STAIR Stable Method™: A Pre-Stabilization Protocol for Hypersensitive Patients

By Cynthia Adinig, Founder of CYNAERA

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 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.

References

1. 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

2. 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

3. National Institutes of Health (NIH). (2024). RECOVER Initiative: Researching COVID to Enhance Recovery. https://recovercovid.org

4. U.S. Food and Drug Administration (FDA). (2023). Patient-Focused Drug Development: Guidance Series. https://www.fda.gov/patients/patient-focused-drug-development

5. Adinig, C. (2025). The Science of Remission: Reversing the Terrain of Infection-Associated Chronic Conditions. CYNAERA. https://www.cynaera.com/post/science-of-remission

6. Adinig, C. (2024). The Unified Theory of Infection-Associated Chronic Conditions. CYNAERA. https://www.cynaera.com/post/unified-theory

7. 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

8. 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

9. 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

10. 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).

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.

Applied Infrastructure Models Supporting This Analysis

Several standardized diagnostic and forecasting models available through CYNAERA were utilized or referenced in the construction of this white paper. These tools support real-time health surveillance, economic forecasting, and symptom stabilization planning for infection-associated chronic conditions (IACCs). You can get licensing here at CYNAERA Market.

Note: These models were developed to bridge critical infrastructure gaps in early diagnosis, stabilization tracking, and economic impact modeling. Select academic and public health partnerships may access these modules under non-commercial terms to accelerate independent research and system modernization efforts.

Licensing and Customization

Enterprise, institutional, and EHR/API integrations are available through CYNAERA Market for organizations seeking to license, customize, or scale CYNAERA's predictive systems.

Learn More: https://www.cynaera.com/systems

About the Author 

Cynthia Adinig is a researcher, health policy advisor, author, and patient advocate. She is the founder of CYNAERA and creator of the patent-pending Bioadaptive Systems Therapeutics (BST)™ platform. She serves as a PCORI Merit Reviewer, Board Member at Solve M.E., and collaborator with Selin Lab for t cell research at the University of Massachusetts.

Cynthia has co-authored research with Harlan Krumholz, MD, Dr. Akiko Iwasaki, and Dr. David Putrino, though Yale’s LISTEN Study, advised Amy Proal, PhD’s research group at Mount Sinai through its patient advisory board, and worked with Dr. Peter Rowe of Johns Hopkins on national education and outreach focused on post-viral and autonomic illness. She has also authored a Milken Institute essay on AI and healthcare, testified before Congress, and worked with congressional offices on multiple legislative initiatives. Cynthia has led national advocacy teams on Capitol Hill and continues to advise on chronic-illness policy and data-modernization efforts.

Through CYNAERA, she develops modular AI platforms, including the IACC Progression Continuum™, Primary Chronic Trigger (PCT)™, RAVYNS™, and US-CCUC™, that are made to help governments, universities, and clinical teams model infection-associated conditions and improve precision in research and trial design. She has been featured in TIME, Bloomberg, USA Today, and other major outlets, for community engagement, policy and reflecting her ongoing commitment to advancing innovation and resilience from her home in Northern Virginia.

Cynthia’s work with complex chronic conditions is deeply informed by her lived experience surviving the first wave of the pandemic, which strengthened her dedication to reforming how chronic conditions are understood, studied, and treated. She is also an advocate for domestic-violence prevention and patient safety, bringing a trauma-informed perspective to her research and policy initiatives.