​​What the work-up looks at

 

The body side depends on which question you are asking. Mold illness is not one condition, and the work-up differs for allergy, infection or colonization, mycotoxin burden, and CIRS.

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CIRS (Chronic Inflammatory Response Syndrome). Under the Shoemaker framework, diagnosis is built from several pieces rather than one result:

• A symptom cluster questionnaire

• Visual contrast sensitivity (VCS), a screening test of how well your eyes detect contrast

• Inflammatory and hormone markers, including TGF-beta 1, C4a, MMP-9, MSH, VEGF, ACTH/cortisol and ADH/osmolality

• HLA-DR genetic testing, which looks at susceptibility

• A nasal culture for MARCoNS, a resistant staph pattern often seen alongside CIRS

• Exclusion of conditions that look similar, such as thyroid and rheumatologic disease

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Urine mycotoxin panels. Common in functional medicine. Interpretation is debated, so they are best read by a practitioner who knows what the panel can and cannot show.

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Why the order matters. Labs drawn without knowing your exposure timeline, medications and recent reactions are hard to read. The same marker means different things in a person who just left a damaged building and one who is still living in it.

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The work-up by condition

 

Mold illness. Splits into allergy, infection or colonization, and mycotoxin burden. Each has its own testing, which is why a single panel rarely settles it.

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CIRS. The marker set above, read together with VCS, genetics and your exposure timeline.

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MCAS. Diagnosis rests on symptoms in more than one organ system, evidence of mast cell mediators in lab work, and response to mast cell-directed treatment. Mediator labs are timing sensitive: they read best when collected during or soon after a reaction, so ask your clinician how to plan the draw.

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Other chronic illness. A first pass usually rules out look-alikes such as thyroid and rheumatologic disease before attributing the picture to exposure.