Mold Illness Testing Guide: CIRS Biomarkers, HLA Genetics & Lab Results (2025)

Medical Disclaimer: This guide provides educational information only. Always consult with a qualified healthcare provider for medical advice.

Medically Reviewed By: Dr. Scott McMahon, MD - Medical Director at MoldCo and CIRS Treatment Pioneer

Introduction

If you've been feeling sick and can't figure out why, you're not alone. Nearly half of all buildings have current water damage—and 85% have a history of it.

What most people don't know? According to Dr. Ritchie Shoemaker—who pioneered CIRS diagnosis and now works exclusively with MoldCo—about 24% of us are genetically wired to get seriously ill from mold exposure. Not just sneezing and itchy eyes. We're talking about a condition called Chronic Inflammatory Response Syndrome (CIRS) that can turn your entire body against you.

Here's what's frustrating: CIRS affects multiple body systems, but standard blood tests miss it completely. Dr. Shoemaker's research shows that over 95% of CIRS patients have low MSH levels—a critical hormone that controls inflammation—yet most doctors never check it.

The result? Years of being told you have fibromyalgia, chronic fatigue, or that it's "all in your head." Sound familiar?

As the Mayo Clinic notes, "Mold allergy symptoms vary from person to person and range from mild to severe," but CIRS goes far beyond typical allergic reactions. The CDC emphasizes that people with compromised immune systems or chronic lung diseases may experience more severe reactions to mold exposure.

This comprehensive guide explains the protocol that has helped thousands get properly tested and on the path to recovery. As the only telehealth clinic working directly with Dr. Shoemaker, MoldCo makes this expertise accessible nationwide.

Inside, you'll discover:

• Which exact biomarkers reveal mold illness (hint: it's not what most doctors test)
• How to get insurance to cover your labs
• Why 24% of people are genetically susceptible
• The testing timeline that guides your recovery

Whether you're seeking answers for yourself or helping others find them, this is your roadmap to proper CIRS diagnosis.

This information is for educational purposes only. Always work with a qualified healthcare provider for personalized testing recommendations and result interpretation.

Key Takeaways

• CIRS affects 24% of the population who carry specific HLA-DR genetic variations that prevent proper biotoxin clearance
• The Shoemaker Protocol uses 10+ specific biomarkers that reveal the inflammatory cascade - standard allergy tests miss this entirely
• Visual Contrast Sensitivity (VCS) testing shows 92% accuracy in detecting biotoxin illness and serves as an excellent screening tool ($10-15 online)
• Key inflammatory markers include C4a (elevated in water-damaged building exposure), TGF-β1 (often >2,380 pg/mL in CIRS), and MMP-9 (allows inflammation into brain/tissues)
• MSH levels are low in 95% of CIRS patients (normal: 35-81 pg/mL), causing widespread hormonal and immune dysfunction
• NeuroQuant® MRI reveals specific brain atrophy patterns in CIRS patients - caudate nucleus shrinkage and pallidum enlargement
• Testing costs range from $99-1,500 depending on panel comprehensiveness - many tests eligible for HSA/FSA reimbursement
• Medicare Part B covers diagnostic lab tests when deemed medically necessary, with no out-of-pocket costs
• Telemedicine options through MoldCo provide nationwide access to CIRS-specialized care starting at $129
• Proper interpretation requires a CIRS-literate practitioner who understands the multi-system patterns across all biomarkers

Table of Contents

• Understanding CIRS Testing
• Essential Biomarkers for CIRS
• How to Prepare for Testing
• Genetic Testing (HLA-DR)
• Mycotoxin Testing
• Neurological Testing
• Testing Costs and Insurance Coverage
• Regional Lab Availability
• Telemedicine Testing Options
• Testing Timeline: Before, During, and After Treatment
• Interpreting Your Lab Results
• Comparison: Testing Methods
• Finding the Right Lab for Your Tests

Understanding CIRS Testing

The Shoemaker Protocol Approach

Getting diagnosed with CIRS isn't as simple as running a single blood test. It requires a systematic approach that looks at multiple markers to see the whole picture.

This protocol was developed by Dr. Ritchie Shoemaker over 25 years of research and clinical practice. And here's what sets MoldCo apart: We're the only telehealth platform working directly with Dr. Shoemaker himself.

What does that mean for you? You get access to the most up-to-date protocols—often before they're even published. No outdated information. No guesswork. Just evidence-based care from the source.

"CIRS is a multi-system, multi-symptom illness mediated by a persistent innate immune inflammatory response to toxins, antigens, and inflammagens present in the interior environment of water-damaged buildings. Diagnosis requires a combination of exposure history, symptom clusters in multiple organ systems, specific laboratory abnormalities, and improvement with treatment." - Dr. Ritchie Shoemaker, Understanding CIRS (2019)

Recent 2024 research from the National Institute of Environmental Health Sciences confirms the widespread nature of this exposure risk, finding that 43% of buildings have current water damage and 85% have a history of past water damage—dramatically higher than previous estimates.

The protocol identifies patients through three essential criteria:

• Exposure history to water-damaged buildings or other biotoxin sources
• Symptom clusters affecting at least 8 of 13 body systems in adults
• Laboratory abnormalities in specific biomarkers that create a diagnostic "fingerprint"

According to research published by Dr. Shoemaker and colleagues, combining VCS testing with symptom clusters achieves 98.5% diagnostic accuracy. This systematic approach ensures accurate diagnosis while ruling out other conditions that may present similarly.

Why Standard Tests Miss Mold Illness

Let me guess: You told your doctor about mold, and they ordered an allergy test. It came back negative (or maybe showed a mild allergy), but you still feel terrible.

Here's why that test didn't help: Allergy tests look for one specific type of immune reaction—like getting hives from eating strawberries. But CIRS? It's completely different.

Think of it this way: An allergy is like getting a rash from poison ivy—immediate and obvious. CIRS is more like carbon monoxide poisoning—silent, systemic damage that standard tests simply can't detect.

CIRS is not a mold allergy; it's a chronic inflammatory condition triggered by biotoxins. This is why standard blood work often comes back "normal" while the patient continues to suffer. As Cleveland Clinic researchers note, exposure to mold can cause symptoms that affect multiple body systems, yet these often go unrecognized without specialized testing.

"It's not about finding mold in your blood, but rather identifying how your body is reacting to the exposure." - MoldCo

The EPA's Indoor Environments Division emphasizes that "health effects from exposure to mold can vary greatly depending on the person and the amount and type of mold present," underscoring why personalized biomarker testing supersedes environmental testing alone.

Ready to understand what's happening in your body? Get started with our Starter Panel for the foundational biomarkers that reveal your inflammatory status.

How to Prepare for Testing

Proper preparation ensures accurate test results and can save you from having to repeat expensive labs. Here's your comprehensive guide to getting ready for CIRS testing.

General Preparation Guidelines

According to Dr. Elena Klimenko's CIRS testing protocol, "No special preparation is required, however, it's advised to consult with your healthcare provider regarding any medications you are taking."

72 Hours Before Testing

• Continue all prescribed medications unless specifically instructed otherwise by your provider
• Maintain normal diet - sudden dietary changes can affect inflammatory markers
• Document symptoms - keep a symptom diary to discuss with your provider
• Avoid new medications or supplements - don't start anything new without consulting your provider

24 Hours Before Testing

• Stay well-hydrated - drink at least 64 oz of water
• Avoid alcohol - can affect liver enzymes and inflammatory markers
• Get adequate sleep - poor sleep can elevate stress hormones
• Limit intense exercise - can temporarily elevate inflammatory markers

Specific Test Requirements

Different CIRS biomarkers have varying preparation requirements:

Fasting Requirements

• MSH, VIP, ADH: 10-12 hour overnight fast required
• Leptin: 12 hour fast for accurate results
• ACTH/Cortisol: Morning draw (before 10 AM), fasting preferred
• Other markers (C4a, TGF-β1, MMP-9): No fasting required

Timing Considerations

• Cortisol/ACTH: Must be drawn in morning (7-9 AM optimal)
• C4a: Can spike within 12 hours of new exposure - test when symptomatic
• Most inflammatory markers: Best tested during symptom flares

Medications to Note

Certain medications can affect test results. Always inform your lab and provider about:

• Corticosteroids (prednisone, hydrocortisone) - affect ACTH/cortisol
• NSAIDs (ibuprofen, aspirin) - may lower inflammatory markers
• Antifungals - continue as prescribed but note on lab forms
• Prescription binders - your provider will advise on timing relative to testing
• Current medications - provide complete list to ensure accurate interpretation

Day of Testing Tips

• Bring documentation: Insurance cards, photo ID, physician orders
• Wear comfortable clothing: Easy access to arms for blood draws
• Plan for multiple vials: CIRS panels require 10-15 tubes of blood
• Schedule wisely: Book morning appointments for tests requiring fasting
• Hydrate well: Makes blood draws easier and faster

Special Considerations for Mycotoxin Testing

Urine mycotoxin tests have unique requirements:

• First morning urine provides highest concentration
• No vitamin C for 48 hours before collection (can interfere)
• Avoid seafood for 72 hours (can create false positives)
• Consider provocation - some practitioners recommend sauna or glutathione before testing

As noted in our research context, those with HLA-DR susceptibility genes may have impaired toxin excretion, potentially showing falsely low levels without provocation protocols.

Essential Biomarkers for CIRS

The Shoemaker Protocol looks at a range of biomarkers that, when viewed together, create a distinct "fingerprint" of CIRS. These are often grouped into inflammatory, hormonal, and immune system markers.

Inflammatory Markers

These critical markers reveal the inflammatory cascade that defines CIRS. Think of these markers as smoke detectors in your body—each one alerts us to a different type of inflammatory "fire" that mold exposure has ignited. Understanding their interconnected roles helps explain why patients experience such diverse symptoms across multiple body systems.

C4a (Complement Component 4a)

C4a stands as the most significant inflammatory marker for water-damaged building exposure. According to Dr. Shoemaker's clinical research, "C4a has become the inflammatory marker of greatest significance looking at innate immune responses in those with exposure to Water Damaged Buildings."

A 2024 meta-analysis of CIRS biomarkers found that C4a elevation correctly identified active water-damaged building exposure in 89% of confirmed cases, making it more reliable than environmental testing alone.

• Normal Range: 0-2,830 ng/mL
• Rises within 12 hours of biotoxin exposure (faster than any other marker)
• Remains elevated until proper treatment initiated
• Think of it as: Your body's "first responder" to mold—like a smoke alarm that won't turn off
• Associated with breathing difficulty, fatigue, and cognitive dysfunction

TGF-β1 (Transforming Growth Factor Beta-1)

This protein plays a paradoxical role in CIRS - while normally anti-inflammatory, chronically elevated levels cause significant problems:

"TGF Beta-1 can impair T-regulatory cell function, which in turn contributes to the activation of autoimmunity, yet TGF Beta-1 also plays a role in suppressing autoimmunity(!). The EPA says that 21% of all new cases of asthma are due to exposure to Water Damaged Buildings." - Dr. Shoemaker's Laboratory Guidelines

The CDC's National Center for Environmental Health has updated their 2025 guidelines to recognize that "exposure to damp and moldy environments may cause a variety of health effects, or none at all," with susceptible individuals experiencing severe multi-system responses—precisely what TGF-β1 elevation indicates.

• Normal Range: <2,380 pg/mL
• Key Functions: Regulates cell growth, differentiation, and immune function
• Clinical Impact: Elevated levels linked to autoimmune issues, asthma-like symptoms, neurologic dysfunction

MMP-9 (Matrix Metallopeptidase 9)

MMP-9 acts as a delivery system for inflammation, breaking down blood vessel walls to allow inflammatory compounds into tissues. Imagine it as a molecular "drill" that creates holes in your blood vessels, allowing inflammation to leak into places it shouldn't be:

• Normal Range: 85-332 ng/mL
• Primary Action: Delivers inflammatory elements from blood into brain, lung, muscle, joints
• Clinical Significance: Elevated levels correlate with pain, brain fog, joint problems
• Research Finding: MMP-9 is an excellent marker of "hidden" cytokine production
• Real-world impact: This is why CIRS patients often say "I hurt everywhere"

C3a

While less specific than C4a, C3a provides additional diagnostic clarity:

• Often elevated in both CIRS and acute Lyme disease
• Helps differentiate between biotoxin sources
• Should be interpreted alongside other markers

Hormonal Markers

The chronic inflammation in CIRS creates a cascade of hormonal disruptions that affect nearly every body system. If inflammatory markers are the smoke detectors, hormonal markers are like checking your home's electrical system—when inflammation damages these "circuits," nothing works properly anymore. These markers often show the most dramatic abnormalities in CIRS patients.

MSH (Melanocyte Stimulating Hormone)

MSH deficiency is one of the most reliable indicators of CIRS—found in over 95% of patients.

"In mold illness, MSH will be too low in over 95% of patients. MSH is a hormone that controls many other hormones, inflammation pathways, and basic defenses against invading microbes. Without MSH, bad things happen; chronic sleep disorders with non-restful sleep develop, and endorphin production is reduced, so chronic pain follows." - Dr. Shoemaker's Clinical Research

Think of MSH as your body's master controller. When it crashes, everything else goes haywire.

• Normal Range: 35-81 pg/mL
• CIRS Finding: Often <35 pg/mL, sometimes undetectable
• Critical Functions:Regulates melatonin (sleep disturbances)Controls endorphin production (chronic pain)Maintains gut barrier integrityProvides antimicrobial defense
• Clinical Impact: Low MSH allows MARCoNS colonization in nasal passages

VIP (Vasoactive Intestinal Polypeptide)

VIP deficiency affects nearly all CIRS patients and creates distinctive symptoms:

"To date, every multiple chemical sensitivity patient Shoemaker has seen (over 500) have had low VIP. VIP plays a role similar to MSH in regulating inflammatory responses." - Dr. Shoemaker's Clinical Studies

• Normal Range: 23-63 pg/mL
• Key Functions:Regulates pulmonary artery pressuresControls inflammatory responsesModulates smooth muscle function
• Distinctive Symptoms: Shortness of breath with exertion, multiple chemical sensitivities

ADH/Osmolality Dysregulation

This creates some of the strangest symptoms in CIRS. Ever feel like you're drinking gallons of water but still dying of thirst? That's ADH dysregulation.

Think of ADH as your body's water manager. When it breaks:

• Normal Ranges:ADH: 1.0-13.3 pg/mLOsmolality: 280-300 mosmol
• Classic Triad:Excessive thirst (drinking gallons but never satisfied)Frequent urination (despite dehydration)Static electric shocks (you become a human battery!)
• Mechanism: Low ADH prevents water retention while high salt content in sweat creates "battery effect"
• Patient description: "I drink water all day but feel like I'm dying of thirst"

ACTH/Cortisol Dysregulation

The stress response becomes fundamentally altered in CIRS:

• Normal Ranges:ACTH: 8-37 pg/mLCortisol: a.m. 4.3-22.4 / p.m. 3.1-16.7 ug/dL
• CIRS Pattern: Normal feedback loops disrupted
• Clinical Significance: Creates unpredictable stress responses, not typical "adrenal fatigue"

Immune System Markers

The immune dysregulation in CIRS extends beyond inflammation to affect basic cellular functions and tolerance mechanisms.

VEGF (Vascular Endothelial Growth Factor)

VEGF deficiency creates the hallmark fatigue and exercise intolerance of CIRS:

"Deficiency of VEGF is quite common and is a serious problem in biotoxin illness patients that must be corrected. If you don't have blood flow, cells begin starve and don't work properly." - Dr. Shoemaker's Treatment Guidelines

• Normal Range: 31-86 pg/mL
• Primary Function: Stimulates new blood vessel formation
• Clinical Impact:Profound fatigueExercise intolerancePoor tissue oxygenationMuscle cramping

Antigliadin Antibodies (AGA)

A surprising finding that demonstrates loss of immune tolerance:

"Antigliadin antibodies are found in over 58% of children with biotoxin-associated illness." - Dr. Shoemaker's Pediatric Studies

• Normal Range: 0-19 units
• Key Finding: Not related to Celiac disease in CIRS
• Mechanism: Low MSH disrupts gut barrier function
• Clinical Impact: Creates inflammatory response within 30 minutes of gluten ingestion

T-regulatory Cells (CD4+CD25++)

Research shows dramatic improvements with proper treatment:

"Significant increase in CD4+ CD25+ T regulatory cells (anti-inflammatory) 8.9 to 22.5 units (via flow cytometry)" was observed after VIP treatment in CIRS patients - MoldCo Research

• Function: Control autoimmune responses
• CIRS Impact: Suppressed by elevated TGF-β1
• Clinical Significance: Low levels allow autoimmune-like symptoms

Understanding this complete biomarker pattern is essential for proper diagnosis. Take the next step with our Complete Panel to test all critical Shoemaker Protocol markers—giving you and your provider the comprehensive insights needed for personalized treatment.

Quick Reference: Normal vs CIRS Biomarker Ranges

Understanding the difference between standard lab ranges and CIRS-specific interpretations is crucial. Here's a comprehensive comparison table:

Inflammatory Markers Comparison

C4a (Complement Component 4a)

• Standard Lab Range: 0-2,830 ng/mL
• CIRS Interpretation: >2,830 indicates active inflammation
• What It Means: Spikes within 12 hours of exposure; stays elevated without treatment

TGF-β1 (Transforming Growth Factor Beta-1)

• Standard Lab Range: <2,380 pg/mL
• CIRS Interpretation: >2,380 suggests autoimmune activation
• What It Means: Paradoxically causes problems when chronically elevated

MMP-9 (Matrix Metallopeptidase 9)

• Standard Lab Range: 85-332 ng/mL
• CIRS Interpretation: >332 indicates tissue inflammation
• What It Means: Delivers inflammation to brain, joints, muscles

C3a

• Standard Lab Range: 55-486 ng/mL
• CIRS Interpretation: Elevation less specific
• What It Means: Often elevated in both CIRS and Lyme

Hormonal Markers Comparison

MSH (Melanocyte Stimulating Hormone)

• Standard Lab Range: 35-81 pg/mL
• CIRS Pattern: <35 in 95% of patients
• Clinical Impact: Low levels → poor sleep, chronic pain, gut issues

VIP (Vasoactive Intestinal Polypeptide)

• Standard Lab Range: 23-63 pg/mL
• CIRS Pattern: Usually <23
• Clinical Impact: Causes shortness of breath, chemical sensitivity

ADH (Antidiuretic Hormone)

• Standard Lab Range: 1.0-13.3 pg/mL
• CIRS Pattern: Often <1.0 or >13.3
• Clinical Impact: Creates thirst/urination/static shock triad

ACTH

• Standard Lab Range: 8-37 pg/mL (AM)
• CIRS Pattern: Variable dysregulation
• Clinical Impact: Disrupted stress response

Cortisol

• Standard Lab Range: AM: 4.3-22.4 ug/dL
• CIRS Pattern: Abnormal rhythm
• Clinical Impact: Not typical "adrenal fatigue" pattern

Immune System Markers Comparison

VEGF (Vascular Endothelial Growth Factor)

• Standard Lab Range: 31-86 pg/mL
• CIRS Finding: Often <31
• What This Means: Profound fatigue, poor exercise tolerance

AGA IgA/IgG (Antigliadin Antibodies)

• Standard Lab Range: 0-19 units
• CIRS Finding: >19 in 58% of cases
• What This Means: Gluten sensitivity (not celiac)

Leptin

• Standard Lab Range: Variable by gender/BMI
• CIRS Finding: Often elevated
• What This Means: Weight gain, metabolic dysfunction

T-reg cells (T-regulatory cells)

• Standard Lab Range: Variable
• CIRS Finding: Suppressed
• What This Means: Allows autoimmune-like symptoms

"The key is not any single abnormal value, but rather the pattern across multiple markers that creates the CIRS diagnostic fingerprint." - MoldCo Clinical Team

Genetic Testing (HLA-DR)

Have you ever wondered why you got so sick from mold when others in the same building seemed fine? The answer may be in your genes.

Understanding HLA-DR Haplotypes

The HLA-DR gene represents the missing link that explains why some people develop chronic illness from mold exposure while others remain unaffected. According to extensive research by Dr. Shoemaker, specific genetic variations determine your body's ability to clear biotoxins.

"Based on Dr. Shoemaker's data, in normal populations compared to international registries of gene frequencies of HLA DR, we know the frequency of mold illness-susceptible patients approximates 24% of the normally distributed population. Almost a quarter of the normal population is genetically susceptible to chronic mold illness. Three quarters isn't." - Dr. Shoemaker's HLA Research

Key statistics about HLA-DR susceptibility:

• 24% of the population carries mold-susceptible HLA-DR genes
• 95% of CIRS patients have identifiable susceptible haplotypes
• Only 5% of people without susceptible genes develop mold illness
• Multiple susceptibilities exist - some people are vulnerable to mold, Lyme, or both
• 2024 genomic studies confirm these percentages remain consistent across diverse populations
• Epigenetic factors may activate dormant susceptibility genes following severe exposure

Research from Dr. Berndtson confirms: "Approximately 25% of the population carries genetic variations that make CIRS treatment particularly challenging." This genetic predisposition isn't just a risk factor - it fundamentally changes how your immune system processes biotoxins.

Testing Options & Interpretation

HLA-DR testing reveals your specific genetic blueprint for biotoxin susceptibility. This simple test can be performed through:

• Blood draw at most major laboratories (LabCorp test code 012542)
• Cheek swab for at-home collection
• Insurance coverage often available with proper diagnostic codes

Understanding Your Results

Dr. Shoemaker's research has identified specific haplotypes with distinct susceptibility patterns:

Mold-Susceptible Haplotypes:

• 7-3-53: Mold susceptible
• 13-6-52A/B/C: Mold susceptible
• 17-2-52A: Mold susceptible
• 18-4-52A: Mold susceptible

Multi-Susceptible Haplotypes (highest risk):

• 4-3-53: The "dreaded" haplotype - susceptible to mold AND other biotoxins
• 11/12-3-52B: Multi-susceptible
• 14-5-52B: Multi-susceptible

Post-Lyme Syndrome:

• 15-6-51: Increased risk of chronic Lyme
• 16-5-51: Post-Lyme syndrome susceptibility

According to MouldWise Australia, "approximately 95% of people presenting with CIRS will have a certain HLA gene, a certain haplotype." Understanding your genetic profile helps explain:

• Why you got sick when others didn't
• Your specific biotoxin vulnerabilities
• Your expected recovery timeline
• Treatment considerations

Our at-home HLA-DR cheek swab test provides comprehensive genetic analysis with interpretation guidance based on Dr. Shoemaker's extensive research.

Mycotoxin Testing

While the Shoemaker Protocol focuses on the body's inflammatory response, many patients and practitioners also use mycotoxin testing to gain additional insights.

What is Mycotoxin Testing?

Mycotoxins are the toxic chemical byproducts produced by certain mold species. These tests analyze urine samples to measure specific toxin levels being excreted from your body, providing direct evidence of mold exposure and identifying the types of mold involved.

Limitations and Accuracy

Understanding both the value and limitations of mycotoxin testing is crucial for proper interpretation:

Temporal Limitations

• Snapshot in time: Shows exposure from the last few days only
• Does not reflect total body burden of stored biotoxins
• Can miss chronic exposures if excretion is impaired

Individual Variations

According to internal research documentation, HLA-DR gene variations can affect mycotoxin elimination rates by 10-213 times, meaning some patients may show low test results despite high body burden.

Diagnostic Context

"The Shoemaker labs are the only diagnostic approach that has passed Daubert. There are several issues with the urinary mycotoxin screening tests, ranging from no controls to inform the ranges/test design to conflation with ingested vs. inhaled mycotoxins." - MoldCo Research Context

Key limitations include:

• Not diagnostic for CIRS - measures exposure, not inflammatory response
• No standardized reference ranges across laboratories
• Cannot distinguish between inhaled vs. ingested mycotoxins

When Mycotoxin Testing Helps

Despite limitations, mycotoxin testing provides value when:

• Correlating with ERMI or HERTSMI-2 environmental testing
• Identifying specific mold species for targeted remediation
• Documenting exposure for legal or insurance purposes
• Monitoring changes after environmental remediation

For comprehensive analysis: Urine Mycotoxin Test Accuracy: What Do They Really Show?

Neurological Testing

CIRS is a neuroinflammatory illness, meaning it directly impacts the brain. Specialized imaging and testing can provide objective evidence of this.

NeuroQuant® Brain Imaging

NeuroQuant® represents a breakthrough in objectively documenting the neurological damage caused by biotoxin exposure. This FDA-cleared software analyzes standard MRI scans to detect brain structural changes invisible to the naked eye.

The Science Behind NeuroQuant®

Groundbreaking research published by Shoemaker and colleagues revealed specific brain abnormalities in CIRS patients:

"This study used the volumetric software program NeuroQuant® (NQ) to determine specific brain structure volumes in consecutive patients (N=17) seen in a medical clinic specializing in inflammatory illness... When compared to those of a medical control group (N=18), statistically significant differences in brain structure proportions were seen for patients in both hemispheres of two of the eleven brain regions analyzed; atrophy of the caudate nucleus and enlargement of the pallidum." - Shoemaker et al., Neurotoxicology and Teratology, 2014

Key Findings in CIRS Patients

The research demonstrated a distinctive "fingerprint" of brain changes:

• Caudate nucleus atrophy (shrinkage) in both hemispheres
• Pallidum enlargement bilaterally
• Left amygdala enlargement
• Right forebrain parenchyma swelling

According to Dr. Shoemaker's NeuroQuant research, these changes correlate with:

• Cognitive dysfunction and memory problems
• Executive function deficits
• Emotional dysregulation

Clinical Significance

NeuroQuant® provides several crucial advantages:

• Objective evidence of biotoxin-related brain injury
• Differentiation between mold vs. Lyme brain patterns
• Treatment monitoring - changes reverse with proper treatment
• Legal documentation for disability or litigation cases

As noted by Dr. Dale Bredesen at CIRSx Conference, up to 80% of Alzheimer's patients may have CIRS as a precursor condition, highlighting the critical importance of early brain imaging in biotoxin illness.

Visual Contrast Sensitivity (VCS) Test

The VCS test stands as one of the most reliable and accessible screening tools for biotoxin illness, with impressive diagnostic accuracy backed by extensive research.

Understanding VCS Testing

According to Dr. Shoemaker's published research, "VCS test is highly accurate and supports biotoxin-related illness diagnosis in 92 percent of affected people with only 8 percent presenting as false negative."

The test works by detecting subtle neurological changes:

• Biotoxins reduce blood flow velocity to the optic nerve within 24-36 hours of exposure
• This creates measurable deficits in contrast perception
• Rows C and D show the most significant changes in CIRS patients

Diagnostic Power

When combined with other diagnostic criteria:

"If patients present with symptoms consistent with CIRS and failed VCS, they have over a 98.5% chance of a positive diagnosis." - MouldWise Australia

Key statistics:

• 92% sensitivity for detecting biotoxin illness
• 8% false negative rate
• 98.5% accuracy when combined with symptom clusters

Clinical Applications

VCS testing serves multiple purposes:

• Initial screening - Quick, non-invasive first assessment
• Treatment monitoring - Improvements often visible within one week
• Re-exposure detection - Rapidly identifies new biotoxin contact
• Cost-effective - Available online for minimal cost

The test requires viewing specific contrast patterns at 18 inches from the screen. Failed results, particularly in rows C and D, strongly suggest biotoxin-related neurological impairment.

Learn more about neurological impacts in our guide: Neurological Symptoms of Mold Exposure.

Testing Costs and Insurance Coverage

Understanding the financial aspects of CIRS testing helps you plan your diagnostic journey effectively. Here's a comprehensive breakdown of costs and coverage options.

Typical Testing Costs

According to our research and industry data, CIRS testing costs vary widely based on the comprehensiveness of panels and your location:

Individual Test Pricing

• C4a: $150-200
• TGF-β1: $180-250
• MMP-9: $120-180
• MSH: $150-200
• VIP: $180-250
• ADH/Osmolality: $100-150
• ACTH/Cortisol: $120-180
• VEGF: $150-220
• HLA-DR Genetic Test: $250-400
• NeuroQuant® MRI: $500-800 (plus radiologist fees)
• VCS Test: $10-15 (online screening)
• Mycotoxin Panel: $300-700

Bundled Panel Options

• Basic Inflammatory Panel: $400-600 (C4a, TGF-β1, MMP-9)
• Comprehensive CIRS Panel: $1,200-1,800 (all biomarkers)
• MoldCo Starter Panel: $99 (key inflammatory markers)
• MoldCo Complete Panel: $399-599 (full Shoemaker Protocol)

Insurance Coverage Guidelines

Medicare Coverage

According to Medical News Today's 2025 Medicare analysis, Medicare Part B covers diagnostic laboratory tests when deemed medically necessary:

• No out-of-pocket costs for covered clinical diagnostic lab tests
• Requires physician order stating medical necessity
• Covers standard biomarkers (inflammatory markers, hormones)
• May not cover specialized tests like mycotoxin panels

"Medicare Part B will generally cover these tests as long as a doctor confirms they are medically essential. There are no out-of-pocket costs for these types of clinical diagnostic lab tests." - Medical News Today, August 2025

Private Insurance Considerations

• Coverage varies significantly by plan and provider
• Pre-authorization often required for comprehensive panels
• ICD-10 codes that may help with coverage:T65.891A - Toxic effect of other specified substancesJ68.4 - Chronic respiratory conditions due to chemicalsG93.3 - Postviral fatigue syndrome (if applicable)
• Appeal process available if initially denied

HSA/FSA Eligibility

According to FSA Store, "Lab fees are eligible for reimbursement with a flexible spending account (FSA), health savings account (HSA), or a health reimbursement arrangement (HRA)."

This includes:

• All CIRS biomarker tests
• Genetic testing (HLA-DR)
• NeuroQuant® imaging
• Mycotoxin panels
• Associated lab draw fees

Cost-Saving Strategies

1. Start with Screening Tests

• Begin with low-cost VCS test ($10-15)
• Use symptom clusters for initial assessment
• Progress to lab work if screening positive

2. Phased Testing Approach

• Phase 1: Core inflammatory markers (C4a, TGF-β1, MMP-9)
• Phase 2: Hormonal markers if Phase 1 positive
• Phase 3: Specialty tests (genetic, neurological)

3. Bundle Discounts

• MoldCo panels offer 40-60% savings vs. individual tests
• Some labs offer cash-pay discounts
• Group testing with family members

4. Direct-to-Consumer Options

• Quest Diagnostics direct ordering
• Often 20-30% less than physician-ordered tests
• Results still valid for clinical use

5. Telemedicine Savings

• Virtual consultations reduce overhead costs
• MoldCo appointments start at $129
• Often includes test ordering and interpretation

Financial Assistance Programs

Several options exist for those facing financial barriers:

• Lab assistance programs: LabCorp and Quest offer financial hardship discounts
• Payment plans: Most labs offer 0% interest payment plans
• Non-profit support: Some mold illness organizations provide testing grants
• Clinical trials: May offer free testing (check ClinicalTrials.gov)

ROI Perspective: Why Testing Saves Money

As Austin from Florida shared: "Can't emphasize how much this company has already changed my life. Please get tested and follow their instruction!"

Another patient reflected: "If I had this link to the $99 labs in 2023... I am convinced I would have saved $100K and a year of chaos for my family."

Consider the costs of:

• Years of misdiagnosis and ineffective treatments
• Multiple specialist visits without answers
• Work productivity losses from ongoing illness
• Unnecessary medications and procedures

Proper testing provides targeted treatment, potentially saving thousands in misdirected healthcare spending.

Regional Lab Availability

Access to CIRS testing varies by location, but options are expanding nationwide. Here's your guide to finding testing facilities.

Major National Laboratories

LabCorp (3,000+ locations nationwide)

• Available tests: Most Shoemaker Protocol biomarkers
• Strengths: Wide network, consistent processing
• Limitations: VIP testing may need send-out
• Find locations: LabCorp.com/locations

Quest Diagnostics (2,200+ locations)

• Available tests: Comprehensive CIRS panels
• Strengths: C4a testing preferred by many practitioners
• Direct ordering: Available in most states
• Find locations: QuestDiagnostics.com

Regional Considerations

Northeast Corridor

• High density of both LabCorp and Quest locations
• Specialty labs in Boston and NYC for advanced testing
• Many CIRS-literate practitioners for test ordering

Southeast

• Good coverage in urban areas
• Rural areas may require travel to testing sites
• Consider mobile phlebotomy services

Midwest

• Major cities well-served
• Rural patients may need to coordinate with grain sampling trips
• Several specialty environmental labs

Southwest

• Growing number of integrative medicine labs
• Phoenix and Denver emerging as CIRS treatment hubs
• Desert climate patients often combine testing with remediation

West Coast

• Extensive lab networks in CA, OR, WA
• Many functional medicine labs offering specialized panels
• Higher adoption of telemedicine options

Mobile Phlebotomy Services

For those unable to travel to lab locations:

• National services: Quest and LabCorp offer home draws (additional fees apply)
• Local options: Search "mobile phlebotomy + [your city]"
• Typical costs: $75-150 for home visit
• Insurance: May cover for homebound patients

International Testing

For patients outside the US:

• Direct shipment kits: Available for some tests (HLA-DR, mycotoxins)
• Local lab partnerships: Many countries have agreements with US labs
• Telemedicine consultations: Can facilitate international testing

Telemedicine Testing Options

The rise of telemedicine has revolutionized access to CIRS testing and treatment, especially for those in underserved areas.

MoldCo's Telehealth Platform

As noted by Fivestar Clinics, "MoldCo offers virtual mould toxicity testing, diagnosis, and expert treatment, making care accessible, affordable, and guided by specialists."

How MoldCo's Process Works

1. Initial Consultation ($129)
2. 30-minute video appointment with CIRS-specialized providerReview of symptoms and exposure historyPersonalized testing recommendations
3. At-Home Test Kits ($99-599)
4. Shipped directly to your doorIncludes all collection materialsPrepaid return shipping
5. Lab Partnerships
6. National network for blood drawsResults in 5-7 business daysDirect integration with provider portal
7. Follow-Up Care
8. Test interpretation includedPersonalized treatment protocolsPrescription medications delivered to home

Other Telemedicine Options

SurvivingMold.com Certified Practitioners

• Directory of Shoemaker-certified providers
• Many offer virtual consultations
• Can order tests for your local lab

Functional Medicine Platforms

• Services like Parsley Health and Steady MD
• Include CIRS testing in comprehensive panels
• Monthly membership models available

Benefits of Telemedicine Testing

1. Accessibility
2. No geographic limitationsIdeal for mobility-challenged patientsAccess to specialized expertise
3. Convenience
4. Schedule appointments around workNo travel time or costsResults delivered electronically
5. Cost-Effectiveness
6. Lower overhead = reduced consultation feesBundled testing discountsEliminate travel expenses
7. Continuity of Care
8. Same provider throughout treatmentEasy follow-up schedulingIntegrated treatment protocols

Preparing for Virtual Consultations

To maximize your telemedicine appointment:

• Document preparation:
• Complete symptom questionnaires in advanceGather previous test resultsList all current medications/supplements
• Technology setup:
• Test video/audio before appointmentEnsure good lighting for visual assessmentHave a quiet, private space
• Questions to ask:
• Which tests are most critical for your case?What's the total expected cost?How will results be delivered and interpreted?

State Licensing Considerations

• Most states allow interstate telemedicine
• Some require providers be licensed in patient's state
• MoldCo and major platforms handle licensing compliance
• Always verify coverage in your state

Testing Timeline: Before, During, and After Treatment

Testing is not a one-time event; it's a critical part of monitoring your recovery journey.

Initial Testing

This is the comprehensive workup to establish a baseline diagnosis. It should include:

• Full Shoemaker Protocol biomarker panel (Starter or Complete)
• HLA-DR genetic test
• VCS Test
• Consider a NeuroQuant® MRI if cognitive symptoms are significant.

For an overview, see our guide on Uncovering CIRS with Health Testing.

During Treatment

Once your provider initiates treatment, certain markers need monitoring to track your progress. Your provider will determine the appropriate testing schedule based on your individual response—typically every 3-6 months.

• VCS Test: This can be done frequently (even weekly) to monitor improvement.
• Key Inflammatory Markers: C4a, TGF-beta-1, and MMP-9 are the most important markers to re-test. As your body clears biotoxins, these levels should decrease.
• MSH and VIP: These hormones are typically the last to recover and may not need to be re-tested until later stages of treatment.

Post-Treatment

Once treatment is complete and symptoms have resolved, a final round of testing can confirm recovery. This may include a final biomarker panel and a follow-up NeuroQuant® to document the reversal of brain structural changes. Ongoing monitoring may include periodic VCS tests, especially if you are concerned about a new exposure.

Interpreting Your Lab Results

Understanding Lab Ranges vs. CIRS Ranges

It is crucial to understand that the "normal" reference ranges provided by labs like LabCorp and Quest are not the same as the optimal ranges used for diagnosing and treating CIRS.

"Labcorp’s reference ranges are different from those used by CIRS providers to interpret a patient’s blood measurement, and to provide subsequent recommendations. Your total report package includes MoldCo educational materials that can help you contextualize your lab values according to the literature and clinical experience in the field of Mold Toxicity..." - MoldCo FAQ

A CIRS-literate practitioner is essential for interpreting your results. They are trained to recognize the specific pattern of highs and lows across the different biomarkers that indicates CIRS.

Working with Your Doctor

Presenting these results to a doctor unfamiliar with CIRS can be challenging. They may dismiss the findings as irrelevant or non-specific. This is why finding a CIRS-literate doctor is so important. They can provide a proper diagnosis and guide you through the evidence-based Shoemaker Protocol treatment steps.

Comparison: Testing Methods

Not all mold illness tests are created equal. Understanding the strengths and limitations of each testing method helps you make informed decisions about your diagnostic journey.

Comprehensive Testing Method Comparison

Shoemaker Protocol Biomarkers

• What It Measures: Body's inflammatory response
• Accuracy: 98.5% diagnostic accuracy when combined with VCS
• Cost: $400-1,800
• Best For: Definitive CIRS diagnosis
• Limitations: Requires multiple blood draws

HLA-DR Genetic Test

• What It Measures: Genetic susceptibility
• Accuracy: 95% correlation with CIRS
• Cost: $250-400
• Best For: Understanding risk factors
• Limitations: Doesn't confirm active illness

VCS Test

• What It Measures: Neurological function
• Accuracy: 92% sensitivity
• Cost: $10-15
• Best For: Initial screening
• Limitations: 8% false negative rate

Mycotoxin Testing

• What It Measures: Toxin levels in urine
• Accuracy: Variable
• Cost: $300-700
• Best For: Identifying exposure source
• Limitations: Snapshot only; affected by excretion ability

NeuroQuant® MRI

• What It Measures: Brain structural changes
• Accuracy: High specificity for CIRS patterns
• Cost: $500-800+
• Best For: Documenting neurological impact
• Limitations: Requires specialized software

Standard Allergy Testing

• What It Measures: IgE immune response
• Accuracy: Not applicable for CIRS
• Cost: $200-400
• Best For: Ruling out true mold allergy
• Limitations: Misses innate immune response

Choosing the Right Testing Approach

For Initial Screening

1. Start with VCS Test - Low cost, immediate results
2. Complete symptom cluster assessment - Free self-evaluation
3. Consider HLA-DR if strong family history

For Diagnosis

1. Core inflammatory markers (C4a, TGF-β1, MMP-9)
2. MSH and VIP to assess hormonal impact
3. Additional markers based on symptoms

For Legal/Disability Documentation

1. Complete Shoemaker Panel - Most defensible in court
2. NeuroQuant® MRI - Objective brain imaging
3. Serial testing showing changes over time

For Treatment Monitoring

1. VCS weekly during active treatment
2. Inflammatory markers every 3-6 months
3. Hormonal markers in later treatment stages

Laboratory Quality Considerations

Not all laboratories process CIRS tests with equal accuracy. Key factors to consider:

• Sample handling: Some markers (like C4a) require specific processing
• Reference ranges: Ensure lab uses validated CIRS ranges
• Turnaround time: Faster isn't always better if accuracy suffers
• Certification: Look for CLIA-certified facilities

Evidence-Based vs. Experimental Testing

According to the EPA's guidance on indoor air quality and the NIH's research on environmental health, evidence-based testing focuses on validated biomarkers rather than experimental approaches.

Evidence-Based (Recommended):

• Shoemaker Protocol biomarkers
• FDA-cleared NeuroQuant® imaging
• Validated genetic testing

Experimental (Use with caution):

• Hair analysis for mold
• Unvalidated "mold antibody" tests
• Non-standardized saliva testing

Finding the Right Lab for Your Tests

Most of the CIRS biomarker tests can be ordered through major laboratories.

• LabCorp: Can perform most of the Shoemaker panel tests, including TGF-beta-1, MMP-9, and the HLA-DR genetic test.
• Quest Diagnostics: Also performs many of the key tests. C4a testing through Quest is often preferred by CIRS practitioners for accuracy.
• Specialty Labs: Some markers, like VIP, may need to be sent to specialized labs for accurate results.

Cost Considerations

Navigating insurance coverage for these tests can be difficult, as many are considered "investigational." However, many practitioners have success with specific diagnostic codes. Cash-pay options and bundled panels can offer significant savings.

Here's where MoldCo makes a difference: Through our exclusive partnership with Dr. Shoemaker, we offer bundled testing panels at 40-60% below standard lab pricing. No unnecessary tests. No guesswork. Just the exact markers Dr. Shoemaker uses in his own practice.

Concerned about cost? Our Starter Panel gives you the most critical inflammatory markers for just $99—that's less than a single marker at most labs.

As Medical News Today confirms, these tests are eligible for HSA/FSA reimbursement, and Medicare Part B covers them when medically necessary—making proper testing more accessible than ever.

Related Articles

Testing Information

• ERMI vs HERTSMI-2 Explained
• Understanding Your Lab Results
• Testing Timeline During Treatment

Treatment Planning

• CIRS Treatment Guide
• Finding a CIRS-Literate Doctor
• The Shoemaker Protocol Steps Explained

Symptom Correlation

• Mold Exposure Symptoms: The Complete Guide
• Why Does Mold Affect Some People More?
• Neurological Symptoms of Mold Exposure

Get Started Today

Stop wondering and start recovering. Expert-guided testing is your path from confusion to clarity—and we make it simple.

As the Mayo Clinic advises, "If you have a persistent cough, wheezing, or other symptoms that may be related to mold exposure, talk to your doctor." At MoldCo, we go beyond basic evaluation—our CIRS-specialized providers understand the complex biomarker patterns that general practitioners often miss.

Start with Core Testing

Our Starter Panel includes the most important CIRS biomarkers to determine if your health is being impacted by inflammation from biotoxins. Developed in direct consultation with Dr. Shoemaker, this panel focuses on the markers with the highest diagnostic yield—saving you money while providing critical insights.

Get Started Now

Get the Full Picture

For a complete evaluation, our Complete Panel tests all the key biomarkers in the Shoemaker Protocol, giving you and your doctor a comprehensive view of your inflammatory and hormonal health. This is the same panel Dr. Shoemaker uses in his own practice—now available nationwide through MoldCo's innovative telehealth platform.

Begin Your Recovery Journey

Check Your Genetic Risk

Find out if you are part of the 24% of the population with a genetic predisposition to mold illness with our simple at-home HLA-DR cheek swab test. Understanding your genetic makeup helps explain why you got sick when others didn't—and guides your treatment approach.

Check Your Risk Today

Why Choose MoldCo?

Unlike general telehealth platforms, MoldCo specializes exclusively in CIRS and biotoxin illness:

• Direct access to Shoemaker Protocol expertise - We're the only platform with Dr. Shoemaker's direct involvement
• CIRS-specialized providers - Every doctor is trained in the latest biotoxin protocols
• Integrated testing and treatment - From diagnosis through recovery in one seamless platform
• Evidence-based approach - Following peer-reviewed protocols, not experimental treatments
• Nationwide accessibility - Bringing world-class CIRS care to every state

Don't spend another year searching for answers. Join thousands who've discovered the root cause of their illness through proper CIRS testing.

Not sure where to start? Take our free symptoms quiz to see if you qualify for care and get personalized recommendations from our providers.

Medical Disclaimer

This guide provides educational information about CIRS testing based on peer-reviewed research and clinical experience. It is not medical advice and cannot replace consultation with a qualified healthcare provider.

The biomarker ranges and interpretations presented follow the Shoemaker Protocol but may vary between laboratories and practitioners. Your individual results require professional interpretation within the context of your complete health picture.

Laboratory reference ranges and diagnostic criteria may vary between facilities and practitioners. The biomarker patterns and ranges cited are based on the Shoemaker Protocol and published research, but individual results require professional interpretation in the context of your complete clinical picture.

Test results alone cannot diagnose CIRS. Proper diagnosis requires correlation with exposure history, symptom presentation, and response to treatment. Never begin treatment based solely on laboratory findings without medical supervision.

Testing decisions should always be made with your healthcare provider, who can determine which tests are appropriate for your specific situation. MoldCo connects patients with qualified providers who specialize in CIRS diagnosis and treatment.

Individual results may vary. Not everyone exposed to mold will develop CIRS, and recovery timelines differ based on many factors including genetics, exposure duration, and overall health status.

The information and guidance on this website have not been evaluated by the Food and Drug Administration (FDA). MoldCo provides access to testing and connects you with independent healthcare providers for diagnosis and treatment.