CIRS Shoemaker Protocol Step #10

In reading proceeding blogs, you’ve caught onto the idea that chronic inflammatory response syndrome (CIRS) and erythromelalgia (EM) can be related. You’ve learned that the first step in recovery from CIRS and therefore EM is removal from exposure. This can mean moving away from or remediating a moldy home but can have other implications if something other than mold is driving your illness. You learned that the second step in treatment is taking a binder to remove the toxin that your immune system can’t see and therefore tag and remove.  This is typically a prescription medication- either colesevelam or cholestyramine. You read that the third step involved treating something nicknamed “MARCoNS” that can live deep in the nose of those with CIRS. These multiple antibiotic resistant coagulase negative staphylococci can impair the boy’s ability to produce normal amounts of  melanocyte stimulating hormone (MSH). This is a problem because adequate MSH is pivotal to recovery from biotoxin-induced illness. You read that the fourth step is testing to detect antigliadin antibodies. We defined the difference between gluten sensitivity that can happen in CIRS and celiac disease. You’ve learned about the importance of correcting abnormal androgens (AKA- out-of-whack hormones). In Shoemaker Step #6 you learned all about correction of dysregulation in the production of antidiuretic hormone (ADH)–also called vasopressin–and a disproportionate serum osmolality which commonly seen in CIRS. In step #7, you learned of the importance of correcting elevated MMP-9 as an over-abundance can lead to inflammation in the brain, nerve, muscle, lungs, and joints. In step #8 you learned about all things VEG-F and how a drop in it can drive shortness of breath, fatigue, cognitive issues, and muscle pain. Step #9, correcting C3a, should be addressed should it be elevated. What next?!

Step #10- CORRECTING C4a

C4a is a split product of compliment activation associated with inflammation and activation of the innate immune system [2, 6]. Testing C4a is a challenge at present due to testing unavailability at labs that produce reliable results [3]. However, if your provider notes dermatographia when lightly scratching your skin, this result hints at an elevated C4a. Transcriptomic testing can also point to histamine excess. Due to C4a’s “cytokine role with basophils and mast cell dysregulation, it is often evidenced by symptoms of histamine excess. Overproduction of C4a results in unregulated inflammation [2]. This can lead a provider to an erroneous diagnosis of Mast Cell Activation Syndrome (MCAS). The diagnosis is incorrect, because while mast cells play a role in histamine release in CIRS it is important to understand that all nucleated cells are producing excess histamine! “Symptoms of elevated C4a include fatigue, musculoskeletal issues, capillary hypoperfusion, and cognitive impairment” [6]. When C4a is elevated, auto-activation of the enzyme that cleaves C4a called “MASP2” can occur [6]. Simply removing oneself from exposure to the toxin triggering the innate immune system does not stop the over-production of C4a which creates persistent elevation of C4a, but thankfully following the Shoemaker Provider can bring C4a back into a normal range [6]. Each step of Dr. Shoemaker’s brilliant and painstakingly evidence-based protocol will bring you closer home to the vitality that went missing when your symptoms started rearing their ugly heads. Take my hand. I see a light at the end of what has been a dark tunnel.

You can read about CIRS Shoemaker Protocol starting from the beginning at Step #1 here.

You can read more about my journey as a medical provider hellbent on healing her own erythromelalgia here.

Read about healing my chronic inflammatory response syndrome (CIRS) and how that connects to EM here.

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[1] S. Low, W. Robbins and V. Tawfik, "Complex Management of a Patient with Refractory Primary Erythromalalgia Lacking a SCN9A Mutation," Journal of Pain Research, vol. 10, pp. 973-977, 2017.

[2] R. Shoemaker, K. Johnson, J. Lysander, Y. Berry, M. Dooley, R. James and S. McMahon, "Diagnostic Process for Chronic Inflammatory Response Syndrome (CIRS): A Consensus Statement Report of the Consensus Committee of Surviving Mold," Internal Medicine Review, vol. 4, no. 5, pp. 1-47., 2018.

[3] M. DiTulio, "Surviving Mold," 23 March 2015. [Online]. Available: https://www.survivingmold.com/DRAFT_OF_SCIENTIFIC_SUPPORT_-_DITULIO.pdf. [Accessed 23 October 2021].

[4] R. Shoemaker, Proficiency Partners Lecture, 2018.

[5] Surviving Mold, "12 Step Protocol Overview," [Online]. Available: https://www.survivingmold.com/legal-resources/12-step-protocol-overview. [Accessed 23 October 2021].

[6] R. Shoemaker, S. McMahon and A. Heyman, The Art and Science of CIRS Medicine, 2018.

[7] R. Shoemaker, Surviving Mold, Baltimore: Otter Bay Books, 2010.

[8] J. Abel, "Surviving Mold Shoemaker Protocol Certified Physicians," [Online]. Available: https://www.survivingmold.com/docs/Shoemakers_Protocol_for_publishing.pdf. [Accessed 24 Octover 2021].

[9] L. Leo, "Surviving Mold Shoemaker Protocol Certified Physicians," [Online]. Available: https://www.survivingmold.com/docs/Treatment_of_CIRS_Leonard_Leo.pdf. [Accessed 24 October 2021].

[10] Surviving Mold, "Biotoxin Pathway," 12 December 2005. [Online]. Available: https://www.survivingmold.com/docs/biotoxinpathway.pdf. [Accessed 25 October 2021].

[11] J. Janus and E. Johnson, "PHG Foundation- University of Cambridge," 1 December 2020. [Online]. Available: https://www.phgfoundation.org/explainer/transcriptomics. [Accessed 30 October 2021].