Everything But The Kitchen Sink: POTS, PANS/PANDAS, and the Overlooked Role of Environment

This article is not medical advice. It is an invitation to widen the lens. PANS/PANDAS and POTS are real, serious conditions—and in many cases, environment is the missing piece that explains why a treatment helps in one place and fails in another. Sometimes when the building is quieter, the brain and immune system can finally hear the plan.

Here’s a pattern that keeps showing up once you learn how to see it: a child with a history of strep suddenly flips into neuropsychiatric chaos — OCD, tics, food refusal, meltdowns — and gets a PANS or PANDAS label. A teenager or adult develops POTS, with dizziness, heart racing, and fatigue that no amount of Gatorade really fixes. An adult who’s been stable for years moves into a new house and suddenly can’t get out of bed. The hunt begins: what’s the diagnosis, what’s the pill, what’s the protocol that explains everything? But the quieter, less glamorous question often gets skipped: what in the environment is pouring gasoline on this fire?

PANS and PANDAS are not vague “maybe” conditions. PANDAS, by definition, is triggered by strep. That infection lights the match, creating an immune cross-reaction that targets the brain. What many families don’t realize is that once strep has kicked the door open, the immune system stays primed — and other triggers can fan the flames. Mold exposure, mycotoxins, chemical toxicants, even renovation dust can provoke the same set of symptoms once the system is sensitized. It’s not about whether strep “caused” the condition. It’s about how the immune system, once destabilized, can be thrown back into chaos by almost any significant environmental stressor.

POTS tells the same story through a different system: the autonomic nervous system fails to regulate blood pressure and heart rate, often after infection, toxicant exposure, or both. Add in mast cell activation and neuroinflammation, and you’ve got a perfect storm where environmental exposures worsen dizziness, tachycardia, brain fog, and fatigue. The overlap with mold illness is striking: dysautonomia, mast-cell chaos, immune hypervigilance.

And here’s the giveaway people miss: location dependence. A kid is fine at home and melts down at school. Or fine at school and unravels at grandma’s. A newly remodeled classroom or a musty HVAC can derail the best-laid treatment plan. This isn’t about bad parenting or bad attitude; it’s about a building shouting at the body through the air it breathes and the dust it carries. The body tells the truth with symptoms long before the air test comes back.

So what do you do? First, don’t throw out your medical team — you need them. But choose wisely. The right practitioner isn’t a dictator handing out meds; they’re a partner who understands that treating strep, calming the immune system, and supporting the autonomic nervous system only works if you also stop the environmental bombardment. If your provider dismisses the environment, you need a different provider. Second, test the hypothesis: change locations and watch what happens. Get deliberate outdoor air. Notice if symptoms shift with even a short “mold sabbatical.” Track patterns between buildings. And yes, at home and school, strip down the environment: one safe room, HEPA filtration, fragrance-free, clean/dirty protocols. These steps aren’t glamorous, but they’re the scaffolding that lets medical treatment actually work.

Kids labeled “manipulative” or “combative” or adults told they’re “anxious” are sometimes the canaries choking on toxins in the air. Pills can help, protocols can help, therapy can help. But if the environment keeps throwing punches, recovery stalls. The north star is simple: if someone consistently improves in one place and crashes in another, the place matters. Pay attention. It’s not an insult to a loved one’s home. It’s data. And in this landscape, data is survival.

References & Key Concepts

• Swedo SE, Frankovich J, Murphy TK. PANDAS and PANS: Clinical description and treatment. Child Adolesc Psychiatr Clin N Am. 2017.

  
  

  Establishes PANDAS as strep-triggered, and PANS as a broader clinical syndrome with multiple triggers once the immune system is sensitized.

  
  

• Chang K, Frankovich J, Cooperstock M, et al. Clinical evaluation of youth with PANS/PANDAS. J Child Adolesc Psychopharmacol. 2015.

  
  

  Shows how infection is the initial driver, but environmental and immune stressors can cause relapse and symptom persistence.

  
  

• Miller CS, Ashford NA. Toxicant-Induced Loss of Tolerance. Environ Health Perspect. 1999.

  
  

  Introduces TILT as the mechanism by which mold, chemicals, and low-level exposures trigger disproportionate immune and neurologic responses.

  
  

• Lopez-Perez M, et al. Mycotoxins and their impact on neuroinflammation. Int J Mol Sci. 2020.

  
  

  Demonstrates that mold toxins directly provoke neuroinflammatory pathways, contributing to anxiety, mood instability, and cognitive dysfunction.

  
  

• Raj SR. Postural tachycardia syndrome (POTS). Circulation. 2013.

  
  

  Defines POTS as autonomic instability and highlights environmental and inflammatory triggers that worsen symptoms.

  
  

• Afrin LB. Mast Cell Activation Syndrome. Immunol Allergy Clin North Am. 2018.

  
  

  Explains how mast-cell chaos links environmental triggers with multi-system flares, overlapping with POTS and mold-related illness.

  
  

Resources & Starting Points

• PANS/PANDAS (clinical overviews & guidance):

  
  

  • PANS Research Consortium & NIMH materials (background, diagnostic criteria, treatment frameworks)

    
    

  • Dr. Neil Nathan — Toxic: clear explanations of environmental triggers, neuroinflammation, and clinical strategies

    
    

  • Dr. Jill Crista — Break the Mold: accessible discussion of mold-related neuropsychiatric effects, including in children

    
    

• Environment & sensitivity:

  
  

  • Paradigm Change (paradigmchange.me): extensive avoidance resources; Erik Johnson’s “Erik On Avoidance” eBook (requestable as a free download)

    
    

  • Dr. Claudia Miller (TILT): toxicant-induced loss of tolerance and environmental intolerance frameworks

    
    

  • ISEAI (iseai.org): practitioner directory focused on environmentally acquired illness; patient guides