The Herxheimer Reaction
The Herxheimer Reaction was discovered by two German dermatologists (Jarisch & Herxheimer) when studying the reactions produced by treating syphilis with mercury. The reaction is seen in 50% of primary syphilis patients and 90% of secondary syphilis patients. It also has been seen in several other infectious treatment protocols for Lyme Disease, Candida albicans, CMV (cytomegalovirus), EBV (Epstein Barr Virus), Q fever and several other infections. The Herxheimer reaction (also known as Jarisch-Herxheimer or herx) occurs when large quantities of toxins are released into the body as bacteria die, due to antibiotic treatment.
Typically the death of these bacteria and the associated release of endotoxins occur faster than the body can remove the toxins via the natural detoxification process performed by the kidneys and liver. It is manifested by fever, chills, headache, increased joint pain, myalgias (muscle aches), a drop in blood pressure, hives, and exacerbation of cutaneous (skin) lesions. Duration in syphilis is normally only a few hours but can be much longer in other diseases. The intensity of the reaction reflects the intensity of inflammation present. The Herxheimer Reaction has shown an increase in inflammatory cytokines during the period of exacerbation, including tumor necrosis factor alpha, Interleukin-6 and Interleukin-8.
Worth noting is that hives and rash are sometimes mistaken for an allergic reaction. It is up to one’s physician to determine this, but with close observation and the use of medications such as Benedryl often prevents stopping antibiotics prematurely. In more severe cases of the Herxheimer Reaction, a reduction of the dosage or temporarily cessation of the treatment is an alternative. Many times, patients think they have a bad reaction to an antibiotic, when in reality, they are actually having the Herxheimer reaction.
The timing, frequency and duration of the Herx reaction are individualistic and Herxheimer can occur within days to weeks after the onset of antibiotic therapy. In some patients they occur only once or twice (if at all) and with others continue throughout the course of treatment, usually lessening in severity. They can occur and are more often described in cycles (example: every 4 weeks) and have been reported to last from days to weeks.
It can be very beneficial to document these exacerbations. Some physicians use this as a guideline for treatment. Further it may help differentiate Herxheimer’s from the normal symptoms or progression of Lyme disease.
Herxheimer reactions can be very difficult on patients and affect compliance with therapy so supportive measures should be sought or utilized to lessen discomfort if needed. The use of aspirin, NSAIDs (non steroidal anti inflammatory drugs), pain medication, muscle relaxers, hot baths or others remedies can be appropriate. Of note, some have found Benedryl helpful even in the absence of rash or hives. An herbal product, Burbur, has often been used with good success as well as Benicar (prescription blood pressure medication) in reducing Herxheimer reactions.
The good news is that the Herxheimer is thought to indicate that the antibiotics are indeed working and that following each worsening may bring about more improvement. However the lack of Herxheimer reaction should not cause anxiety if symptoms are improving.
Something often overlooked but can present with similar symptoms as a Herxheimer is Candida (yeast) infection. Treatment with acidophilus and, if needed, prescription medications such as Nystatin or Diflucan can be utilized.
September 15th, 2007 at 8:24 pm
being a lyme disease patient and also a nurse who has treated specifically lyme disease as a speciality, i have become very familar with the herx reaction and i applaud your company for its recognition to the enitre lyme protocol. i have been hearing great things about your treatments and being a patient myself from the philadelphia center, the medical staff there were very educated on the “herx” reaction and some homeopatic remedies as well as prescriptions that i have never heard of previously. i received a well needed education.
November 4th, 2007 at 3:23 pm
I am taking antibiotics for suspected Lyme
within acouple days some of my symptoms got
worse and within 7 days I have become very
ill. I am having another blood test on friday
because so far I have not had a positve Lyme test
(2 neg test) but clinically I exhibit MANY signs
of the disease. Because I am having this Herx reaction does it seems more likely that it is Lyme Disease? Thanks KP
November 8th, 2007 at 9:24 pm
You can add Chlamydia Pneumonia to the list of illnesses that can have herx reactions. I am presently treating this insidious bacteria getting better with a treatment protocol outlined on www.cpnhelp.org.
It is important for patients to know they are not having an allergic reaction to the antibiotics, but high toxin levels.
Charcoal capsules, vitamin C (ascorbate powder) and glucose tablets with lots of water are very effective ways of countering these bacteria die off reactions.
January 8th, 2008 at 2:32 am
Just got the final diagnosis of erhlicia and babesia. Started zyth and on Wednesday I add in the Mepron.I also have been on Heparin 5000 units/twice daily for the past month. They will add in doxy 3 weeks later. I have long standing symptoms and been labled a “fibro” pt for about 23 years. Finally found a dr willing to dig because he was tired of just giving me pain meds and not really helping. Have to say I am happy & scared at the same time. I am also a nurse and know too much. Very worried about the herx because my history has been whatever “gets” someone else…I get it about 10 times worse. Does anyone every die from the”die off”? So, if anyone can address this I would be so greatful. My personal email is lkfwoa94@aol.com. Prayers will also be very greatful as well.
God bless!
January 15th, 2008 at 5:46 pm
Paige Davis
Man i love reading your blog, interesting posts !
April 2nd, 2008 at 2:18 pm
happy to have read this, i tested positive for lyme after 7 years of people thinking i was crazy. The delay in a diagnosis has caused very severe symptoms. Ive already had 3 mo. of IV treatments, before my insurance cut me off. During that time I had reactions approx. every 4 weeks. I was off antibiotics for 3 mo. and my symptoms returned, worse this time around. I just started oral antibiotics and Im experiencing the worst herx reaction yet. Ugh. Atleast i know the meds are working.
April 21st, 2008 at 12:39 pm
Don’t be afraid! It is easy to be so deep into Lyme and its coinfections that merely getting through the day is a triumph in itself, so the idea of getting worse (even temporarily) feels overwhelming. I got a yeast infection 3 weeks into Lyme treatment (check the medical literature before taking Diflucan with a “-mycin” family drug — serious heart rate problems can result — published drug information does not say that, but a 2004 study in the NEJM does). Once that was over, I got a major Herx at 4 weeks into treatment. The presentation was exactly like the onset of Lyme symptoms, in my case that being severe dehydration, electrolyte imbalance, irregular heartbeat, and being totally out of it. This may be an unusual reaction, but now I have a crate of Gatorade in the closet in case it happens again. Be not afraid — though it is natural to be so. Beating this disease is what’s important. Take back your life!