Medical Consensus - Medically sound investigation and remediation of water-damaged buildings in cases of chronic inflammatory response syndrome.

Keith Berndtson, Scott W. McMahon,Mary Ackerley, Sonia Rapaport, Sandeep Gupta, Ritchie C. Shoemaker Center for Research on Biotoxin Associated Illness, Pocomoke, MD Corresponding author: K Berndtson:

ABSTRACT Evidence supports a cause-effect relationship between exposure to the air and dust in water-damaged buildings (WDBs) and chronic inflammatory response syndrome (CIRS). This syndrome has an increased relative risk associated with specific HLA genotypes. CIRS-WDB is mediated by a persistent innate immune inflammatory response to toxins, antigens, and inflammagenspresent in the interior environment of WDBs. Dose-response relationships in this condition are supralinear in nature. For patients with CIRS-WDB, current methods of WDB investigation and remediation are often not sufficient to prevent a relapse of symptoms with re-exposure. CIRS-WDB is a growing public health hazard best addressed by collaboration among experts in CIRS-WDB medicine,indoor air quality, remediation, and moisture-controlled building design and construction. Assessments of human health effects associated with exposure to WDBsbefore and after remediation are mandatory to ensure adequacy of remediation efforts.