Mold & Water-Damaged Buildings: CIRS Research

1,285 papers · Curated by Lauren Lowenstein, The Biotoxin Lady

If you've been told "it's just a little mold" or "everyone has mold," this page is for you.

Water damage doesn't just grow mold. A water-damaged building turns into a mix of fungi, bacteria, mycotoxins, endotoxins, actinobacteria, beta-glucans and tiny fragments that float in the air and settle into dust. For most people that exposure is unpleasant. For people who are genetically susceptible, it can switch on an inflammatory response that doesn't switch back off. That's Chronic Inflammatory Response Syndrome (CIRS).

I lived it. We moved into a home that passed two inspections, and over five years my health, and then my kids' health, slowly came apart. An ERMI finally showed us what was behind the walls. You don't know what you don't know.

This hub collects about 1,285 research papers on indoor mold, dampness and water-damaged buildings (WDB) and their links to mold illness, CIRS and chronic inflammation. You'll find exposure studies, building science, respiratory and neurological research, and papers on why "just bleach it" doesn't cut it.

Whether you're a patient trying to make sense of your symptoms or a practitioner building the case for a client, start here. One thing comes up again and again: your body can't heal if you're still being exposed.

Ready for next steps? Start with my Where do I start? guide and learn how to clean small particles out of your home.

Educational only, not medical advice. Please talk with your provider about your own situation.

— Lauren Lowenstein, The Biotoxin Lady · Last reviewed October 19, 2026

Key facts

  • Water-damaged buildings contain a complex mix of biocontaminants, not just mold spores: mycotoxins, bacteria (including actinobacteria), endotoxins, beta-glucans and fragments.
  • In the Shoemaker framework, removing the person from exposure is Step 1. Later steps work poorly while exposure continues.
  • Visual inspections and spore traps can miss contamination. DNA-based dust testing (ERMI, HERTSMI-2) is the standard in the CIRS community.
  • Not everyone in the same building gets sick the same way. Genetic susceptibility (HLA-DR) is part of why.

Key research papers

  1. Association of exposure to indoor molds and dampness with allergic diseases at water-damaged dwellings in Korea

    Seokwon Lee et al. · Scientific Reports · 2024

  2. Molds and Mycotoxins in Indoor Environments — A Survey in Water-Damaged Buildings

    Bloom E et al. · Journal of Occupational and Environmental Hygiene · 2009

  3. Rhinosinusitis and mold as risk factors for asthma symptoms in occupants of a water-damaged building

    J.-H. Park et al. · Indoor Air · 2012

  4. A Review of the Mechanism of Injury and Treatment Approaches for Illness Resulting from Exposure to Water‐Damaged Buildings, Mold, and Mycotoxins

    Janette Hope · The Scientific World JOURNAL · 2013

  5. Non-Thyroidal Illness Syndrome in Patients Exposed to Indoor Air Dampness Microbiota Treated Successfully with Triiodothyronine.

    Taija Liisa Somppi · Frontiers in immunology · 2017

  6. Associations between Fungal Species and Water-Damaged Building Materials

    Birgitte Andersen et al. · Applied and Environmental Microbiology · 2011

  7. Neural autoantibodies and neurophysiologic abnormalities in patients exposed to molds in water-damaged buildings

    Andrew W. Campbell et al. · Archives of Environmental Health An International Journal · 2003

  8. Legal and Ethical Considerations in Mold, Mycotoxins, CIRS and Building Biology

    Scott W. McMahon · 2023

  9. Mycobiota and the Contribution of Yeasts in Floor Dust of 50 Elementary Schools Characterized with Sequencing Internal Transcribed Spacer Region of Ribosomal DNA

    Ju‐Hyeong Park et al. · Environmental Science & Technology · 2022

  10. Stachybotrys: relevance to human disease

    Terr AI · Annals of Allergy Asthma & Immunology · 2001

  11. A water-damaged home and health of occupants: a case study

    Thrasher J et al. · Journal of Environmental and Public Health · 2012

  12. Comparison of work‐related symptoms and visual contrast sensitivity between employees at a severely water‐damaged school and a school without significant water damage

    Gregory W. Thomas et al. · American Journal of Industrial Medicine · 2012

  13. Mycotoxin production by indoor molds

    Fog Nielsen K · Fungal Genetics and Biology · 2003

  14. Misalignment between Clinical Mold Antigen Extracts and Airborne Molds Found in Water-damaged Homes

    W. Sothern et al. · Annals of the American Thoracic Society · 2021

  15. A different suite: The assemblage of distinct fungal communities in water-damaged units of a poorly-maintained public housing building.

    Iman A Sylvain et al. · PloS one · 2019

  16. Satratoxin G from the Black Mold Stachybotrys chartarum Evokes Olfactory Sensory Neuron Loss and Inflammation in the Murine Noseand Brain

    Islam Z et al. · Environmental Health Perspectives · 2006

  17. Mycobiota and mycotoxin-producing fungi in southern California: their colonisation and in vitro interactions

    P. Chakravarty · Mycology&#58 An International Journal on Fungal Biology · 2022

  18. Characterization of Airborne Molds, Endotoxins, and Glucans in Homes in New Orleans after Hurricanes Katrina and Rita

    Rao CY et al. · Applied and Environmental Microbiology · 2007

  19. Detection of Mycotoxins in Patients with Chronic Fatigue Syndrome

    Joseph Brewer et al. · Toxins · 2013

  20. Clinical Diagnosis of the Dampness and Mold Hypersensitivity Syndrome: Review of the Literature and Suggested Diagnostic Criteria.

    Ville Valtonen · Frontiers in immunology · 2017

  21. Mass Spectrometry-Based Strategy for Direct Detection and Quantification of Some Mycotoxins Produced by Stachybotrys and Aspergillus spp. in Indoor Environments

    Bloom E et al. · Applied and Environmental Microbiology · 2007

  22. Specific molds associated with asthma in water-damaged homes

    Vesper SJ et al. · Journal of Occupational and Environmental Medicine · 2006

  23. Molds and mycotoxins in dust from water-damaged homes in New Orleans after hurricane Katrina

    Bloom E et al. · Indoor Air · 2009

  24. Prevalence of Aspergillus-Derived Mycotoxins (Ochratoxin, Aflatoxin, and Gliotoxin) and Their Distribution in the Urinalysis of ME/CFS Patients

    Ting Yu Wu et al. · International Journal of Environmental Research and Public Health · 2022

  25. Mycotoxins in crude building materials from water-damaged buildings

    Tuomi T et al. · Applied and Environmental Microbiology · 2000

  26. Indoor dampness and mould health effects – ongoing questions on microbial exposures and allergic versus nonallergic mechanisms

    Jean M. Cox‐Ganser · Clinical & Experimental Allergy · 2015

  27. Reduction in Asthma Morbidity in Children as a Result of Home Remediation Aimed at Moisture Sources

    Kercsmar CM et al. · Environmental Health Perspectives · 2006

  28. Observational scores of dampness and mold associated with measurements of microbial agents and moisture in three public schools.

    S J Cho et al. · Indoor air · 2016

  29. NIOSH Dampness and Mold Assessment Tool (DMAT): Documentation and Data Analysis of Dampness and Mold-Related Damage in Buildings and Its Application

    Ju‐Hyeong Park et al. · Buildings · 2022

  30. Stachybotrys, a Mycotoxin-Producing Fungus of Increasing Toxicologic Importance

    Fung F et al. · Journal of Toxicology Clinical Toxicology · 1998

  31. Is Mold Toxicity Really a Problem for Our Patients? Part 2-Nonrespiratory Conditions.

    Joseph Pizzorno et al. · Integrative medicine (Encinitas, Calif.) · 2016

  32. Stachybotrys mycotoxins: from culture extracts to dust samples

    Ina Došen et al. · Analytical and Bioanalytical Chemistry · 2016

  33. The relationship between indicators of building dampness and respiratory health in young Swedish adults

    Gunnbjörnsdottir MI et al. · Respiratory Medicine · 2003

  34. Sick Building Syndrome. III.Stachybotrys chartarum

    Mahmoudi M et al. · Journal of Asthma · 2000

  35. Effects of mold, water damage and window pane condensation on adult rhinitis and asthma partly mediated by different odors

    Juan Wang et al. · Building and Environment · 2022

  36. Detection of AirborneStachybotrys chartarumMacrocyclic Trichothecene Mycotoxins on Particulates Smaller than Conidia

    Brasel TL et al. · Applied and Environmental Microbiology · 2005

  37. Bacteria, molds, and toxins in water-damaged building materials

    Andersson MA et al. · Applied and Environmental Microbiology · 1997

  38. A Chemically Defined Medium That Supports Mycotoxin Production by Stachybotrys chartarum Enabled Analysis of the Impact of Nitrogen and Carbon Sources on the Biosynthesis of Macrocyclic Trichothecenes and Stachybotrylactam

    Katharina Tribelhorn et al. · Applied and Environmental Microbiology · 2023

  39. Managing building-related Aspergillus exposure

    Hocking AD · Medical Mycology · 2006

  40. Nonsteroidal Anti-inflammatory Drugs (NSAIDS) Inhibit the Growth and Reproduction of Chaetomium globosum and Other Fungi Associated with Water-Damaged Buildings.

    Kelsey Dalmont et al. · Mycopathologia · 2017

  41. Modulation of lipopolysaccharide-induced proinflammatory cytokine production by satratoxins and other macrocyclic trichothecenes in the murine macrophage

    Chung YJ et al. · Journal of Toxicology and Environmental Health · 2003

  42. Double blind placebo controlled exposure to molds: exposure system and clinical results

    Meyer HW et al. · Indoor Air · 2005

  43. Measurement of macrocyclic trichothecene in floor dust of water-damaged buildings using gas chromatography/tandem mass spectrometry-dust matrix effects.

    Rena Saito et al. · Journal of occupational and environmental hygiene · 2016

  44. Sick building syndrome (SBS) and exposure to water-damaged buildings: Time series study, clinical trial and mechanisms

    Ritchie C. Shoemaker et al. · Neurotoxicology and Teratology · 2006

  45. Toxigenic fungi in a water-damaged building: an intervention study

    Sudakin DL · American Journal of Industrial Medicine · 1998

  46. Dampness and mold in homes across China: Associations with rhinitis, ocular, throat and dermal symptoms, headache and fatigue among adults

    Xin Zhang et al. · Indoor Air · 2019

  47. Adverse health effects among adults exposed to home dampness and molds

    Dales RE et al. · American Review of Respiratory Disease · 1991

  48. Residential Dampness and Molds and the Risk of Developing Asthma: A Systematic Review and Meta-Analysis

    Reginald Quansah et al. · PLoS ONE · 2012

  49. THIRTY YEARS OF PUBLISHED RESEARCH ON HUMAN HEALTH EFFECTS OF EXPOSURE TO THE INTERIOR ENVIRONMENT OF WATER-DAMAGED BUILT ENVIRONMENTS

    Ritchie C. Shoemaker et al. · Medical Research Archives · 2025

  50. Atranone-an underestimated secondary metabolite?

    Mareike Dabisch‐Ruthe et al. · Mycotoxin Research · 2025

  51. Inflammatory effect of environmental proteases on airway mucosa

    Reed C · Current Allergy and Asthma Reports · 2007

  52. Reversal of Refractory Ulcerative Colitis and Severe Chronic Fatigue Syndrome Symptoms Arising from Immune Disturbance in an HLA-DR/DQ Genetically Susceptible Individual with Multiple Biotoxin Exposures

    Shelly Gunn et al. · American Journal of Case Reports · 2016

  53. Evaluation of individual-based and group-based exposure estimation of microbial agents in health effects associated with a damp building

    Sook Ja Cho et al. · Journal of Exposure Science & Environmental Epidemiology · 2013

  54. Fungal Signature of Moisture Damage in Buildings: Identification by Targeted and Untargeted Approaches with Mycobiome Data

    Rachel I. Adams et al. · Applied and Environmental Microbiology · 2020

  55. Does dampness and mold in schools affect health? Results of a meta‐analysis

    William J. Fisk et al. · Indoor Air · 2019

  56. Indoor dampness and molds and development of adult-onset asthma: a population-based incident case-control study

    Jaakkola MS et al. · Environmental Health Perspectives · 2002

  57. The biocontaminants and complexity of damp indoor spaces: more than what meets the eyes

    Thrasher J et al. · Toxicology and Industrial Health · 2009

  58. Chronic Illness Associated with Mold and Mycotoxins: Is Naso-Sinus Fungal Biofilm the Culprit?

    Joseph Brewer et al. · Toxins · 2014

  59. A time-series study of sick building syndrome: chronic, biotoxin-associated illness from exposure to water-damaged buildings

    Ritchie C. Shoemaker et al. · Neurotoxicology and Teratology · 2005

  60. A Novel Therapeutic Approach to Parkinson's Disease: Using Transcriptomics to Identify Unique Patterns of Gene Expression including 'Triple Positives,' Toll receptors, and Endotoxin Exposure

    R Shoemaker et al. · Medical Research Archives · 2025

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