STAIR Stable Method™: A Pre-Stabilization Protocol for Hypersensitive Patients
- May 2, 2025
- 8 min read
Updated: Apr 30
By Cynthia Adinig
Updated January 2026
Introduction
For millions of people living with infection-associated chronic conditions, the central problem is not that treatments do not exist, or that medicine has “run out of options.” The problem is that their bodies cannot safely tolerate the path to care that medicine assumes everyone can take.
Conditions such as mast cell activation syndrome (MCAS), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Long COVID, postural orthostatic tachycardia syndrome (POTS), multiple chemical sensitivity (MCS), and post-infectious autoimmune overlap are not rare edge cases. They are defined by systemic instability across immune, autonomic, hormonal, and neuroinflammatory pathways.
These systems do not fail independently. They amplify one another, producing a biological terrain that is highly reactive, poorly buffered, and prone to disproportionate responses to otherwise low-risk stimuli (Al-Aly et al., 2021; Sudre et al., 2021; NIH RECOVER, 2024). Within this terrain, even a quarter of a pill can precipitate an emergency department visit. This is not because the dose is inappropriate or the substance is inherently dangerous, but because the body receiving it is already operating near its tolerance ceiling. When baseline instability is high, any additional input functions as a stress test the system is not equipped to pass.
This state-dependence of reactivity is routinely underrecognized in standard clinical frameworks.
Clinical care pathways assume a stable baseline. Clinical trials assume tolerability. Medication guidelines assume that patients can introduce interventions incrementally and assess side effects in a linear, controlled fashion. Patients who cannot do so are frequently labeled “too sensitive,” “too complex,” anxious, or noncompliant, and are often excluded from further care or research participation (FDA, 2023; NIH RECOVER, 2024). As a result, the most biologically fragile patients are systematically underrepresented in both evidence generation and therapeutic innovation.
STAIR Stable Method™ was developed to address this gap.
First introduced in CYNAERA’s white paper The Science of Remission: Reversing the Terrain of Infection-Associated Chronic Conditions, STAIR stands for Stabilization, Tolerance, and Immune Readiness. It is a biological preparation framework designed to reduce risk before introducing any new exposure, including medications, supplements, clinical trial interventions, or food reintroductions. STAIR is consistent with CYNAERA’s broader terrain-first architecture, which treats readiness, sequencing, and system stability as primary determinants of outcomes across infection-associated chronic conditions. The logic behind STAIR emerged from lived physiology.
I developed STAIR while living in a body that reacted to nearly everything. I experienced severe reactions to substances commonly regarded as benign, including quercetin, vitamin C, and a prescribed beta blocker. During one high-reactivity flare, I developed an anaphylactic reaction to saline flushes, a substance assumed to be universally inert. At a later point, once my biological terrain had stabilized, I tolerated intravenous fluids by the liter without adverse effects. This contrast is a key overlooked signal.
What This Actually Shows
It demonstrates that many adverse reactions are not substance-specific intolerances, but state-dependent responses. The same input can be harmful or entirely tolerable depending on the stability of immune, autonomic, and hormonal systems at the time of exposure. This pattern aligns with existing literature on post-exertional malaise, delayed immune crashes, autonomic volatility, and non-linear symptom escalation in ME/CFS and Long COVID populations (Jason et al., 2018; Davis et al., 2023; Pretorius et al., 2024).
This lived understanding also informed my role in patient-advisory and operational work supporting complex multisystem care models, including contributions connected to Mount Sinai’s post-COVID clinical approach under Dr. David Putrino. That work focused on identifying high-risk patients, refining clinic processes, supporting provider education, and contributing to CME development for managing hypersensitive cases that fall outside standard assumptions. STAIR builds on these insights but extends beyond what most clinical settings are currently structured to offer.
It incorporates timing strategies, exposure sequencing, and stabilization logic derived from patient communities, real-world failures, and systems analysis. These elements were not adapted from existing playbooks. They were developed because existing protocols do not adequately account for bodies operating in sustained physiological threat states.
At its core, STAIR is grounded in a simple but frequently ignored principle: when immune, autonomic, and hormonal systems are already dysregulated, any new input, even one that is theoretically beneficial, can provoke disproportionate harm. Preparing the terrain first is not optional for these patients. It is the difference between progress and crisis.
Core Stabilizers
Foundational supports used by most patients to lower baseline reactivity
These are intended to calm histamine signaling, reduce immune noise, and support basic physiological buffering before any new exposure.
Histamine buffering H1 antihistamine Cetirizine 10 mg or Loratadine 10 mg daily
H2 antihistamine Famotidine 20–40 mg once or twice daily
Mast cell baseline support Cromolyn sodium (GI formulation) or Ketotifen. Typically started earlier when possible, often several weeks ahead
Oxidative stress buffering Buffered vitamin C Sodium ascorbate or Ester-C
Volume and electrolyte support Hydration with clean electrolytes or oral rehydration solution
Dietary stability Low-histamine, MCAS-safe meals only No new foods during stabilization window
Optional STAIR Add-Ons
Used when sensitivity is moderate and baseline stability allows
These supports are layered only if tolerated and only when the system shows signs of handling additional inputs without escalation.
Leukotriene modulation Montelukast 10 mg, if previously tolerated
Flavonoid support Quercetin 250–500 mgLuteolin optional
Glutathione pathway support NAC or glutathione precursors, low and slow
Microbiome support Probiotics limited to low-histamine strains Example: Bifidobacterium infantis
High-Risk Modifiers
These are not routine. They are used selectively when exposure risk is high or prior reactions have been severe.
Inflammatory buffering Low-dose corticosteroid buffer. Prednisone 5–10 mg (unless patient requets higher or has had success with higher doses.)
Emergency readiness Diphenhydramine available. EpiPen on hand when indicated. Rescue inhaler if prescribed,
Autonomic stabilization Midodrine or fludrocortisone. Only if already prescribed and tolerated
Post-exposure symptom control Acetaminophen for immune-driven symptom spikes. Used cautiously and intentionally
Day-of Exposure Support
The goal on exposure day is not productivity. It is physiological quiet.
• Repeat H1 and H2 antihistamines as scheduled
• Take prescribed mast cell stabilizers or steroid buffers if part of plan
• Electrolyte hydration deliberately
• Rest in a calm, fragrance-free environment
• Avoid sensory stimulation for 4–8 hours post-exposure
• Track symptoms for the next 48 hours, without forcing interpretation
Why It Works
Most adverse reactions do not occur because a substance is “too strong.” They occur because the biological terrain is too unstable. STAIR cushions stress systems and immune thresholds, particularly in patients with hormone-linked flares, trauma-associated hypersensitivity, autonomic instability, or immune rebound patterns (Al-Aly et al., 2021; Davis et al., 2023).
In practice, this preparation-first approach has prevented hormone-linked crashes, increased tolerability to medications after years of failed attempts, and reduced emergency-level escalations by shifting the clinical question from what should be tried next to whether the body is ready to tolerate anything at all. For the most severely affected patients, stabilization is not rapid. It may take weeks or months before any new exposure is appropriate. This is not resistance, fear, or failure. It is predictable biology following prolonged immune injury and repeated destabilization.
STAIR is not about doing more interventions or moving faster. It is about sequencing, timing, and restraint. It creates the conditions under which care becomes possible for bodies that medicine has historically excluded because they did not behave predictably enough. For patients labeled too sensitive, too complex, or too difficult to include, STAIR is not a workaround. It is recognition that order of operations matters, and that stability is not a luxury.
CYNAERA Framework Papers and Core Research Libraries
This paper draws on a defined subset of CYNAERA Institute white papers that establish the methodological and analytical foundations of CYNAERA’s frameworks. These publications provide deeper context on prevalence reconstruction, remission, combination therapies and biomarker approaches. Our Long COVID Library, ME/CFS Library, Lyme Library, Autoimmune Library and CRISPR Remission Library are also in depth resources.
Author’s Note:
All insights, frameworks, and recommendations in this written material reflect the author's independent analysis and synthesis. References to researchers, clinicians, and advocacy organizations acknowledge their contributions to the field but do not imply endorsement of the specific frameworks, conclusions, or policy models proposed herein. This information is not medical guidance.
Patent-Pending Systems
Bioadaptive Systems Therapeutics™ (BST) and affiliated CYNAERA frameworks are protected under U.S. Provisional Patent Application No. 63/909,951. CYNAERA is built as modular intelligence infrastructure designed for licensing, integration, and strategic deployment across health, research, public sector, and enterprise environments.
Licensing and Integration
CYNAERA supports licensing of individual modules, bundled systems, and broader architecture layers. Current applications include research modernization, trial stabilization, diagnostic innovation, environmental forecasting, and population level modeling for complex chronic conditions. Basic licensing is available through CYNAERA Market, with additional pathways for pilot programs, institutional partnerships, and enterprise integration.
About the Author
Cynthia Adinig is the founder of CYNAERA, a modular intelligence infrastructure company that transforms fragmented real world data into predictive insight across healthcare, climate, and public sector risk environments. Her work sits at the intersection of AI infrastructure, federal policy, and complex health system modeling, with a focus on helping institutions detect hidden costs, anticipate service demand, and strengthen planning in high uncertainty environments.
Cynthia has contributed to federal health and data modernization efforts spanning HHS, NIH, CDC, FDA, AHRQ, and NASEM, and has worked with congressional offices including Senator Tim Kaine, Senator Ed Markey, Representative Don Beyer, and Representative Jack Bergman on legislative initiatives related to chronic illness surveillance, healthcare access, and data infrastructure. In 2025, she was appointed to advise the U.S. Department of Health and Human Services and has testified before Congress on healthcare data gaps and system level risk.
She is a PCORI Merit Reviewer, currently advises Selin Lab at UMass Chan, and has co-authored research with Harlan Krumholz, MD, Akiko Iwasaki, PhD, and David Putrino, PhD, including through Yale’s LISTEN Study. She also advised Amy Proal, PhD’s research group at Mount Sinai through its CoRE advisory board and has worked with Dr. Peter Rowe of Johns Hopkins on national education and outreach focused on post-viral and autonomic illness. Her CRISPR Remission™ abstract was presented at CRISPRMED26 and she has authored a Milken Institute essay on artificial intelligence and healthcare.
Cynthia has been covered by outlets including TIME, Bloomberg, Fortune, and USA Today for her policy, advocacy, and public health work. Her perspective on complex chronic conditions is also informed by lived experience, which sharpened her commitment to reforming how chronic illness is understood, studied, and treated. She also advocates for domestic violence prevention and patient safety, bringing a trauma informed lens to her research, systems design, and policy work. Based in Northern Virginia, she brings more than a decade of experience in strategy, narrative design, and systems thinking to the development of cross sector intelligence infrastructure designed to reduce uncertainty, improve resilience, and support institutional decision making at scale.
References
Al-Aly, Z., Xie, Y., & Bowe, B. (2021). High-dimensional characterization of post-acute sequelae of COVID-19. Nature, 594(7862), 259–264. https://doi.org/10.1038/s41586-021-03553-9
Sudre, C. H., Murray, B., Varsavsky, T., et al. (2021). Attributes and predictors of long COVID. Nature Medicine, 27(4), 626–631. https://doi.org/10.1038/s41591-021-01292-y
National Institutes of Health (NIH). (2024). RECOVER Initiative: Researching COVID to Enhance Recovery. https://recovercovid.org
U.S. Food and Drug Administration (FDA). (2023). Patient-Focused Drug Development: Guidance Series. https://www.fda.gov/patients/patient-focused-drug-development
Adinig, C. (2025). The Science of Remission: Reversing the Terrain of Infection-Associated Chronic Conditions. CYNAERA. https://www.cynaera.com/post/science-of-remission
Adinig, C. (2024). The Unified Theory of Infection-Associated Chronic Conditions. CYNAERA. https://www.cynaera.com/post/unified-theory
Jason, L. A., Sunnquist, M., Brown, A., et al. (2018). Examining case definition criteria for chronic fatigue syndrome and myalgic encephalomyelitis. Fatigue: Biomedicine, Health & Behavior, 6(1), 1–11. https://doi.org/10.1080/21641846.2018.1430751
Davis, H. E., McCorkell, L., Vogel, J. M., & Topol, E. J. (2023). Long COVID: Major findings, mechanisms, and recommendations. Nature Reviews Microbiology, 21, 133–146. https://doi.org/10.1038/s41579-022-00846-2
Pretorius, E., Vlok, M., Venter, C., et al. (2024). Persistent clotting protein pathology in long COVID/post-acute sequelae of COVID-19 (PASC). Cardiovascular Diabetology, 23, 1–15. https://doi.org/10.1186/s12933-024-02187-9
Putrino, D., Rojas, M., Wang, S., et al. (2022–2024). Post-COVID care models for complex multisystem disease. Mount Sinai Health System (clinical protocols and CME materials).
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