The honest answer about CIRS in the UK
CIRS — Chronic Inflammatory Response Syndrome, often associated with the Shoemaker protocol and biotoxin/mould exposure — is not recognised by NICE, has no Royal College position statement, and is not an NHS care pathway. There is no NICE guideline number to cite. There is no NHS specialty that "treats CIRS" as such.
That is why a letter that simply demands a GP "diagnose and treat CIRS" will almost always fail. The GP can — accurately — say there is no UK guideline that obliges them to do that. We've seen this play out in patient groups, and it's a fair objection. We don't pretend otherwise.
Why that doesn't end the conversation
A GP's duty under GMC Good Medical Practice is to investigate symptoms, not to validate or invalidate a particular diagnostic label. Whatever you call the cluster of symptoms — mast-cell flares, post-viral fatigue, autonomic dysfunction, chronic pain — the NHS has recognised pathways for each of those clinical features, and the GP is expected to use them or document why they won't.
That documentation point matters: under GMC standards, a GP refusing to investigate or refer must record a clinical reason in your notes. If they refuse verbally and write nothing, that itself is a recordable failing — see our guide on your GP's duty of care.
The NHS-recognised routes that overlap CIRS
Most people who identify with CIRS have symptoms that map onto one or more UK-recognised clinical pictures. Those are the levers the letter actually uses.
- MCAS (Mast Cell Activation Syndrome) — recognised by the British Society for Allergy and Clinical Immunology (BSACI). NHS immunology and allergy services accept MCAS referrals. Diagnostic levers include serum tryptase (baseline and during a symptomatic episode). See the MCAS condition page.
- Post-viral and autonomic symptoms — NICE NG188 (Long COVID) covers fatigue, brain fog, post-exertional malaise and autonomic features, and triggers a post-COVID assessment service referral where one exists. See our Long COVID page.
- ME/CFS overlap — NICE NG206 sets out the diagnostic criteria and management for myalgic encephalomyelitis / chronic fatigue syndrome. See our ME/CFS page.
- Chronic pain — NICE NG193 covers assessment and management of chronic primary pain.
- Standard fatigue workup — basic endocrine and haematology investigations (thyroid, ferritin, B12/folate, vitamin D, fasting glucose, coeliac screen) are standard GP investigations for unexplained fatigue and should not be refused.
What our letter actually does for a CIRS-identifying patient
The letter does not ask the GP to accept the CIRS label. Instead it:
- Sets out the symptom picture clearly, in the language UK clinicians use (multi-system mast-cell, post-viral, autonomic, pain, fatigue — whichever apply to you).
- Maps those symptoms onto the recognised UK guidance above — BSACI for mast-cell features, NICE NG188 for post-viral / autonomic features, NG206 for ME/CFS overlap, NG193 for chronic pain, plus standard fatigue investigations.
- Requests specific, named investigations and referrals against those guidelines — not a CIRS protocol.
- Asks the GP, under GMC Good Medical Practice, to document any refusal in writing with a clinical reason.
That makes the letter much harder to ignore, because nothing in it depends on the GP "believing in" a contested label.
How to fill in the assessment if you identify as CIRS: tick MCAS if you have mast-cell symptoms (flushing, GI flares, dermatological reactions), tick Long COVID if you have post-viral or autonomic symptoms, type "CIRS" or "mould illness" in the Anything else box, and describe everything in your own words in the symptoms field. The letter will lean on the recognised UK pathways your symptoms map onto — not the CIRS label itself.
If your GP still refuses
Ask for the refusal in writing with the clinical reason. Then your options open up:
- A Stage 1 complaint to the practice — see how to complain about your GP.
- A second-opinion request to a different GP at the practice.
- NHS Right to Choose for any specialty involved (allergy, immunology, neurology).
- Request your full record — see getting your NHS medical records — so the paper trail is in your hands.
Frequently asked questions
›Is CIRS recognised by the NHS?
No. CIRS (Chronic Inflammatory Response Syndrome, sometimes called the Shoemaker protocol) is not in any NICE guideline, has no Royal College position statement, and is not an NHS care pathway. Most NHS clinicians will not treat 'CIRS' as a diagnosis. That doesn't mean your symptoms aren't real — it means the label itself isn't the right lever to pull with an NHS GP.
›If CIRS isn't recognised, can a GP just refuse to do anything?
No. A GP's duty under GMC Good Medical Practice is to investigate symptoms, not labels. Whatever you call the picture, multi-system symptoms (mast-cell, post-viral, autonomic, pain, fatigue) still trigger recognised UK investigation and referral pathways. The GP also has to document their reasoning in writing if they refuse.
›What about MCAS — isn't that the same thing?
They overlap but aren't identical. MCAS (Mast Cell Activation Syndrome) is recognised by the British Society for Allergy and Clinical Immunology (BSACI), and NHS immunology services do accept MCAS referrals. Many people who self-identify as CIRS meet criteria that are far better served by the MCAS pathway, which has actual tests (serum tryptase) and an actual NHS referral route.
›Will your letter work for me if I have CIRS?
Yes, but it won't ask the GP to 'treat your CIRS' — that would fail. Our letter leans on the recognised pathways your symptoms map onto: MCAS via BSACI, post-viral and autonomic symptoms via NICE NG188, ME/CFS via NG206, chronic pain via NG193, plus standard endocrine workup for fatigue. That's honest, evidence-based, and much harder for a GP to refuse on the record.
›What if my GP still refuses to investigate anything?
Ask for the refusal in writing with the clinical reason. GMC Good Medical Practice requires this. A written refusal is itself useful — it gives you grounds for a Stage 1 NHS complaint, a second-opinion request, or Right to Choose for any specialty involved.