What is a Herheimer reaction?

[Guest guest]

I think I have got a pretty good handle on what a herx is. My

understnding of it comes from in part the RBF which says:

" the Jarisch -Herxheimer, or Herxheimer reaction, was named for the

German dermatologist, Karl Herxheimer (1844-1947). Dorlands Medical

Dictionary refers to the Herxheimer reaction as a transient, short-

term, immunological reaction commonly seen following antibiotic

treatment of early and later stage [infectious] diseases which [may

be] manifested by fever, chills, headache, myalgias (muscle pain), and

exacerbations of cutaneous lesions. The reaction has been attributed

to liberation of endotoxins-like substances or of antigens (a

substance which causes an immune reaction) from the killed or dying

microorganisms. "

Interesting to note though is Herxheimer died in 1947. That is a

loooong time ago and there has been learned just in the past 10 years

in reagrds to some organisms he never heard of. Some of these

organisms weren't even understood until now in that they morph and

become things no one was even looking for before. How they survive is

a mystery that is just being unraveled.

I think Mr. Herx is talking about orgaisms that are more typically

seen, that usually are dead and gone in a few days, so the herx ends

in a few days. Thing different is, these creatures don't die so easy.

They have a strategy and don't give in. Hence the battle in which they

continue to die goes on for months and at times years, so heck ya, the

herx is going to last for longer then a few days. As long as there are

dead and decaying little bodies, there will be toxins and so there

will be this herxheimer reaction.

Herxheimer info continued: " What does this mean in layman's terms? The

Herxheimer flare reaction may be the first indication that the

antibiotic is reaching its target and is therefore considered a good

sign. In his original book, The Road Back, the late McPherson

Brown, MD noted that the reaction caused a temporary worsening of

symptoms.

The amount of medication may be directly related to the intensity of

the flare. Medications which have no effect on mycoplasma (or other

microbes) do not provoke this reaction nor do these medications

generally have a favorable long-term effect on the disease. Unlike the

RA flare, which can last for weeks or even months, the Herxheimer

flare reaction is often of short duration. (Scleroderma patients who

do not exhibit inflammatory components to their disease generally do

not report a Herxheimer of clinical significance.)

Large doses of antibiotics may initially caused a worsening or flare

reaction in many of the rheumatic diseases. The rheumatic diseases

which are most hypersensitive (rheumatoid arthritis, lupus, psoriatic

arthritis, etc.) have shown similar, distinct and often severe flare

reactions from even a low dose of antibiotic. According to Dr. Brown,

when the resulting released toxins go to the joints, joint pain is the

result; when they go to the brain, depression may result.

Dr. Brown found the Herxheimer effect showed a number of important

principles at work. It demonstrated that the disease was a

hypersensitive reaction, not to the drug itself, but to the toxins

that a microbe creates in response to the drug's presence. And, it

opened the way to a chemical attack (with medications) on the whole

area of arthritis and rheumatic diseases.

Dr. Brown found that rheumatic diseases are often associated with a

high degree of tissue sensitivity. It was soon observed that a more

potent antibiotic would produce a more marked flare reaction because

of this tissue sensitivity. By keeping the dosage low, it was possible

to gradually remove the microorganisms from the tissues without

causing major clinical worsening of the disease. If these

microorganisms were truly present and responsible for the

hypersensitivity reaction, long term, low dose treatment would result

in clinical improvement of symptoms in patients.

Dr. Brown recognized he was not dealing with an ordinary infectious

problem where microbial invasion was the prominent feature. The

reaction of the patient to the infectious organism was as important as

the organism itself.

In the historical protocol as determined by Dr. Brown, the use of low

dosage cortisone in conjunction with the antibiotics, either prevented

or modified such flare reactions. Chemical worsening of the blood

figures in lab testing was not generally noticeable until much larger

doses of the antibiotics were given.

Usually the first clinical changes to occur are those of lessening of

the duration of morning stiffness. In many patients under long term

management, the morning stiffness disappears altogether.

When the severity of the arthritic condition begins to lessen, either

from a spontaneous improvement or as a result of the continued

treatment with a carefully measured dose of antibiotic, a greater

tolerance of the antibiotic is generally noticed and larger doses are

tolerated without the return of the Herxheimer flare reaction. If the

dose has been increased too rapidly at any time, the initial flare

reaction may occur again. However, some patients need to remain on a

low, intermittent dose and respond well.

The standard prescription for antibiotic use in non-rheumatic diseases

is a high dose for a short period of time. The overall guidelines for

rheumatic diseases for avoiding too severe a Herxheimer flare are

dependent on careful use of low dose and attention to frequency of

administration. This treatment methodology calls for low dose

antibiotics prescribed over a long period of time-- a very different

protocol than usual for the prescribing of antibiotics.

TREATING THE FLARE

Since the Herxheimer is a drug related flare, treating the symptoms

and allowing the flare to run its course will enable the antibiotic to

attack the offending microorganism and hasten recovery. Treat the pain

symptoms with pain medications which don't block the effect of the

antibiotic and which don't suppress the immune system ( i.e.: not high

doses of steroids.) The pain of the Herxheimer will diminish as the

reaction runs its course, making the need for pain medications or

those which address increased inflammation less needed over time.

Remember, a Herxheimer is a reaction to the effects of an antibiotic

on the microorganism causing the disease, while an RA flare is a

worsening of disease.