Evidence-Based, Simplified Nutrition and Lifestyle Strategies


CIRS and Home Testing

CIRS and Home Testing

Chronic Inflammatory Response Syndrome (CIRS) presents a challenging health condition that necessitates a meticulous approach to diagnosis and treatment, paramount among these is creating a safe living environment. As the foundation of the Shoemaker protocol, the only peer-reviewed and clinically replicable method for treating CIRS, getting out of exposure is the first step.


In order to create a safe environment, the first step is home testing. Individuals may need to do additional testing for their work and school environments. However, we will touch on this in a later article during our CIRS series. As we look into the complexities of creating a safe space for those affected by CIRS, it becomes evident that traditional mold testing methods often fall short. They lack the precision and reliability needed to confirm a space’s safety for CIRS patients.


Let’s take a closer look at the critical importance of home testing practices, highlighting specific measures required to meet the standards of the Shoemaker protocol and safeguard the health of individuals battling CIRS.


What Is CIRS?



Chronic Inflammatory Response Syndrome (CIRS) is a multifaceted disorder marked by extensive inflammation and a broad range of symptoms affecting multiple body systems, caused by an overly sensitive immune system. Officially recognized as a legitimate medical condition, CIRS requires detailed laboratory testing and an exhaustive review of a patient’s medical history for accurate diagnosis. The diverse symptoms that vary from person to person frequently result in misdiagnosis or inadequate treatment. Unlike other immune disorders characterized by dysfunctional immune responses, CIRS cannot be identified through conventional autoimmune blood tests.


what is cirs


What causes the severe immune reactions and widespread inflammation seen in CIRS? The culprits are biotoxins—naturally occurring toxic substances with specific molecular weight. Biotoxins are the primary agents responsible for CIRS, originating from a variety of sources:

  • Water-damaged buildings: Approximately 80% of CIRS cases are associated with breathing air from environments damaged by water, which contain a combination of mold mycotoxins, bacteria, and other chemical irritants. These substances trigger inflammatory responses in individuals susceptible to CIRS, with both living and non-living mold components causing significant inflammation throughout the body and brain.


  • Tick and spider bites: Certain tick bites may lead to chronic Lyme disease, resulting from pathogens such as Borrelia burgdorferi and Babesia microti. Likewise, toxins from recluse spider bites can have enduring effects.


  • Seafood consumption: Eating tropical reef fish contaminated with ciguatera toxin, linked to Pfiesteria, and harmful algae blooms including cyanobacteria (blue-green algae), can lead to biotoxin-related health issues. This toxin builds up as larger reef fish consume smaller fish that have ingested dinoflagellates.


  • Exposure to contaminated water: Coming into contact with or inhaling water contaminated with algae blooms (Pfiesteria) and cyanobacteria can provoke the inflammatory responses characteristic of CIRS.


  • Other sources of biotoxins: CIRS can also be triggered by exposure to certain vaccines, viruses, volatile organic compounds (VOCs), endotoxins, and actinomycetes.


cirs water damaged building toxins


Due to their tiny molecular size, biotoxins can pass through cell membranes, rendering them almost invisible in standard blood tests. These toxins generally enter the body through inhalation, but they can also be absorbed via ingestion, tick and spider bites, and direct contact with contaminated water.


Not everyone exposed to common biotoxins like mold will develop CIRS; however, genetic predisposition and traumatic life events play significant roles in increasing the likelihood of biotoxin-related illnesses. Stressful events such as severe illnesses, surgeries, high fevers, pregnancies, major biotoxin exposure, and other traumatic experiences can trigger a cytokine storm. This may activate the CIRS gene in individuals who are genetically prone, particularly those with HLA-DR genes, illustrating that CIRS can develop at any point in life. It’s crucial to note that not showing symptoms doesn’t mean one is immune, and genetic testing can offer critical preventive information.


While biotoxins can cause immediate sickness, most people’s immune systems can detect and clear these toxins effectively. However, for those genetically predisposed to CIRS, their immune systems fail to recognize and eliminate these toxins, leading to their continuous presence in the body. This causes an ongoing, severe immune response and widespread inflammation, resulting in a range of symptoms and health complications.


The biotoxin pathway explains why CIRS is a multi-system, multi-symptom condition, you can learn more about the biotoxin pathway here.


For a more detailed understanding of CIRS, click here.


Pro-Tip: If you think you’re suffering from CIRS, start with our White Glove Service for comprehensive care.


Why Is Environmental Testing Important for CIRS?


cirs treatment shoemaker protocol


The first step of the Shoemaker Protocol is getting out of biotoxin exposure. This is foundational for all CIRS treatment. In order to complete this step, environmental testing is essential. It illuminates if further inspection and remediation are needed or if a property can be deemed safe before moving on to the next step of treatment.


CIRS patients will need to begin by testing their homes first. Work with your trusted practitioner to see if testing other environments you frequently visit is needed.


What’s the Most Accurate Mold Testing for CIRS?

The most accurate mold testing for CIRS is the Environmental Relative Moldiness Index (ERMI). The ERMI is an indoor air quality testing method developed by the US Environmental Protection Agency (EPA), Office of Research and Development (ORD).


What Is an ERMI?

Essentially, the ERMI was designed to be a sensitive and standardized method to assess indoor air quality and mold contamination. The ERMI test uses DNA-based technology to determine and measure the presence of specific indoor mold species. The ERMI is the gold standard for indoor mold testing, specifically for CIRS patients.


Other testing methods such as air sampling, gravity plate petri dishes, and tape lift tests have never been validated for the statistical likelihood for CIRS patients to heal. The ERMI testing also compares your results with the results from one thousand US households gathered from a national home survey. This comparison data calculates the ERMI score of your property. Since its creation in 2007, ERMI metrics have been used in several studies as an indicator and predictor of mold contamination, water damage, and various health conditions.


Relative Moldiness Index Values

The MSqPCR technology is designed to recognize the 36 mold species divided into two categories. CATEGORY 1 contains 26 mold species typically found at higher levels in water-damaged homes. CATEGORY 2 contains 10 common species not associated with water damage but are common indoor molds.


These 36 species have been chosen among the 82 species analyzed in samples of water-damaged and control homes. The quantified result can then be compared to a national database. This database is composed of results gathered from 1,096 households across the United States during the 2006 Housing and Urban Development (HUD) American Healthy Home Survey. Individual results, ranked from lowest to highest, were used to compile the national Relative Moldiness Index (RMI) Scale.


The Science Behind the ERMI

The ERMI test uses mold-specific quantitative polymerase chain reaction (MSqPCR) technology to conclude which of the 36 mold species may be present in your property and then quantify each species. The tested samples come from the dust collected from your property (e.g. home, work, car). Settled dust throughout the property is considered a great representative of the comprehensive archive for the overall microbial condition. This method is fairly accurate since certain surfaces capture mold microflora particles well.


In the laboratory, the sampled mold particles must be manipulated before their DNA can be extracted. The DNA is then enlarged many thousand times via qPCR technology so there are enough copies of certain genes for experts (or machines) to read and detect exactly which mold species are present. The qPCR technology also gives you a real-time quantified estimate of the number of certain mold species on your property. This can provide insight into potential mold damage located somewhere within your property.


What Is a HERTSMI-2?

The HERTSMI-2 test is a more targeted mold assessment tool that stands for Health Effects Roster of Type Specific Formers of Mycotoxins and Inflammagens – 2nd Version. This tool is derived from the ERMI methodology, but it focuses on a smaller subset of molds that are particularly associated with water-damaged buildings and are more prevalent for CIRS patients.


Specifically, the HERTSMI-2 test examines the presence and quantity of five specific mold species:

  • Aspergillus penicillioides
  • Aspergillus versicolor
  • Chaetomium globosum
  • Stachybotrys chartarum
  • Wallemia sebi


Each of these molds is scored based on its quantity in a dust sample from an indoor environment, and then the scores are summed to provide a total HERTSMI-2 score.


The HERTSMI-2 Score

The HERTSMI-2 scoring system, including the threshold value of 10 as being the safest, is derived from research on mold species and their observed impact on human health, particularly in individuals diagnosed with CIRS due to water-damaged buildings. The scoring system was specifically designed to help physicians determine the safety of a building for individuals with CIRS.


The mold species in the HERTSMI-2 test were selected due to their known or suspected ability to produce mycotoxins or cause inflammagenic reactions in susceptible individuals. The specific score cutoffs are based on observed clinical outcomes in individuals with CIRS and their reactions to different quantities of these molds in their living or working environments.


General Interpretation of HERTSMI-2 Scores

  • 0-10: Indicates a building is safe for those with CIRS as long as the individual is not symptomatic. If this score is received prior to remediation and there are still sources of water damage in the property, individuals often still have to remediate.
  • 11-15: The building is somewhat risky and may not be safe for those with CIRS due to the amount of mold.
  • Greater than 15: The building is risky and not safe for those with CIRS due to the higher quantity of mold.


The HERTSMI-2 score is particularly useful for those who are concerned about health effects related to mold exposure, such as individuals with CIRS or those particularly sensitive to mold. While it’s a more focused assessment than ERMI, it offers a quick way to gauge the safety of a building based on a subset of particularly problematic molds. However, like any test, interpretation should be done in conjunction with a holistic understanding of the building’s history, the individual’s health status, and consultation with experts.



While the ERMI test uses MSqPCR technology to conclude which of the 36 mold species may be present, the HERTSMI-2 test is a more specialized indoor mold test that only quantifies the presence of five particular mold species. These species are considered to be the most impactful for CIRS and other mold-related conditions.


hertsmi vs ermi cirs home testing


HERTSMI-2 is a derivative test of the ERMI; it is more affordable because it searches for only five types of molds. Every ERMI includes a HERTSMI-2 quantification and report, so you should only purchase one or the other.


This means that even though HERTSMI-2 uses similar technology, it is not as accurate in assessing indoor air quality as ERMI. Both serve different purposes in application.


How Can ERMI Testing Help Me?

Here are some ways the ERMI test can assist you:


  • Health Concerns: Many individuals, even those without CIRS, are sensitive to mold, and exposure can lead to a variety of health issues, including respiratory problems, serious conditions, and other symptoms. By identifying the moldiness level in your home using an ERMI test, you can potentially link existing health concerns to mold exposure.
  • Home Purchases or Rentals: Before purchasing or renting a home, an ERMI test can provide valuable information about the potential mold burden in that property. This can help you make an informed decision.
  • Mold Remediation: If you’ve already identified mold or experienced water damage, an ERMI test can give you a baseline moldiness score. After remediation or repairs, a follow-up ERMI test can help assess the effectiveness of the intervention. Detailed
  • Mold Identification: Unlike a simple visual inspection, the ERMI test quantifies specific mold species. This can be beneficial since some molds are more problematic or hazardous than others.
  • Comparative Analysis: The ERMI score allows you to compare the moldiness of your home to a national database. This can help put your mold situation in perspective.
  • Insurance or Legal Matters: If you’re dealing with insurance claims or legal matters related to mold, an ERMI test can provide objective data to support your case.
  • Peace of Mind: If you’re concerned about mold but aren’t sure about the extent of the problem, an ERMI test can either confirm your suspicions or provide reassurance.


However, it’s essential to keep in mind the limitations of the ERMI test. While it provides a comprehensive view of mold types present in the sampled dust, it doesn’t necessarily provide information on the active growth areas of mold in the home. Depending on your concerns and circumstances, additional evaluations, such as a thorough visual inspection by a Shoemaker IEP or specialized CIRS mold inspection company, is often necessary.


Where Do I Purchase ERMI and HERTSMI-2 Testing?

There are three qualified companies that CIRS patients can purchase their kits from:



Other Home Testing

In addition to an ERMI test, usually as a requirement by practitioners, CIRS patients generally need to test their homes for endotoxins (endos) and actinomycetes (actinos). Elevated results for either test typically require deep cleaning protocols and occasionally home repairs for endotoxins (i.e., proper ventilation for sewer gas).


However, proper, successful remediation followed by a whole-home small particle clean should take care of elevated endos and actinos. You can learn more about the nuances of actinos cleaning and ongoing maintenance here.


These tests can be purchased from EnviroBiomics. The reasons for consolidating home testing to only an ERMI or HERTSMI-2 are financial constraints or you’re testing a temporary living situation.


Endo and actinos testing can be purchased from EnviroBiomics:


How Do I Perform an ERMI Test?

The practicality of the ERMI test allows you to collect your own dust samples without a professional. The samples are collected either by a Swiffer cloth or by vacuuming. Swiffer tests are preferred for CIRS testing. A different Swiffer test should be used for each level. Each Swiffer test should sample from at least 10 different areas for that corresponding level.


A vacuum test should be treated the same, vacuuming a standard-sized area of the floor in several rooms of your property. This is done with a special vacuum cleaner extension nozzle and a dust collector, provided with the ordered ERMI mold test kit. Vacuuming is done on different 3.5×7 ft rectangular sampling areas for at least 5 minutes.


Interpreting ERMI Scores

An IEP or practitioner will need to further evaluate your ERMI test results as there are other factors that can come into play. For instance, various mold species can occur at higher rates in certain geographic locations, requiring a professional to determine if your levels are normal for your area or signify a potential problem in your home.


The ERMI test results and score provide a lot of great data but often warrant further investigation by a Shoemaker IEP or specialized CIRS mold inspection company. The ERMI score itself can be highly controversial – It‘s important to know that the Relative Moldiness Index Values provide a general guideline and won’t necessarily guarantee it’s a safe environment for you. Everyone has a different threshold when it comes to their environmental tolerance and the ERMI score can help you determine what that threshold is for you.


ERMI Molds and ERMI Testing Best Practices

An ERMI test provides great insight into the concentrations of specific mold species in your property. This offers the opportunity to personalize deep cleaning efforts, help determine items that may require additional care or removal, and so on. In order to get the most accurate ERMI results, specific testing measures and best practices also come into play.


For the remainder of this content and an in-depth, comprehensive look at ERMI molds and best testing practices, our ERMI Guide is available for purchase below. (*Important Note: Our Actinos and Personal Property Cleaning Guide is currently being updated with our new protocols based on our research found here. This bundle contains the previous version of this guide.)  

Closing Thoughts On CIRS and Home Testing

Since getting out of exposure serves as the foundation of the Shoemaker Protocol, home testing will always be essential for successful treatment. While this can sometimes be the most difficult step for many patients, proper ERMI testing delivers valuable, actionable insight into any home environment.


This testing can also be used for schools, work, cars, and other non-home environments.


Remember, the goal isn’t to create a mold-free, toxin-free environment. That level of perfection is never possible and can be far more harmful when trying to achieve it in terms of limbic and nervous system dysregulation. Instead, we’re trying to create a safe environment with the level of mold your body can tolerate while healing. The threshold of acceptable mold in an environment will be different for everyone.


nwj cirs support group


Pro-Tip: Are you looking for practitioner resources and a like-minded community to support you through your CIRS journey? Join our exclusive CIRS Support Group for the latest research, step-by-step protocol tools, and support to successfully achieve root-cause healing.


Work With Our Trusted CIRS Practitioners

The Nutrition with Judy practice is honored to be a trusted CIRS practitioner support serving clients from around the globe. We’re passionate about helping our clients achieve root-cause healing in order to lead the best quality of life possible that’s nearly symptom-free. Our team is dedicated to finding the answers our patients need. We welcome you to explore our free resources and are always available to support you through personalized protocols. If you’re interested in working one-on-one with our CIRS nutritional therapy team to support you through your journey, our CIRS Support Package delivers the support and accountability for achieving root-cause healing.

Start your root-cause healing journey today and contact us any time with any questions or concerns.


DISCLAIMER: This content is for educational purposes only. While we are board-certified in holistic nutrition and are nutritional therapy practitioners, we are not providing medical advice. Whenever you start a new diet or protocol, always consult with your trusted practitioner first.

Nutrition with Judy

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