CIRS Symptoms: 37 Symptoms in 13 Clusters

CIRS (Chronic Inflammatory Response Syndrome) causes many symptoms at once, all over the body. The most common are fatigue, weakness, aches, headache, memory and concentration problems, and light sensitivity. Many people also have shortness of breath, cough, a blocked nose and sinuses, and joint pain [1].

Some symptoms are less obvious. They include strong thirst, frequent urination, night sweats, trouble keeping a steady body temperature, numbness and tingling, vertigo, static shocks and a metallic taste [1].

What marks CIRS is not one symptom but the pattern: many symptoms in several body systems at the same time, usually after time in a water-damaged building [1, 2].

Want to check your own symptoms? Our interactive CIRS symptom checklist counts your symptom clusters for you. This page explains what the symptoms and clusters mean, and what they cannot tell you.

What are the symptoms of CIRS?

Dr Ritchie Shoemaker is the US doctor who first described CIRS. His group asks about 37 symptoms in a structured medical history, a fixed set of questions the doctor goes through with you [1, 2].

The group’s consensus statement on diagnosing CIRS sorts these symptoms into eight broad groups [1]. A consensus statement is a document in which a group of experts agree on how something should be done. The eight groups show that CIRS can appear almost anywhere in the body:

• General: fatigue, weakness, aches, headache
• Brain and nerves: brain fog, memory problems, difficulty finding words, poor concentration, confusion, disorientation, numbness, tingling, vertigo
• Eyes: light sensitivity, red eyes, blurred vision, tearing
• Breathing: shortness of breath, cough, sinus congestion
• Gut: abdominal pain, diarrhoea, appetite swings
• Muscles and joints: joint pain, morning stiffness, cramps, sudden stabbing “ice-pick” pains
• Hormonal and regulatory (hypothalamic): excessive thirst, frequent urination, sweats, difficulty regulating body temperature, mood swings
• Unusual: static shocks, metallic taste, unusual skin sensitivity

Brain fog means that thinking feels slow and cloudy. Disorientation means briefly losing track of where you are or what time it is. The hypothalamus is a small area deep in the brain. It controls hormones, thirst and body temperature.

In the group’s 2006 study, 26 people fell ill in water-damaged buildings. At their first visit they had on average 23 of the 37 symptoms, well over half [2].

How are the 37 CIRS symptoms sorted into 13 clusters?

A list of 37 symptoms is hard to score. So Dr Shoemaker’s group sorts the symptoms into 13 clusters, small groups of symptoms [1, 3]. According to the consensus statement, this turns the long list into a scoring system that works in practice [1].

A cluster counts as positive if you have at least one symptom in it [1].

Cluster	Symptoms in the cluster
1	Fatigue
2	Weakness, decreased ability to take in new information, aching, headache, light sensitivity
3	Memory problems, difficulty finding words
4	Difficulty concentrating
5	Joint pain, morning stiffness, muscle cramps
6	Unusual skin sensitivity, tingling
7	Shortness of breath, sinus congestion
8	Cough, excessive thirst, confusion
9	Appetite swings, difficulty regulating body temperature, frequent urination
10	Red eyes, blurred vision, sweats (especially at night), mood swings, sudden stabbing “ice-pick” pains and other unusual pains
11	Abdominal pain, diarrhoea, numbness
12	Tearing eyes, disorientation, metallic taste
13	Static shocks, vertigo

Clusters as published in the 2018 consensus statement [1]; “unusual pain” is placed in cluster 10 in Dr Shoemaker’s patent [3]. The group always speaks of 37 symptoms, although the published tables name 35–36 separate items [1, 3].

Why do some clusters look odd?

Why would cough and thirst sit in the same cluster? Because the clusters are not organ groups. The group formed them with a statistical method called cluster analysis, which sorts patients’ symptoms by how they occur together [1].

So read the table as a scoring tool. It does not explain how each symptom arises.

Why do thirst, static shocks and a metallic taste matter?

Many people never mention these symptoms to a doctor. They do not seem to have anything to do with an illness. Yet in the consensus statement’s tables, they were common in people who fell ill in water-damaged buildings. They were rare in healthy controls, the people used for comparison [1]:

Symptom	People ill after a water-damaged building (n = 156)	Controls (n = 239)
Light sensitivity	71%	under 5%
Excessive thirst	69%	under 5%
Frequent urination	66%	under 5%
Difficulty regulating body temperature	63%	under 5%
Tingling	61%	under 5%
Night sweats	61%	under 5%
Numbness	48%	under 5%
Metallic taste	45%	under 5%
Static shocks	41%	under 5%
Vertigo	39%	under 5%
For comparison: fatigue	89%	6%

These figures come from Dr Shoemaker’s own patient groups (the “WDB-1” column of the consensus statement); the selection of controls is not described in detail [1].

Put simply: about 7 in 10 patients had excessive thirst, but fewer than 1 in 20 controls did.

Why would CIRS cause thirst and static shocks?

Expert opinion Dr Shoemaker’s group links several of these symptoms to the hypothalamus. In their model, about 6 in 10 CIRS patients (60%) have a disturbance in antidiuretic hormone (ADH) relative to the concentration of the blood [1]. ADH is the hormone that tells your kidneys to hold on to water.

According to the group, this can show up as excessive thirst with frequent urination, static shocks and headaches [1]. Low MSH (melanocyte-stimulating hormone) is thought to contribute too. MSH is a hormone that, among other things, helps to calm inflammation.

These explanations are the group’s hypotheses. Independent research has not confirmed them.

Why are CIRS symptoms so varied?

Expert opinion According to Dr Shoemaker’s model, CIRS is not a disease of one organ [1, 2]. It is an inflammatory response of the innate immune system, the body’s fast first line of defence. The response keeps running after exposure to biotoxins, natural poisons made by living things such as moulds and bacteria. The model is not fully proven. It goes like this:

Why do symptoms differ from person to person?

Two more points explain why no two people have the same list:

• The same symptoms appear after different exposures. The consensus statement found essentially the same symptom profile in people who fell ill after water-damaged buildings, cyanobacteria (blue-green algae) blooms, ciguatera fish poisoning and Lyme disease [1]. A US Environmental Protection Agency researcher described a similar multi-system illness with a vision deficit in people exposed to Pfiesteria toxins in estuaries [4].
• No two patients are alike. In the consensus statement’s tables, even the most common symptoms were missing in some patients. Most of the less common ones were present in only 40–70%, that is in 4 to 7 patients out of 10 [1]. Two people with CIRS can have quite different lists.

Do other researchers see the same picture?

A Finnish infectious diseases specialist, Ville Valtonen, describes a similar picture in people exposed to moisture-damaged buildings. He uses a different name: dampness and mould hypersensitivity syndrome. He stresses that the symptoms are many and non-specific, which means they also occur in many other illnesses [5].

Well studied Large independent reviews have consistently linked damp and mouldy buildings to respiratory symptoms such as cough, wheeze, shortness of breath and upper airway symptoms [6]. The wider multi-system picture has been studied much less outside Dr Shoemaker’s group.

How many symptom clusters do people with CIRS have?

Preliminary research According to the consensus statement, an adult with symptoms in 8 or more of the 13 clusters has a probability of CIRS above 95%, so more than 95 in 100 [1]. For children, 6 clusters are considered enough to support the diagnosis [1].

If a VCS deficit is also present, the authors put the diagnostic accuracy at 98.5% [1]. The VCS test is a test of visual contrast sensitivity: how well you can see fine shades of grey.

The authors also write the other way round. An adult with fewer than eight clusters probably does not have CIRS, although they may have something similar [1].

How reliable are these figures?

These figures come from the authors’ own clinical material. Independent research has not confirmed them.

The consensus statement does not report how many clusters healthy controls typically have. But in its tables, each individual symptom was reported by at most 11% of controls, about 1 in 9, and most by under 5% [1].

In a small group of people who fell ill after cyanobacteria exposure, the average number of symptoms fell from 19.7 (of 37) to 3.2 after treatment. The authors describe this as equal to controls [1].

Do the symptoms change in different buildings?

Small studies In Dr Shoemaker’s studies, yes. In a 2005 study, people who had recovered fell ill again within 1–7 days of returning to the water-damaged buildings where they had become sick [7]. In the 2006 study, three days of re-exposure raised the average number of symptoms from 4 to 15 [2].

These were small studies, and no independent group has repeated them. Even so, a link between your symptoms and a particular building is one of the most useful clues you can bring to a doctor. Our article on the signs of water damage helps you assess your home.

Can symptoms alone diagnose CIRS?

No. Every symptom on the list can have many other causes. Fatigue, headache and poor concentration are common in thyroid disease, anaemia, depression, sleep apnoea and ME/CFS, among others. ME/CFS is myalgic encephalomyelitis, also called chronic fatigue syndrome.

Even in Dr Shoemaker’s case definition, symptoms are only one of four requirements. A case definition is the list of criteria a person must meet to be counted as having the illness [1]:

1. possible exposure to a damp or water-damaged indoor space
2. a multi-system, multi-symptom illness similar to the published cases
3. laboratory findings similar to those in published studies
4. a documented response to treatment

The consensus statement also says that a trained clinician should take the symptom history and ask follow-up questions. A checklist the patient fills in alone is never enough [1].

So a self-count of clusters can be a reason to see a doctor, but it cannot tell you whether you have CIRS.

CIRS symptoms by body system: read more

We have written separate articles on the main groups of symptoms:

• Brain fog, memory and mood: CIRS and neuroinflammation
• Unrefreshing sleep: CIRS and sleep problems
• Cortisol, thyroid and sex hormones: CIRS and hormones
• Foods that suddenly cause symptoms: CIRS and food sensitivities
• Flushing, itching and reactions to foods: histamine and chronic symptoms
• Recurring bladder symptoms: CIRS and urinary tract infections
• Symptoms linked to electromagnetic fields: CIRS and EMF sensitivity

All symptom articles are collected on the symptoms topic page.

What should I do if I recognise these symptoms?

How strong is the evidence?

Preliminary research The 37-symptom list, the 13 clusters and the 95% and 98.5% figures all come from Dr Shoemaker and clinicians who use his methods. Most of the data come from their own patient groups [1, 2, 7].

A 2024 review by CIRS clinicians found only 13 published articles on CIRS treatment. Of these, 11 were on the Shoemaker protocol. The review also found that large independent trials are lacking [8]. Independent researchers have not validated the cluster method.

Independent research does show clearly that damp and mouldy buildings cause respiratory symptoms [6]. A Finnish clinician also describes a similar multi-symptom illness after exposure to moisture-damaged buildings [5].

The symptom list helps you recognise a pattern and start a conversation with your doctor. On its own, it is not proof.

Remember these

Check yourself: Can you explain why cough and thirst can sit in the same cluster? And why a count of 8 clusters on a checklist is still not a diagnosis?

What next?

• Count your clusters with the interactive CIRS symptom checklist.
• Read how CIRS is diagnosed.
• Find out what it means if your symptoms ease when you are away from home.

References

1. Shoemaker R, Johnson K, Jim L, et al. Diagnostic process for chronic inflammatory response syndrome (CIRS): a consensus statement report of the Consensus Committee of Surviving Mold. Internal Medicine Review. 2018;4(5):1–47. PDF
2. Shoemaker RC, House DE. Sick building syndrome (SBS) and exposure to water-damaged buildings: time series study, clinical trial and mechanisms. Neurotoxicol Teratol. 2006;28(5):573–588. PubMed
3. Shoemaker R, Ryan J. Methods for diagnosing, treating, and monitoring chronic inflammatory response syndrome. US Patent 9,770,170 B2; issued 26 September 2017. Google Patents
4. Hudnell HK. Chronic biotoxin-associated illness: multiple-system symptoms, a vision deficit, and effective treatment. Neurotoxicol Teratol. 2005;27(5):733–743. PubMed
5. Valtonen V. Clinical diagnosis of the dampness and mold hypersensitivity syndrome: review of the literature and suggested diagnostic criteria. Front Immunol. 2017;8:951. PubMed
6. Mendell MJ, Mirer AG, Cheung K, Tong M, Douwes J. Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence. Environ Health Perspect. 2011;119(6):748–756. PubMed
7. Shoemaker RC, House DE. A time-series study of sick building syndrome: chronic, biotoxin-associated illness from exposure to water-damaged buildings. Neurotoxicol Teratol. 2005;27(1):29–46. PubMed
8. Dooley M, Vukelic A, Jim L. Chronic inflammatory response syndrome: a review of the evidence of clinical efficacy of treatment. Ann Med Surg (Lond). 2024;86(12):7248–7254. PubMed

Please note: this article is for information only and does not replace a diagnosis or treatment from a doctor. If you have ongoing symptoms, contact a healthcare professional.