CIRS / Mold Toxicity Starter Checklist – 2026 Edition

A scannable, printable starting point for anyone suspecting mold-related illness

≈ 2 min read

Educational only, not medical advice. This guide shares general information and community experience. It isn’t a diagnosis or a treatment plan. Please talk with your doctor or another licensed healthcare provider before starting, stopping, or changing any test, supplement, medication, or treatment.

Step 1: Quick Symptom Self-Check

Symptom (from the CIRS consensus symptom list)	I have this
Unrelenting fatigue	☐
Brain fog / poor word recall	☐
Chronic sinus issues	☐
Air hunger / shortness of breath	☐
Joint/muscle pain without injury	☐
Temperature dysregulation	☐
Light sensitivity	☐
Static shocks / skin sensitivity	☐
Frequent urination / thirst	☐
Mood swings	☐

Several of these together are worth raising with a clinician, since they can have many causes. The CIRS consensus statement uses a clinician-taken history of 37 symptoms in 13 clusters, and CIRS practitioners treat 8 or more clusters (6 for children) as supporting a CIRS diagnosis. See our CIRS guide for details.

Step 2: Shoemaker’s Key Labs

Lab	What it measures	What CIRS practitioners look for
MSH	Melanocyte Stimulating Hormone	Low
ADH / Osmolality	Antidiuretic Hormone regulation	Out of balance (the consensus statement says about 60% of CIRS patients have ADH/osmolality problems)
TGF-β1	Inflammatory cytokine	High
MMP-9	Tissue remodeling enzyme	High
C4a	Complement activation	High
VEGF	Vascular growth factor	Can be high or low

Reference ranges vary by lab, and the use of these markers is debated, so your clinician should interpret results. These are blood tests a clinician orders through a clinical laboratory. CIRS practitioners usually order these as a panel; ask your clinician which tests make sense for you. See our CIRS guide for what each test measures.

Step 3: First 30 Days Action List

Leave the exposure – Get out of the suspected building if possible (even temporarily). Use HEPA air purifiers + open windows if safe.
Test your environment – Ask about an ERMI or HERTSMI-2 dust test, a lab DNA analysis of settled dust for mold. Dust tests (ERMI/HERTSMI-2) are commonly used by CIRS practitioners; EPA considers ERMI a research tool.
Ask about baseline labs – CIRS practitioners usually start with the Shoemaker lab panel, plus a MARCoNS nasal swab if you have sinus symptoms.
Ask about binders – Cholestyramine or colesevelam only under doctor guidance (step 2 of the Shoemaker Protocol, after removing exposure).
Ask before trying “detox” supports – Some practitioners suggest things like hydration, Epsom salt baths, milk thistle, NAC or infrared sauna. Evidence for these is limited, and many experts caution against “detox” products sold directly to patients, so check with your clinician first.
Find a practitioner – Use Surviving Mold physician finder or ask in trusted Facebook groups.

Common Pitfalls & What NOT to Do

Don’t rush into “detox” treatments on your own — some people report bad flares, and evidence for these treatments is limited.
Don’t ignore sinus issues that persist — CIRS practitioners test for MARCoNS and treat it as step 3 of the Shoemaker Protocol.
Don’t stay in a water-damaged building “just a little longer” — CIRS practitioners call removing exposure the most critical step, and in early studies people who went back into their water-damaged buildings reported relapse within days.
Don’t rely only on visual mold inspection — ERMI/HERTSMI-2 often recommended by CIRS practitioners, though the EPA calls ERMI a research tool.
Don’t self-treat with antifungals — the Surviving Mold consensus statement tells patients to stop nasal, oral and IV antifungals, citing concern about drug-resistant bacteria.