Thirty years of published research on human health effects of exposure to the interior environment of water-damaged built environments Perspectives on human health part A
Main Article Content
Abstract
Learned people have known since biblical times (NKJV, Leviticus 14:33-48) that dank, moldy buildings with musty smells pose health risks to human inhabitants. The observations about sick buildings making people sick were correct, but there was no proof of causation. Older research suggested that the building-related illness involved allergies, infections, and asthma, but cellular and immune inflammatory causes awaited proof. Yes, mold was found in water-damaged buildings (WDB), but it was also present in other areas. As time passed and cytokines were discovered, the role of resident microbes found in WDB was gradually unveiled as suspected culprits in what became to be known as Sick Building Syndrome (SBS). By 1970, indoor paint was marketed that contained benomyl, a substituted benzimidazole. The paint prevented mold from growing on the paint films, but benomyl was a potent mutagen that created a roster of mutant fungi. New isolations of azole-resistant, toxin-forming fungi followed. Given the concurrent oil embargoes from oil-rich countries, the construction of energy-saving, tight buildings boomed. Tight homes reduce ventilation, raising indoor humidity. Even worse, poorly constructed basements and crawl spaces added to the moisture problems.
The recognition of toxigenic fungi in WDB exploded in the United States (US) in 1999 when a court in Texas ('Dripping Springs') awarded an eight-figure settlement to plaintiffs who alleged that exposure to Stachybotrys made a family ill, including dense cognitive impairments. Suddenly, "Black Mold" became a buzzword for lucrative legal awards without proof of causation; association was often enough to win a personal injury/defective construction case in some courts.
Skipping forward to 2026, current academic research has shown that SBS is a Chronic Inflammatory Response Syndrome (CIRS), with specific causation indicating that 42% of cases are due to Actinobacteria, 28% of cases are due to bacterial endotoxins, 7% are due to fungi, and 6-10% are due to beta glucans. The use of Next Generation Sequencing (NGS) has revealed the complexity of microbial residence in WDB. Transcriptomics (Gene Expression: Inflammation Explained; GENIE) provides insight into the molecular pathophysiology of CIRS, while NeuroQuant® indicates that brain injury occurs in more than 50% of cases. When you read claims on the Internet of miracle mold cures, ask to see published, peer-reviewed, data-driven papers that form the basis of those claims.
We present three publications, Human Health and the Built Environment, Part A: Part B respectively, and Part C, focusing on treatment in this Perspective. We will discuss (i) what makes wet buildings dangerous and (ii) how does a building owner correct the microbial ecosystem associated with excessive moisture; (iii) how can the CIRS patients be diagnosed with transparent, medically sound protocols; (iv) how treatment, including healing brain injury, can restore health, even after years of illness in a CIRS patient.
Keywords:
Water-Damaged Buildings (WDB), Sick Building Syndrome (SBS), Chronic Inflammatory Response Syndrome (CIRS), Indoor environmental health, Toxigenic fungi, Actinobacteria, Next Generation Sequencing (NGS), NeuroQuant®, Indoor air quality
Article Details
How to Cite
SHOEMAKER, R et al.
Thirty years of published research on human health effects of exposure to the interior environment of water-damaged built environments.
Medical Research Archives, [S.l.], v. 13, n. 8, aug. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6769>. Date accessed: 07 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i8.6769.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
Shoemaker
1. Diagnosis of Pfiesteria-human illness syndrome. Md Med J 1997 521-523L
2. Shoemaker R. Treatment of persistent Pfiesteria-human illness syndrome. Md Med J 1998; 47:64-66.
LARK
1. Donlan, R. M., & Costerton, J. W. “Biofilms: Survival mechanisms of clinically relevant microorganisms.” Clinical Microbiology Reviews, vol. 15, no. 2, 2002, pp. 167–193.
2. Etzel, R. A. “Stachybotrys.” Pediatric Clinics of North America, vol. 48, no. 5, 2001, pp. 1189–1201.
3. Gareis, M., et al. “Toxic effects of mycotoxins in humans.” Archives of Toxicology, vol. 64, 1990, pp. 117–122.
4. Hanski, I., et al. “Environmental biodiversity, human microbiota, and allergy are interrelated.” PNAS, vol. 109, no. 21, 2012, pp. 8334–8339.
5. Li, D. W., & Haugland, R. A. “Gene sequences reveal fungal identities in building-related illnesses.” Mycopathologia, vol. 156, 2003, pp. 129–136.
6. Lighthart, B. “Bioaerosols associated with plants.” Applied and Environmental Microbiology, vol. 63, no. 5, 1997, pp. 1839–1845.
7. Pascual, J., et al. “Actinobacteria in special habitats and their metabolic potential.” Frontiers in Microbiology, vol. 6, 2015, p. 1198.
8. Reponen, T., et al. “Viable mold propagules in indoor air.” Environmental Health Perspectives, vol. 105, no. 6, 1997, pp. 633–640.
9. Rizzatti, G., et al. “Intestinal microbiota: Involvement in human health and disease.” Frontiers in Cellular and Infection Microbiology, vol. 7, 2017, p. 140.
10. Shoemaker RC, House DE. Sick building syndrome (SBS) and exposure to water-damaged buildings: Time series study, clinical trial and mechanisms. NTT 2006; 28: 573-588.
11. Straus, D. C. “Molds, mycotoxins, and sick building syndrome.” Toxicology and Industrial Health, vol. 25, no. 9–10, 2009, pp. 617–635.
McMahon References
1. Policy Holders of America: Research Committee Report on Diagnosis and Treatment of Chronic Inflammatory Response Syndrome Caused by Exposure to the Interior Environment of Water-Damaged Buildings (2010).
2. Dooley M, McMahon SW. A comprehensive review of mold research literature from 2011 – 2018. Internal Medicine Review. 2020;3(1):1-39.
3 Shoemaker R. Residential and recreational acquisition of possible estuary-associated syndrome: A new approach to successful diagnosis and treatment. Environmental Health Perspectives 2001;109:791-796
4 Shoemaker R, Hudnell K. Possible Estuary-Associated Syndrome: Symptoms, vision, and treatment. Environmental Health Perspectives 2001;109:539-545.
5 Shoemaker R, House D, Ryan J. Vasoactive intestinal polypeptide (VIP) corrects chronic inflammatory response syndrome (CIRS) acquired following exposure to water-damaged buildings. Health 2013;5(3):396-401.
6 Shoemaker R. House D, Ryan J. Structural brain abnormalities in patients with inflammatory illness acquired following exposure to water damaged buildings: A volumetric MRI study using NeuroQuant®. Neurotoxicology Teratol. 2014;45:18-26.
7 McMahon SW, Shoemaker RC, and Ryan. Reduction in forebrain parenchymal and cortical grey matter swelling across treatment groups in patients with inflammatory illness acquired following exposure to water-damaged buildings. J Neurosci Clin Res 1:1. April 12, 2016
8 Ryan C, Shoemaker RC. RNA-Seq on patients with chronic inflammatory response syndrome (CIRS) treated with vasoactive intestinal peptide (VIP) shows a shift in metabolic state and innate immune functions that coincide with healing. Medical Research Archives, Volume 4, Issue 7. November 2016.
9 Shoemaker R, Heyman A, Lark D. Transcriptomics and brain volumetrics define the causes of cognitive impairment in patients with CIRS and support the use of VIP in treatment. Medical Research Archives. March 2023. 11(3):online.
10 Shoemaker RC, House DE. Sick building syndrome (SBS) and exposure to water-damaged buildings: Time series study, clinical trial and mechanisms. NTT 2006; 28: 573-588.
11 Shoemaker RC, Katz D, Ackerley M, Rapaport S, McMahon SW, Berndston K, Ryan JC. Intranasal VIP safely restores volume to multiple grey matter nuclei in patients with CIRS. Internal Medicine Review. 2017;1-14.
12 Shoemaker R. Diagnosis of Pfiesteria-human illness syndrome. Maryland Medical Journal 1997; 521-523.
13 Shoemaker R. Treatment of persistent Pfiesteria-human illness syndrome. Maryland Medical Journal 1998; 47: 64-66.
14 Grattan L, Oldach D, Perl T, Lowitt M, Matuszak D, Dickson C, Parrott C, Shoemaker R, Kauffman L, Wasserman M, Hebel R, Charache P, Morris G. Learning and memory difficulties after environmental exposure to waterways containing toxin-producing Pfiesteria or Pfiesteria-like dinoflagellates. The Lancet 1998; 352: 532-539
15 US Environmental Protection Agency. Indoor air quality in buildings: Building assessment survey and evaluation (BASE) study. www.epa.gov/iaq/base
16 Taylor K, Clifford R, Kollmeyer B, Pielak J. Toxic mold assessment, mitigation, and prevention at DoD facilities. Federal Facilities Environmental Journal. July 2004. https://doi.org/10.1002/ffej.20014
17 Shoemaker R, Lipsey R. Results of health screening and visual contrast testing. St. Bernard’s Parish, Louisiana. 2006. published on-line.
18 Shoemaker RC, House DE. Sick building syndrome (SBS) and exposure to water-damaged buildings: Time series study, clinical trial and mechanisms. Neurotoxicology and Teratology. 2006;28:573-588.
19 Shoemaker R, House DE. A time-series study of sick building syndrome: chronic, biotoxin-associated illness from exposure to water-damaged buildings. Neurotoxicology and Teratology. 2005;27:29-46.
20 Shoemaker RC, Rash JM, Simon EW. Sick Building syndrome in water damaged buildings: generalization of the chronic biotoxin associated illness paradigm to indoor toxigenic fungi. Bioaerosols, fungi, bacteria, mycotoxins and human health. Dr med Eckardt Johanning MD editor 2006.
21 Fisk W.J, Eliseeva EA, Mendell MJ. Association of residential dampness and mold with respiratory tract infections and bronchitis: a meta-analysis. Environ Health 2010. 9(72). https://doi.org/10.1186/1476-069X-9-72
22 Mudarri DH. Valuing the economic costs of allergic rhinitis, acute bronchitis, and asthma from exposure to indoor dampness and mold in the US. Journal of Environmental and Public Health. 2016. https://doi.org/10.1155/2016/2386596
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30 Shoemaker R, Maizel M. Exposure to interior environments of water-damaged buildings causes a CFS-like illness in pediatric patients: a case/control study. Bulletin of the IACFS. 2008.
31 Shoemaker R, House D, Ryan J. Defining the neurotoxin derived illness chronic ciguatera using markers of chronic systemic inflammatory disturbances: A case/control study. Neurotoxicology and Teratology 2010; 633-639.
32 Thomas G, Burton NC, Mueller C, Page E, Vesper S. Comparison of work-related symptoms and visual contrast sensitivity between employees at a severely water-damaged school and a school without significant water damage. American Journal of Industrial Medicine. 2012;55(9):844-854.
33 Shoemaker R, House D, Ryan J. Vasoactive intestinal polypeptide (VIP) corrects chronic inflammatory response syndrome (CIRS) acquired following exposure to water-damaged buildings. Health 2013;5(3):396-401.
34 Shoemaker R. House D, Ryan J. Structural brain abnormalities in patients with inflammatory illness acquired following exposure to water damaged buildings: A volumetric MRI study using Neuroquant®. Neurotoxicology Teratol 2014;45:18-26.
35 McMahon SW, Shoemaker RC, and Ryan. Reduction in Forebrain Parenchymal and Cortical Grey Matter Swelling across Treatment Groups in Patients with Inflammatory Illness Acquired Following Exposure to Water-Damaged Buildings. J Neurosci Clin Res 1:1. April 12, 2016.
36 Shoemaker RC, Katz D, Ackerley M, Rapaport S, McMahon SW, Berndston K, Ryan JC. Intranasal VIP safely restores volume to multiple grey matter nuclei in patients with CIRS. Internal Medicine Review. 2017;1-14.
37 Medically sound investigation and remediation of water-damaged buildings in cases of chronic inflammatory response syndrome. Berndtson K, McMahon S, Ackerley M, Rapaport S, Gupta S, Shoemaker R. January 19, 2016.
38 Ryan JC, Shoemaker RC. RNA-Seq on patients with chronic inflammatory response syndrome (CIRS) treated with vasoactive intestinal peptide (VIP) shows a shift in metabolic state and innate immune functions that coincide with healing. Medical Research Archives. 2016;4(7):online.
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40 Shoemaker, RC and Lark, D - 2016, HERTSMI-2 and ERMI: “Correlating Human Health Risk with Mold Specific qPCR in Water-Damaged Buildings” #658 in Proceedings of the 14th International Conference on Indoor Air Quality and Climate, International Society for Indoor Air Quality and Climate, Ghent, Belgium.
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46 Shoemaker R, Neil V, Heyman A, van der Westhuizen, McMahon S, Lark D. Newer molecular methods bring new insights into human- and building-health risk assessments from water-damaged buildings: defining exposure and reactivity, the two sides of causation of CIRS-WDB illness. Medical Research Archives. 2021;9(3):1-36.
47 Shoemaker R, McMahon S, Heyman A, Lark D, van der Westhuizen M. Treatable metabolic and inflammatory abnormalities in post COVID syndrome (PCS) define the transcriptomic basis for persistent symptoms: Lessons from CIRS. Medical Research Archives. 2021;9(7):1-18.
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50 Shoemaker R, Ryan J, Heyman A, Dorninger E, McMahon S, Lark D. A Novel therapeutic approach to Parkinsons Disease: Using transcriptomics to identify unique patterns of gene expression including triple positives, Toll receptors, and endotoxin exposure. Medical Research Archives. 2025 Accepted but not in print.
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Ibid 1
Ibid 1
Ibid 1
Ibid 1
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Ibid 5
3..Naviaux RK. Incomplete Healing as a Cause of Aging: The Role of Mitochondria and the Cell Danger Response. Biology (Basel). 2019 May 11;8(2):27. doi: 10.3390/biology8020027. PMID: 31083530; PMCID: PMC6627909.
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Ibid 11
Ibid 11
Ibid 11
5.Zhao N, Liu CC, Qiao W, Bu G. Apolipoprotein E, Receptors, and Modulation of Alzheimer's Disease. Biol Psychiatry. 2018 Feb 15;83(4):347-357. doi: 10.1016/j.biopsych.2017.03.003. Epub 2017 Mar 14. PMID: 28434655; PMCID: PMC5599322.
Ibid 12
IBID
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6. Dooley, M., & McMahon, S. W. (2020). A comprehensive review of mold research literature from 2011–2018. Internal Medicine Review, 6(1), 1–38. https://www.internalmedicinereview.org/index.php/imr/article/view/836
7. Fisk, W. J., Eliseeva, E. A., & Mendell, M. J. (2010). Association of residential dampness and mold with respiratory tract infections and bronchitis: A meta-analysis. Environmental Health, 9, Article 72. https://doi.org/10.1186/1476-069X-9-72
8. Heyman, A., & Shoemaker, R. (2025). Clinical management of Chronic Inflammatory Response Syndrome [Online continuing education course]. George Washington University School of Medicine and Health Sciences. https://cme.smhs.gwu.edu/a4m-mmi-/content/clinical-management-chronic-inflammatory-response-syndrome
9. Institute of Inspection, Cleaning and Restoration Certification. (n.d.). ANSI/IICRC S520: Standard for professional mold remediation. IICRC. Retrieved July 2, 2025, from https://iicrc.org/s520/
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13. Mayo Clinic. (1999, September 10). The study of the Mayo Clinic implies fungus as the cause of chronic sinusitis. ScienceDaily. https://www.sciencedaily.com/releases/1999/09/990910080344.htm
14. McMahon, S. W. (n.d.). About [Web page]. Retrieved July 2, 2025, from https://scottmcmahon.doctor/about
1. Diagnosis of Pfiesteria-human illness syndrome. Md Med J 1997 521-523L
2. Shoemaker R. Treatment of persistent Pfiesteria-human illness syndrome. Md Med J 1998; 47:64-66.
LARK
1. Donlan, R. M., & Costerton, J. W. “Biofilms: Survival mechanisms of clinically relevant microorganisms.” Clinical Microbiology Reviews, vol. 15, no. 2, 2002, pp. 167–193.
2. Etzel, R. A. “Stachybotrys.” Pediatric Clinics of North America, vol. 48, no. 5, 2001, pp. 1189–1201.
3. Gareis, M., et al. “Toxic effects of mycotoxins in humans.” Archives of Toxicology, vol. 64, 1990, pp. 117–122.
4. Hanski, I., et al. “Environmental biodiversity, human microbiota, and allergy are interrelated.” PNAS, vol. 109, no. 21, 2012, pp. 8334–8339.
5. Li, D. W., & Haugland, R. A. “Gene sequences reveal fungal identities in building-related illnesses.” Mycopathologia, vol. 156, 2003, pp. 129–136.
6. Lighthart, B. “Bioaerosols associated with plants.” Applied and Environmental Microbiology, vol. 63, no. 5, 1997, pp. 1839–1845.
7. Pascual, J., et al. “Actinobacteria in special habitats and their metabolic potential.” Frontiers in Microbiology, vol. 6, 2015, p. 1198.
8. Reponen, T., et al. “Viable mold propagules in indoor air.” Environmental Health Perspectives, vol. 105, no. 6, 1997, pp. 633–640.
9. Rizzatti, G., et al. “Intestinal microbiota: Involvement in human health and disease.” Frontiers in Cellular and Infection Microbiology, vol. 7, 2017, p. 140.
10. Shoemaker RC, House DE. Sick building syndrome (SBS) and exposure to water-damaged buildings: Time series study, clinical trial and mechanisms. NTT 2006; 28: 573-588.
11. Straus, D. C. “Molds, mycotoxins, and sick building syndrome.” Toxicology and Industrial Health, vol. 25, no. 9–10, 2009, pp. 617–635.
McMahon References
1. Policy Holders of America: Research Committee Report on Diagnosis and Treatment of Chronic Inflammatory Response Syndrome Caused by Exposure to the Interior Environment of Water-Damaged Buildings (2010).
2. Dooley M, McMahon SW. A comprehensive review of mold research literature from 2011 – 2018. Internal Medicine Review. 2020;3(1):1-39.
3 Shoemaker R. Residential and recreational acquisition of possible estuary-associated syndrome: A new approach to successful diagnosis and treatment. Environmental Health Perspectives 2001;109:791-796
4 Shoemaker R, Hudnell K. Possible Estuary-Associated Syndrome: Symptoms, vision, and treatment. Environmental Health Perspectives 2001;109:539-545.
5 Shoemaker R, House D, Ryan J. Vasoactive intestinal polypeptide (VIP) corrects chronic inflammatory response syndrome (CIRS) acquired following exposure to water-damaged buildings. Health 2013;5(3):396-401.
6 Shoemaker R. House D, Ryan J. Structural brain abnormalities in patients with inflammatory illness acquired following exposure to water damaged buildings: A volumetric MRI study using NeuroQuant®. Neurotoxicology Teratol. 2014;45:18-26.
7 McMahon SW, Shoemaker RC, and Ryan. Reduction in forebrain parenchymal and cortical grey matter swelling across treatment groups in patients with inflammatory illness acquired following exposure to water-damaged buildings. J Neurosci Clin Res 1:1. April 12, 2016
8 Ryan C, Shoemaker RC. RNA-Seq on patients with chronic inflammatory response syndrome (CIRS) treated with vasoactive intestinal peptide (VIP) shows a shift in metabolic state and innate immune functions that coincide with healing. Medical Research Archives, Volume 4, Issue 7. November 2016.
9 Shoemaker R, Heyman A, Lark D. Transcriptomics and brain volumetrics define the causes of cognitive impairment in patients with CIRS and support the use of VIP in treatment. Medical Research Archives. March 2023. 11(3):online.
10 Shoemaker RC, House DE. Sick building syndrome (SBS) and exposure to water-damaged buildings: Time series study, clinical trial and mechanisms. NTT 2006; 28: 573-588.
11 Shoemaker RC, Katz D, Ackerley M, Rapaport S, McMahon SW, Berndston K, Ryan JC. Intranasal VIP safely restores volume to multiple grey matter nuclei in patients with CIRS. Internal Medicine Review. 2017;1-14.
12 Shoemaker R. Diagnosis of Pfiesteria-human illness syndrome. Maryland Medical Journal 1997; 521-523.
13 Shoemaker R. Treatment of persistent Pfiesteria-human illness syndrome. Maryland Medical Journal 1998; 47: 64-66.
14 Grattan L, Oldach D, Perl T, Lowitt M, Matuszak D, Dickson C, Parrott C, Shoemaker R, Kauffman L, Wasserman M, Hebel R, Charache P, Morris G. Learning and memory difficulties after environmental exposure to waterways containing toxin-producing Pfiesteria or Pfiesteria-like dinoflagellates. The Lancet 1998; 352: 532-539
15 US Environmental Protection Agency. Indoor air quality in buildings: Building assessment survey and evaluation (BASE) study. www.epa.gov/iaq/base
16 Taylor K, Clifford R, Kollmeyer B, Pielak J. Toxic mold assessment, mitigation, and prevention at DoD facilities. Federal Facilities Environmental Journal. July 2004. https://doi.org/10.1002/ffej.20014
17 Shoemaker R, Lipsey R. Results of health screening and visual contrast testing. St. Bernard’s Parish, Louisiana. 2006. published on-line.
18 Shoemaker RC, House DE. Sick building syndrome (SBS) and exposure to water-damaged buildings: Time series study, clinical trial and mechanisms. Neurotoxicology and Teratology. 2006;28:573-588.
19 Shoemaker R, House DE. A time-series study of sick building syndrome: chronic, biotoxin-associated illness from exposure to water-damaged buildings. Neurotoxicology and Teratology. 2005;27:29-46.
20 Shoemaker RC, Rash JM, Simon EW. Sick Building syndrome in water damaged buildings: generalization of the chronic biotoxin associated illness paradigm to indoor toxigenic fungi. Bioaerosols, fungi, bacteria, mycotoxins and human health. Dr med Eckardt Johanning MD editor 2006.
21 Fisk W.J, Eliseeva EA, Mendell MJ. Association of residential dampness and mold with respiratory tract infections and bronchitis: a meta-analysis. Environ Health 2010. 9(72). https://doi.org/10.1186/1476-069X-9-72
22 Mudarri DH. Valuing the economic costs of allergic rhinitis, acute bronchitis, and asthma from exposure to indoor dampness and mold in the US. Journal of Environmental and Public Health. 2016. https://doi.org/10.1155/2016/2386596
23 Vesper S, McKinstry C, Haugland R, Wymer L, Bradham K, Ashley P, Cox D, Dewalt G, Friedman, Warren PhD. Development of an Environmental Relative Moldiness Index for US Homes. Journal of Occupational and Environmental Medicine 49(8):p 829-833, August 2007. | DOI: 10.1097/JOM.0b0 13e3181255e98
24 Reponen T, Vesper, Levin L, Johansson E, Ryan P, Burkle J, Grinshpun SA, Zheng S, Bernstein D I, Lockey J, Villareal M, Khurana Hershey GK, LeMasters G. High environmental relative moldiness index during infancy as a predictor of asthma at 7 years of age. Annals of Allergy, Asthma & Immunology. 2011;107(2):120-126. https://doi.org/10.1016/j.anai.2011.04.018
25 Vesper S, Wymer L, Cox D, Dewalt G, Pinzer E, Friedman W, Ashley PJ. Comparison of ERMI results from dust collected from homes by an electrostatic cloth and by the standard vacuum method. Journal of Occupational and Environmental Hygiene. 2021;18(9):423–429. https://doi.org/10.1080/15459624.2021.1946254
26 Shoemaker R, Lin K. Inside indoor air quality: Environmental relative moldiness index (ERMI). Filtration News. 2007;32:36.
27 Vesper SJ. The development and application of the environmental relative Moldiness index (ERMI). Critical Reviews in Microbiology. 2025;51(2):285–295. https://doi.org/10.1080/1040841X.2024.2344112
28 GAO Report to the Chairman, Committee on Health, Education, Labor and Pensions, U.S. Senate, Indoor Mold. In: 2008.
29 Hudnell HK. Cyanobacterial Harmful Algal Blooms: State of the Science and Research Needs. Springer. New York, New York. 2008.
30 Shoemaker R, Maizel M. Exposure to interior environments of water-damaged buildings causes a CFS-like illness in pediatric patients: a case/control study. Bulletin of the IACFS. 2008.
31 Shoemaker R, House D, Ryan J. Defining the neurotoxin derived illness chronic ciguatera using markers of chronic systemic inflammatory disturbances: A case/control study. Neurotoxicology and Teratology 2010; 633-639.
32 Thomas G, Burton NC, Mueller C, Page E, Vesper S. Comparison of work-related symptoms and visual contrast sensitivity between employees at a severely water-damaged school and a school without significant water damage. American Journal of Industrial Medicine. 2012;55(9):844-854.
33 Shoemaker R, House D, Ryan J. Vasoactive intestinal polypeptide (VIP) corrects chronic inflammatory response syndrome (CIRS) acquired following exposure to water-damaged buildings. Health 2013;5(3):396-401.
34 Shoemaker R. House D, Ryan J. Structural brain abnormalities in patients with inflammatory illness acquired following exposure to water damaged buildings: A volumetric MRI study using Neuroquant®. Neurotoxicology Teratol 2014;45:18-26.
35 McMahon SW, Shoemaker RC, and Ryan. Reduction in Forebrain Parenchymal and Cortical Grey Matter Swelling across Treatment Groups in Patients with Inflammatory Illness Acquired Following Exposure to Water-Damaged Buildings. J Neurosci Clin Res 1:1. April 12, 2016.
36 Shoemaker RC, Katz D, Ackerley M, Rapaport S, McMahon SW, Berndston K, Ryan JC. Intranasal VIP safely restores volume to multiple grey matter nuclei in patients with CIRS. Internal Medicine Review. 2017;1-14.
37 Medically sound investigation and remediation of water-damaged buildings in cases of chronic inflammatory response syndrome. Berndtson K, McMahon S, Ackerley M, Rapaport S, Gupta S, Shoemaker R. January 19, 2016.
38 Ryan JC, Shoemaker RC. RNA-Seq on patients with chronic inflammatory response syndrome (CIRS) treated with vasoactive intestinal peptide (VIP) shows a shift in metabolic state and innate immune functions that coincide with healing. Medical Research Archives. 2016;4(7):online.
39 Indoor Environmental Professionals Panel of Surviving Mold CONSENSUS STATEMENT Medically sound investigation and remediation of water-damaged Buildings in cases of CIRS-WDB. Larry Schwartz CIEC, BSME, MBA, Greg Weatherman CMC, Michael Schrantz CIEC, CMI, BPI-BA/EP, Will Spates CIAQP, CIEC, Jeff Charlton, ACIEC, AACIEH, Keith Berndtson MD, Ritchie Shoemaker MD April 12, 2016.
40 Shoemaker, RC and Lark, D - 2016, HERTSMI-2 and ERMI: “Correlating Human Health Risk with Mold Specific qPCR in Water-Damaged Buildings” #658 in Proceedings of the 14th International Conference on Indoor Air Quality and Climate, International Society for Indoor Air Quality and Climate, Ghent, Belgium.
41 McMahon, SW. An Evaluation of Alternate Means to Diagnose Chronic Inflammatory Response Syndrome and Determine Prevalence. Medical Research Archives, 2017;5(3):1-18.
42 McMahon SW, Kundomal KA, Yangalasetty S. Pediatrics Norms for Visual Contrast Sensitivity Using an APT VCS Tester. Medical Research Archives 2017;5(5):1-9.
43 Shoemaker RC, Johnson K, Jim L, Berry Y, Dooley M, Ryan J, McMahon SW. Diagnostic Process for Chronic Inflammatory Response Syndrome (CIRS): A Consensus Statement Report of the Consensus Committee of Surviving Mold. Internal Medicine Review, 2018;5(4):1-47.
44 Shoemaker RC. Urinary mycotoxins: A review of contaminated buildings and food in search of a biomarker separating sick patients from controls. Internal Medicine Review. 2019;5(6):1-35.
45 Shoemaker RC, Metabolism, molecular hypometabolism and inflammation: Complications of proliferative physiology include metabolic acidosis, pulmonary hypertension, Treg cell deficiency, insulin resistance and neuronal injury. Trends in Diabetes and Metabolism. 2020;3:1-15.
46 Shoemaker R, Neil V, Heyman A, van der Westhuizen, McMahon S, Lark D. Newer molecular methods bring new insights into human- and building-health risk assessments from water-damaged buildings: defining exposure and reactivity, the two sides of causation of CIRS-WDB illness. Medical Research Archives. 2021;9(3):1-36.
47 Shoemaker R, McMahon S, Heyman A, Lark D, van der Westhuizen M. Treatable metabolic and inflammatory abnormalities in post COVID syndrome (PCS) define the transcriptomic basis for persistent symptoms: Lessons from CIRS. Medical Research Archives. 2021;9(7):1-18.
48 Nutrition and Integrative Medicine for Clinicians Volume Two. Edited Aruna Bakrhu. CRC Press. 2023.
49 Shoemaker R, Ryan J, Heyman A, Dorninger E, McMahon S, Lark D. A Transcriptomic fingerprint for Parkinson's Disease found in patients with Chronic Inflammatory Response Syndrome: Implications for diagnosis, treatment and prevention. Medical Research Archives. 2023;12(10):online.
50 Shoemaker R, Ryan J, Heyman A, Dorninger E, McMahon S, Lark D. A Novel therapeutic approach to Parkinsons Disease: Using transcriptomics to identify unique patterns of gene expression including triple positives, Toll receptors, and endotoxin exposure. Medical Research Archives. 2025 Accepted but not in print.
51 Dooley M. McMahon, S. Fatigue and exposure to mold and/or dampness: A systematic review of the literature from 2011-2018. EAHT. 2025;40:online.
52 Hardin B, Kelman B, Saxon A. Adverse Human Health Effects Associated with Molds in the Indoor Environment. Journal of Occupational and Environmental Medicine. 2003;45(5):470-478.
53 Sanchez-Ramos J. Brain's DNA Repair Response to Neurotoxicants. Tampa University, Florida. Annual report. 1 Jul 2004-30 Jun 2005. Available at: http://www.dtic.mil/dtic/tr/fulltext/u2/a452374.pdf
54 Bush RK, Portnoy J, Saxon A, Terr AI, Wood RA. The Medical Effects of Mold Exposure. The Journal of allergy and clinical immunology. 2006; 117(2):326-323.
55 Chang C, Gershwin ME. Mold Hysteria: Origin of the Hoax. Clinical & Developmental Immunology 2005;12(2):151-158.
56 Chang C, Gershwin ME. The Myth of Mycotoxins and Mold Injury. Clinical Reviews in Allergy & Immunology 2019;57(48). DOI:10.1007/s 12016-019-08767-4.
57 Armstrong D. Amid Suits over Mold Experts Wear Two Hats. Wall Street Journal. 1/9/2007.
Heyman References
1.Cheng SC, Quintin J, Cramer RA, Shepardson KM, Saeed S, Kumar V, Giamarellos-Bourboulis EJ, Martens JH, Rao NA, Aghajanirefah A, Manjeri GR, Li Y, Ifrim DC, Arts RJ, van der Veer BM, Deen PM, Logie C, O'Neill LA, Willems P, van de Veerdonk FL, van der Meer JW, Ng A, Joosten LA, Wijmenga C, Stunnenberg HG, Xavier RJ, Netea MG. mTOR- and HIF-1α-mediated aerobic glycolysis as metabolic basis for trained immunity. Science. 2014 Sep 26;345(6204):1250684. doi: 10.1126/ science.1250684. Erratum in: Science. 2014 Nov 7;346(6210):aaa1503. van der Meer, Brian M J W [corrected to van der Veer, Brian M J W]. PMID: 25258083; PMCID: PMC4226238.
Ibid 1
Ibid 1
Ibid 1
Ibid 1
2. Barka EA, Vatsa P, Sanchez L, Gaveau-Vaillant N, Jacquard C, Meier-Kolthoff JP, Klenk HP, Clément C, Ouhdouch Y, van Wezel GP. Taxonomy, Physiology, and Natural Products of Actinobacteria. Microbiol Mol Biol Rev. 2015 Nov 25;80(1):1-43. doi: 10.1128/MMBR.00019-15. Erratum in: Microbiol Mol Biol Rev. 2016 Nov 9;80(4):iii. doi: 10.1128/MMBR.00044-16. PMID: 26609051; PMCID: PMC4711186.
Ibid 5
3..Naviaux RK. Incomplete Healing as a Cause of Aging: The Role of Mitochondria and the Cell Danger Response. Biology (Basel). 2019 May 11;8(2):27. doi: 10.3390/biology8020027. PMID: 31083530; PMCID: PMC6627909.
4. Zhang X, Alshakhshir N, Zhao L. Glycolytic Metabolism, Brain Resilience, and Alzheimer's Disease. Front Neurosci. 2021 Apr 28 ;15 :662242. Doi: 10.3389/fnins.2021.662242. PMID : 33994936 ; PMCID : PMC8113697.
Ibid 11
Ibid 11
Ibid 11
5.Zhao N, Liu CC, Qiao W, Bu G. Apolipoprotein E, Receptors, and Modulation of Alzheimer's Disease. Biol Psychiatry. 2018 Feb 15;83(4):347-357. doi: 10.1016/j.biopsych.2017.03.003. Epub 2017 Mar 14. PMID: 28434655; PMCID: PMC5599322.
Ibid 12
IBID
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