Chronic Inflammatory Response Syndrome is a chronic inflammatory reaction of the innate immune system, of which 24% of the population is genetically susceptible.
I must admit that there was a time when I was blissfully ignorant about the chronic adverse health effects that could be triggered and perpetuated by exposure to water-damaged indoor environments. Sure, in medical school, I was taught about the allergic reactions that could occur, and I had experienced them myself (asthma,
rhinitis) upon entering a musty building, but it was years later when a fellow physician woke me up to illness occurring by a different inflammatory response not related to the allergy pathway.
Two arms, One Immune System
To understand more about the chronic inflammation of CIRS-WDB, it is best to have a little bit of knowledge about the immune system.
First, there are two main arms of the immune system: the innate and the adaptive arm. The innate response involves cells that recognize a threat (bacteria, virus, etc.) and directly assault it. These cells tend to release a lot of chemicals and signaling molecules. Their attack is effective against the enemy but they also damage a lot the bystanders (healthy tissues). Some of the innate immune system cells are also part of the clean-up crew. Part of the function of the innate response is to present the foreign invader (antigen) to the adaptive immune system. Think of the adaptive immune system as the “smart” immune system. These cells take in the antigen and produce antibodies that attach to the threat (antigen/foreign invader) and allow other cells within the adaptive immune system to recognize the antibody-bound antigen and directly attack it. The adaptive immune system clears the threat with a targeted attack and, in doing so, tells the innate immune system to stop the nonspecific attack. The adaptive side of the immune system learns each new foreign invader and, in the future, is ready to unleash antibodies if said foreign invader returns.
When talking about CIRS, the problem is a defect in the ability of the innate immune system to present the foreign invader to the adaptive immune system, which results in an unrelenting assault by the innate immune system. This defect in antigen presentation means that the “smart” adaptive immune system never learns to recognize this invader and does not produce antibodies for it. Targeted clearance of the invader does not occur. Particles from the invader remain, resulting in continued innate immune system assault. Remember, as the innate immune system cells attack the foreign invader, they also damage the tissues where they find the invaders. This persistent innate immune response produces a chronic inflammatory response, hence the name Chronic Inflammatory Response Syndrome.
Consider other conditions of inflammation. Autoimmune conditions occur when the “smart” adaptive immune system produces antibodies that not only latch onto the threatening foreign invader but get confused and attack the body’s own tissues that may appear similar. Much research dollars go towards disorders of the adaptive immune system and very little towards the innate immune system.
Allergies involve a specific type of antibody, IgE, which can also be produced in an extreme response to things the immune system has seen before (Ex: foods, pollen, medication, etc.). IgE triggers some of the cells in the innate immune system to go overboard with their assault,
resulting in typical allergic symptoms. Remove the allergen, and the allergy does not flare. With CIRS, removing the causative agent does not stop the inflammatory reaction.
What are the symptoms of CIRS?
A better question would probably be, “What aren’t the symptoms of CIRS?” There are many symptoms of CIRS and no two people with persistent innate immune response look alike. Characteristics of people with this condition include:
A person with many chronic symptoms in many body systems
A person who sees many doctors of various specialties and other practitioners trying to find an answer to all of their problems
A person who has good days and bad days in which fatigue and overall achiness limit their activities
A person who has “brain fog” and thinks they are losing their mind
A person who has weird symptoms (ex: getting a lot of static shocks, fine facial muscle twitches, eyelid twitching, sensitivity to smells, severe muscle cramps (clonus), and more)
As a physician who treats people with CIRS, I love it if a new patient comes to me after first having done a symptom screening questionnaire and a Visual Contrast Sensitive (VCS) test. Combining the appropriate validated questionairre with a VCS is the first step in evaluate as well as important metrics to follow during treatment.
Where to get a VCS and symptom questionnaire
The good news is that anyone can do a VCS + screening questionnaire for about $15. My favorite site for completing this testing is VCSTest.com due to clear appearance of the results (as above) and the screening questionnaire that also quantifies each symptom. This site also have a very good FAQ section that explains the testing.
What if I “pass” the VCS but fail the symptom questionnaire?
There are very few tests that are 100% sensitive to picking up a condition. There are always false negatives, meaning a person has a condition, but their test is normal/negative and did not capture the condition. The VCS may be passed more commonly in children, younger women, and people who use their eyes for high contrast and detailed work, such as photographers and artists. Because of this, symptom questionnaires are very helpful in capturing people who likely have CIRS.
Beyond the VCS + screening questionnaire, specific labs must be checked to help further rule in or rule out CIRS conditions. Seeing a physician or other practitioner trained in the diagnosis and care of people with CIRS is an essential next step.
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