can ask your doctor for to achieve a proper diagnosis.

Do You Have CIRS? Testing Before The Doctor’s Office

Before you even make an appointment with your doctor there are a couple things you can do.

First, see how many symptoms you have in the CIRS symptoms clusters below. This system was developed by Dr. Ritchie Shoemaker through the analysis of thousands of patients. People with Chronic Inflammatory Response Syndrome will have symptoms in eight or more clusters.

For example, if you are experiencing night sweats that counts as a positive result for the entire cluster of symptoms in the red box on the right. Even if you don’t have red eyes, blurred vision, mood swings or ice pick pain, because you’re experiencing night sweats that counts as a positive result for the entire cluster. You only need one symptom in a cluster for it to count. You may have symptoms that aren’t on this chart, but if you have CIRS you’ll have at least eight symptom clusters. You can see how many clusters you have right now.

Diagnosing CIRS: Your Complete Guide to Testing

Next, you can take the Multiple Systemic Infectious Diseases Syndrome (MSIDS) Horowitz questionnaire. This questionnaire allows you to assign 0-3 in severity on a number of symptoms that are commonly associated with CIRS that’s been triggered by Lyme disease. At the end, you’ll have a total score which will tell you how likely it is you have a tick-borne illness.

Finally, you can take a Visual Contrast Sensitivity (VCS) test. This is a simple test that costs $10. It checks your ability to distinguish between very similar colors. Those with CIRS often are unable to differentiate between similar shades due to neuroinflammation.

If any of these tests result in a trip to the doctor’s office, be sure to bring your results with you to your appointment. These tools are excellent resources for beginning your CIRS diagnosis.

Testing for CIRS

Remember, because there are numerous underlying causes of CIRS, there are also various tactics in tackling these diagnostics. You’ll need to go through these with a doctor who’s experienced in chronic conditions. You might not need every single test listed here. Your symptoms will tell your doctor where to start.

Testing should include:

  • Mycotoxin testing – These tests can identify biotoxins in your blood created by mold.
  • Human Leukocyte Antigen (HLA) genetic test – An estimated 25 percent of the population have a genetic variation that makes their immune system bad at identifying and ridding the body of biotoxins. Sometimes when mold is an issue in a home,  the rest of the family only notices the problem after a person with the HLA gene becomes sick.
  • MARCoNS – Multiple Antibiotic Resistant Coagulase Negative Staphylococci (MARCoNS) live inside the nasal cavity. These can contribute to CIRS and need to be identified and treated.    
  • Mold CIRS Panel of laboratory markers. This panel tests for MMP9, TGF-beta1, MSH, ADH, and osmolality.


The following are biomarkers commonly associated with CIRS and should be tested:

  • Vasoactive Intestinal Polypeptide (VIP) – Normal range is 23-63 pg/mL. CIRS patients usually have lower levels.
  • Melanocyte Stimulating Hormone (MSH) – Normal range is 35-81 pg/mL. CIRS patients usually have lower levels.
  • Transforming Growth Factor Beta–1 (TGF Beta-1) – Normal range is <2380 pg/ml.
  • C4a – Normal range is 0-2830 ng/ml.
  • Antigliadin (AGA IgA/IgG) – Normal range is 0-19.
  • Adrenocorticotropic hormone (ACTH)/Cortisol – Normal range is ACTH 8-37 pg/mL. Cortisol in the a.m. 4.3-22.4 and p.m. 3.1-16.7 ug/dL. CIRS patients usually have higher levels.
  • Vascular Endothelial Growth Factor (VEGF) – Normal range is 31-86 pg/mL. CIRS patients usually have lower levels.
  • Antidiuretic hormone (ADH)/Osmolality – Normal range is ADH 1-13.3 pg/ml and Osmolality 280-300 mosmol.
  • Matrix Metallopeptidase 9 (MMP-9) – Normal range is 85-332 ng/mL.
  • Leptin – Normal range is 0.5-13.8 ng/mL for men and 1.1-27.5 ng/mL for women.

You should also have an Environmental Relative Moldiness Index (ERMI) test done. The ERMI test is a DNA-based test that’s used to identify specific species living in your home. This is beneficial because it helps identify potential mycotoxins that could be making you sick. Furthermore, it will help you know if you should have any mold remediation done in your home. Removing the cause of CIRS (in this case mold) from your life is the number one step in recovering your health.

Finding a Functional Medicine Doctor for CIRS

If you suspect you have Chronic Inflammatory Response Syndrome, it’s important you make an appointment with a functional medicine doctor who has experience in working with CIRS. If you don’t start with a doctor who’s knowledgeable in complex, chronic conditions it could end up costing you a lot more time, money, and energy down the road.

When potential CIRS patients come to me, not only do we begin diagnostics to completely identify the condition, we also start taking steps to alleviate the symptoms. Together we come up with a treatment plan that reduces any exposures, heals any outstanding infections, reduces inflammation, and supports natural detoxification.

As a certified New York functional medicine doctor with CIRS experience, I’ve helped thousands of patients get their life back from chronic, debilitating conditions. If you are struggling with your health, you don’t have to go through this alone – you can request an appointment here or call 212-696-HEAL (4325). When you catch chronic conditions early, the treatment is often easier, faster, and cheaper – don’t wait any longer, start today.