Chronic inflammatory response syndrome: a review of the evidence of clinical efficacy of treatment

Abstract:

Chronic Inflammatory Response Syndrome (CIRS) is an acquired medical condition characterized by innate immune dysregulation following respiratory exposure to water-damaged buildings (WDB). This chronic syndrome involves a range of symptoms that simultaneously affecting multiple organ systems. The purpose of this literature review was to search the published literature for successful treatments for chronic inflammatory response syndrome, an under-recognized, underdiagnosed, multisymptom multisystem illness that can affect up to 25% of the population, thus representing a silent epidemic.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), a common misdiagnosis for CIRS, is an entity that has broader awareness within the medical community despite the absence of a defined etiology, biomarkers or a treatment protocol that reverses the underlying conditions. Therefore, the search also included treatments for ME/CFS and sick building syndrome (SBS). Thirteen articles referenced treatment for CIRS, and 22 articles referenced treatment for CFS.

The only treatment with documented clinical efficacy was the Shoemaker Protocol, which was described in 11 of the 13 articles. This treatment protocol exhibits superior outcomes compared with the treatment protocols for ME/CFS.

Source: Dooley M, Vukelic A, Jim L. Chronic inflammatory response syndrome: a review of the evidence of clinical efficacy of treatment. Ann Med Surg (Lond). 2024 Nov 8;86(12):7248-7254. doi: 10.1097/MS9.0000000000002718. PMID: 39649915; PMCID: PMC11623837. https://pmc.ncbi.nlm.nih.gov/articles/PMC11623837/ (Full text)

Autoimmune autonomic nervous system imbalance and conditions: Chronic fatigue syndrome, fibromyalgia, silicone breast implants, COVID and post-COVID syndrome, sick building syndrome, post-orthostatic tachycardia syndrome, autoimmune diseases and autoimmune/inflammatory syndrome induced by adjuvants

Abstract:

Chronic fatigue syndrome (CFS), fibromyalgia, silicone breast implants syndrome (SBIs), COVID and post-COVID syndrome (PCS), sick building syndrome (SBS), post-orthostatic tachycardia syndrome (POTS), autoimmune diseases and autoimmune/inflammatory syndrome induced by adjuvants (ASIA) are frequently accompanied by clinical symptoms characteristic for dysautonomia: severe fatigue, dizziness, fogginess, memory loss, dry mouth and eyes, hearing dysfunction, tachycardia etc.

The recent discovery of an imbalance of autoantibodies against G protein-coupled receptors (GPCR) in some autoimmune diseases, post-COVID syndrome, SBIs allowed researchers to assume the novel mechanism in these conditions – autoimmune autonomic nervous system imbalance.

In this review, all data published on an imbalance of autoantibodies against GPCR, clinical symptoms and pathogenic mechanisms in CFS, Fibromyalgia, SBIs, COVID and PCS, SBS, POTS, and some autoimmune diseases were analyzed. Possible criteria to diagnose the autoimmune autonomic nervous system imbalance were created.

Source: A.M.Malkova, Y.Shoenfeld. Autoimmune autonomic nervous system imbalance and conditions: Chronic fatigue syndrome, fibromyalgia, silicone breast implants, COVID and post-COVID syndrome, sick building syndrome, post-orthostatic tachycardia syndrome, autoimmune diseases and autoimmune/inflammatory syndrome induced by adjuvants. Autoimmunity Reviews, 5 November 2022, 103230. https://www.sciencedirect.com/science/article/abs/pii/S1568997222002002 (Full text)

Multiple chemical sensitivity in sick-building syndrome

Abstract:

The sick building syndrome includes irritation of the eyes and the respiratory tract neurotoxicity affectation and skin problems, which can occur in individuals under improperly ventilated buildings. Poor air quality, as shown in CO2 atmospheric levels of more than 1,000 ppm, results in a pathological exposure to biological and chemical products. We present a work-related case of multiple chemical hypersensitivity from a dialysis unit that had no air renewal. This person, who was summitted to continuous exposure despite having taken corrective measures in the ventilation, developed chronic fatigue syndrome. An acoustic voice observation alerted of the case which led to the analysis of the environmental conditions which confirmed the relationship between multiple chemical hypersensitivity and chronic fatigue syndrome. This case stresses the neglected fact that all health service centres pose a high risk of chemical exposure and that there exists a lack of rigoroursness in putting in practice scientific medical knowledge.

 

Source: Arnold Llamosas PA, Arrizabalaga Clemente P, Bonet Agusti M, de la Fuente Brull X. Multiple chemical sensitivity in sick-building syndrome. Med Clin (Barc). 2006 May 27;126(20):774-8. [Article in Spanish] https://www.ncbi.nlm.nih.gov/pubmed/16883665

 

Developing case definitions for symptom-based conditions: the problem of specificity

Symptom-based conditions are postulated organic diseases that are characterized primarily by chronic physical (somatic) symptoms (1, 2). Contemporary conditions associated with multisystem complaints are generally referred to as chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivities, silicone associated atypical rheumatic disease, sick building syndrome, and most recently, Gulf War syndrome (table 1). Possibly related disorders that will not be considered in the following analysis include epidemic neuromyasthenia, hyperventilation syndrome, reactive hypoglycemia, post-lyme disease syndrome, and irritable bowel syndrome (3).

Although the need to consistently define symptombased conditions has been repeatedly emphasized, there has been limited progress in establishing widely accepted diagnostic criteria (1,4). Based on reports in English-language publications, symptom-based conditions were analyzed to determine why it has been difficult to develop case definitions of unique diseases.

You can read the rest of this article here: http://epirev.oxfordjournals.org/content/20/2/148.long

 

Source: Hyams KC. Developing case definitions for symptom-based conditions: the problem of specificity. Epidemiol Rev. 1998;20(2):148-56. http://epirev.oxfordjournals.org/content/20/2/148.long (Full article)

The non-specific environmental syndromes MCS (Multiple Chemical Sensitivity), IEI (Idiopathic Environmental Intolerance) and SBS (Sick Building Syndrome)

Abstract:

This review starts with a clinical description of the most common unspecific environmental diseases, such as Multiple Chemical Sensitivities (MCS), Idiopathic Environmental Intolerances (IEI) and Sick Building Syndrome (SBS). These syndromes are very controversial discussed between scientific medicine and “clinical ecology”. In addition, they have fundamental similarities to Chronic Fatigue Syndrome (CFS) and Fibromyalgia. Finally the spectrum of therapeutic approaches is discussed.

 

Source: Csef H. The non-specific environmental syndromes MCS (Multiple Chemical Sensitivity), IEI (Idiopathic Environmental Intolerance) and SBS (Sick Building Syndrome). Fortschr Med. 1998 Nov 30;116(33):18-20, 22, 24. [Article in German] http://www.ncbi.nlm.nih.gov/pubmed/9889460

 

The natural history of concurrent sick building syndrome and chronic fatigue syndrome

Abstract:

An outbreak of chronic fatigue syndrome linked with sick building syndrome was recently described as a new association. Whether chronic fatigue syndrome acquired in this setting tends to remit or, as sporadic cases often do, persist, is unknown.

To clarify the natural history of chronic fatigue syndrome in association with sick building syndrome the 23 individuals involved in the outbreak were interviewed four years after the onset. In the previous interview one year after the onset of symptoms, 15 (including 5 with chronic fatigue syndrome and 10 with idiopathic chronic fatigue) of the 23 noted fatigue. Three years later 10 of the 15 were “fatigue free” or “much improved”.

Five were only “some better”, “the same”, or “worse”. Three of the five people previously diagnosed with chronic fatigue syndrome were “much improved” (two) or “fatigue free” (one). The remaining two were seriously impaired, homebound and unable to work.

The 10 individuals with substantially improved fatigue (three of the five with chronic fatigue syndrome and seven of the 10 with idiopathic chronic fatigue) were more likely to have noted improvement in nasal and sinus symptoms, sore throats, headaches, and tender cervical lymph nodes when compared to those with a lingering significant fatigue (p < 0.001). Upper respiratory symptoms and headaches improved in those with reduced fatigue but remained problematic in those with persisting significant fatigue.

We conclude that the fatigue related to sick building syndrome, including chronic fatigue syndrome, is significantly more likely to improve than fatigue identified in sporadic cases of chronic fatigue syndrome.

 

Source: Chester AC, Levine PH. The natural history of concurrent sick building syndrome and chronic fatigue syndrome. J Psychiatr Res. 1997 Jan-Feb;31(1):51-7. http://www.ncbi.nlm.nih.gov/pubmed/9201647

 

Concurrent sick building syndrome and chronic fatigue syndrome: epidemic neuromyasthenia revisited

Abstract:

Sick building syndrome (SBS) is usually characterized by upper respiratory complaints, headache, and mild fatigue. Chronic fatigue syndrome (CFS) is an illness with defined criteria including extreme fatigue, sore throat, headache, and neurological symptoms.

We investigated three apparent outbreaks of SBS and observed another more serious illness (or illnesses), characterized predominantly by severe fatigue, that was noted by 9 (90%) of the 10 teachers who frequently used a single conference room at a high school in Truckee, California; 5 (23%) of the 22 responding teachers in the J wing of a high school in Elk Grove, California; and 9 (10%) of the 93 responding workers from an office building in Washington, D.C.

In those individuals with severe fatigue, symptoms of mucous membrane irritation that are characteristic of SBS were noted but also noted were neurological complaints not typical of SBS but quite characteristic of CFS. We conclude that CFS is often associated with SBS.

 

Source: Chester AC, Levine PH. Concurrent sick building syndrome and chronic fatigue syndrome: epidemic neuromyasthenia revisited. Clin Infect Dis. 1994 Jan;18 Suppl 1:S43-8. http://www.ncbi.nlm.nih.gov/pubmed/8148452