Review Chronic inflammatory response syndrome – A review of the evidence of clinical efficacy of treatment, 2024, Dooley

[Dolphin]

https://journals.lww.com/annals-of-...matory_response_syndrome___a_review.2360.aspx

Dooley, Ming DACMa,*; Vukelic, April DOb; Jim, Lysander MDc. Chronic inflammatory response syndrome – A review of the evidence of clinical efficacy of treatment. Annals of Medicine & Surgery ():10.1097/MS9.0000000000002718, November 8, 2024. | DOI: 10.1097/MS9.0000000000002718

Chronic Inflammatory Response Syndrome is a multi-symptom, multisystem illness acquired following respiratory exposure to water-damaged buildings.

It is an underrecognized, underdiagnosed dysregulation of the innate immune system that can affect 25% of the population, therefore representing a silent epidemic.

The only treatment in the published literature documenting clinical efficacy for treatment of Chronic Inflammatory Response Syndrome is the Shoemaker Protocol.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome is a common misdiagnosis for Chronic Inflammatory Response Syndrome but lacks a defined etiology, biomarkers or a treatment protocol that reverses the underlying conditions.

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 underrecognized, underdiagnosed, multi-symptom 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.

https://twitter.com/user/status/1855282111869055328

 

[Robert 1973]

From scanning this paper I’m not at all convinced that CIRS is a syndrome which can be differentiated from ME/CFS. However, it is interesting that people with ME/CFS-like symptoms are reported to have improved after courses of colestyramine (or cholestyramine). These are the 2 small RCTs referred in the paper:

1) https://ehp.niehs.nih.gov/doi/abs/10.1289/ehp.01109s5791

2) https://www.sciencedirect.com/science/article/abs/pii/S0892036206000857

According to Wikipedia:

Colestyramine (INN) or cholestyramine(USAN) (trade names Questran, Questran Light, Cholybar, Olestyr) is a bile acid sequestrant, which binds bile in the gastrointestinal tract to prevent its reabsorption. It is a strong ion exchange resin, which means it can exchange its chloride anions with anionic bile acids in the gastrointestinal tract and bind them strongly in the resin matrix. The functional group of the anion exchange resin is a quaternaryammonium group attached to an inert styrene-divinylbenzene copolymer.

Its medicinal uses include:

the treatment of “pruritus, or itching, that often occurs during liver failure and other types of cholestasis where the ability to eliminate bile acids is reduced

…

the treatment of Clostridioides difficileinfections, to absorb toxins A and B, and reduce the diarrhea and the other symptoms these toxins cause

…

Colestyramine can be helpful in the treatment of Clostridioides difficileinfections, to absorb toxins A and B, and reduce the diarrhea and the other symptoms these toxins cause

…

It is also used in the "wash out" procedure in patients taking leflunomide or teriflunomide to aid drug elimination in the case of drug discontinuation due to severe side effects caused by leflunomide or teriflunomide.[10]

A case report suggests that colestyramine may be useful for cyanobacterial(microcystin) poisoning in dogs.[11]

Ointments containing colestyramine compounded with Aquaphor have been used in topical treatment of diaper rash in infants and toddlers.[12]

Cholestyramine also binds with oxalate in the GI tract, ultimately reducing urine oxalate and calcium oxalate stone formation.[13]