Reference · Mold & CIRS

The CIRS lab panel, marker by marker

What each marker measures, the pattern usually seen, and — the part most write-ups skip — what a given result actually changes about the plan.

The short answer

What is the CIRS lab panel?

The CIRS lab panel is a set of inflammatory and regulatory markers — C4a, TGF-β1, MMP-9, MSH, VIP, VEGF, ADH with osmolality, MARCoNS, HLA-DR and the VCS screen — used to describe how the innate immune system is responding to biotoxin exposure. It does not detect mold itself, which is why it is paired with urinary mycotoxin testing and a building assessment; read alone, individual markers give both false certainty and false reassurance.

Every marker in the panel

Marker	What it measures	Pattern usually seen	What it changes
C4a	Complement split product — innate immune activation	Raised in active biotoxin response; rises again on re-exposure	Supports an active inflammatory picture and is one of the markers re-checked after exposure is removed
TGF-β1	Regulatory cytokine involved in tissue remodelling	Frequently elevated; also rises in autoimmunity and other inflammation	High values on their own are not specific — they matter alongside MSH and VEGF, not instead of them
MMP-9	Matrix metalloproteinase — carries inflammatory signal across tissue barriers	Elevated in active cases, often tracking with symptom flares	Informs how aggressively to move and whether dietary and lipid work is needed before deeper steps
MSH	Melanocyte-stimulating hormone — regulates inflammation, sleep and gut lining	Typically low in longstanding CIRS	Low MSH predicts poor sleep, gut permeability and hormone knock-on effects; it reframes the plan as regulation, not just detox
VIP	Vasoactive intestinal polypeptide — pulmonary and inflammatory regulation	Often low late in the course	Relevant only after exposure has stopped and earlier steps are complete; not a starting point
VEGF	Capillary blood flow and oxygen delivery	Low or low-normal in many cases; occasionally high early	Helps explain exercise intolerance and air hunger, and argues against pushing exertion early
ADH / osmolality	Fluid regulation pair	Mismatched pair — thirst, frequent urination, static shocks	Explains dehydration symptoms that water alone does not fix and affects electrolyte support
MARCoNS (nasal culture)	Multiply antibiotic-resistant coagulase-negative staph in the deep nasal space	Common when MSH is low	If present, sinus work is sequenced before later steps or progress typically stalls
HLA-DR by PCR	Genetic susceptibility to poor biotoxin clearance	Fixed for life — it does not change with treatment	Explains why one person in a household is ill and another is not; run once, never repeated
VCS (visual contrast sensitivity)	Functional screen of neurological effect	Fails in many active cases; cheap and repeatable	A screening and re-check tool, not a diagnosis — a pass does not rule mold out

Reference ranges vary by laboratory, and no marker here is diagnostic on its own. This page is educational and is not medical advice.

Your Integrative Life Compass · Free

Is mold actually your driver — or downstream of something else?

13 questions, about 4 minutes, no email required. The Compass shows whether your pattern points at biotoxin load, and what has to be supported first so binders don't wreck you.

13 questions · 4 minutes · no email required

Is mold the driver or downstream? Start with your energy pattern.

Find Your Root Cause Now

CIRS testing: the questions people actually ask

What labs are in the CIRS panel?

The core CIRS panel is C4a, TGF-β1, MMP-9, MSH, VIP, VEGF, ADH with serum osmolality, a deep nasal MARCoNS culture, HLA-DR by PCR and the VCS screen. Most cases also need thyroid, cortisol and sex hormones alongside it.

The panel is designed to describe innate immune behaviour rather than to find the mould itself. That is why it pairs with urinary mycotoxin testing and a building assessment: one shows how the body is responding, the others show what it is responding to.

Is the CIRS panel the same as a mycotoxin test?

No. A urinary mycotoxin test looks for the toxins themselves; the CIRS panel measures the inflammatory consequences. Ordering one without the other is the most common reason a mold work-up gives an unclear answer.

A positive mycotoxin result with a quiet marker set reads very differently from a negative result with low MSH and a failed VCS. The combination is what determines whether mold is the driver or an incidental finding.

How much does the CIRS panel cost?

Run in full, the marker set plus a mycotoxin panel commonly lands in the high hundreds to low thousands of dollars in the US, and some markers are covered by insurance while specialty ones usually are not.

We rarely order everything at once. The practical approach is to run what would change the next decision — often VCS, MSH, TGF-β1, MMP-9, C4a and a mycotoxin panel first — then add the rest only if the first round justifies it.

Keep reading

Dr. Shoemaker & CIRS — the hubThe framework these markers come from Work with a mold illness practitionerBring results you already have Urine mycotoxins vs ERMIBody testing vs building testing A CIRS case, start to finishHow the markers guided the sequence

Have your labs read properly

Continue in this cluster

Hub

Dr. Ritchie Shoemaker — CIRS & the Shoemaker Protocol

The person hub: who Shoemaker is, what CIRS means, and the 12-step protocol decoded.

Continue

Pillar

CIRS — Chronic Inflammatory Response Syndrome

The biomarker-defined inflammatory cascade behind most unresolving mold illness.

Continue

Pillar

Mold illness practitioner — CIRS & mycotoxin care

Exposure review, mycotoxin and CIRS interpretation, sequenced protocols. Virtual across the US.

Continue

Pillar

Shoemaker protocol vs Klinghardt protocol

Side-by-side on biomarkers, sequencing, binders, cost and who each one suits.

Continue

Read

Shoemaker vs Klinghardt — two mold protocols compared

Biomarker-driven vs drainage-first. Where they disagree and how we hybridize them.

Continue

Read

The Klinghardt mold protocol — a functional update

Drainage first, then binders. The sequencing that keeps fragile patients on protocol.

Continue