Abstract
For millennia, damp and musty buildings have been linked to human illness, as noted in ancient texts, including Leviticus 14. Today, the modern equivalent of priestly oversight falls to Indoor Environmental Professionals (IEPs), who serve as a bridge between clinical understanding and the physical assessment and remediation of structures. This paper—Part B of a three-part series—advances the evolving recognition of the built environment as a medically relevant ecosystem, particularly for individuals with complex chronic illnesses such as Chronic Inflammatory Response Syndrome (CIRS), mast cell activation disorders, and chemical sensitivities.
Building on Part A, which outlined the human health impacts of exposure to microbial and chemical agents in water-damaged buildings (WDBs), this paper reframes conventional assessment and remediation practices by introducing a medically important approach for assessing and remedying WDBs, along with measures to prevent future exposure. It emphasizes the inadequacy of superficial or cosmetic repairs when faced with persistent health symptoms, highlighting the need for a more in-depth approach that prioritizes occupant-specific sensitivities, proper removal of microbial sources, and durable restoration practices. Drawing on decades of interdisciplinary field experience, we argue that effective remediation must also extend beyond Mold-centric models and consider the broader microbial and material ecology of the indoor space.
Key recommendations include redefining thresholds for cleanliness, integrating environmental and health data in building assessments, and selecting non-sensitizing materials to support occupant recovery. The paper positions the building not merely as shelter, but as a dynamic system whose microbial composition can either impede or facilitate healing. By bridging insights from building science, environmental health, and clinical medicine, this work lays the groundwork for transdisciplinary collaboration.
Part C translates these environmental and diagnostic principles into an evidence-based, sequential treatment protocol—the CIRS Protocol—designed to restore health through both environmental correction and biomarker-driven clinical care. Together, this trifecta creates a comprehensive framework for addressing illness rooted in the built environment. In that paper, readers will find a detailed rationale and structure for medically important remediation (MIR), supported by field experience and multidisciplinary research. We conclude that sustainable recovery from environmentally acquired illness requires an integrated, occupant-centered approach that treats the building not only as a source of exposure, but as an active component in the healing process.