What is a Herxheimer Reaction?

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In the over a decade I've been on Lyme forums I've seen the term " herx "

progress from it's original meaning (below) to almost any 'yucky'

feeling a person might have.

I've even seen one person say that she 'herxed' from drinking grapefruit

juice!

In the last 10 years or so there is rarely a mention of the true meaning

of a 'herx'. I doubt if many even know the origin of a

Jarisch-Herxheimer reaction.

A 'herx' is not to be taken lightly if it's truly severe. That's why we

need a truly educated Lyme doctor. He or she will determine if it's so

severe as to warrant a lessening of the antibiotic for a short time.

Lyme Disease

What is a Herxheimer Reaction?

By Donna Herrell

Founder, Lyme Disease Information Resource

Overview:

The herxheimer reaction, nicknamed " herx " , otherwise referred to as

Jarisch-Herxheimer (J-H) is a phenomenon originally observed in the

treatment of Syphilis, but later found in other illness [1]. In general

terms, it is described as a temporary increase of symptoms when

anti-syphilitic drugs (antibiotics) are administered.

What is known or speculated about Lyme disease herxheimers are based

heavily on the reactions seen in Syphilis. [2-3] This is due to the fact

both diseases are caused by a bacteria known as a spirochete, the former

being Treponema pallidum, the latter Borrelia burgdoferi (B.. However,

the herxheimer reactions in Lyme disease are not identical to those seen

in Syphilis, especially in terms of timing, frequency and duration as

noted below. [1-5]

In Lyme disease it is thought that the cause of herxheimers are the

result of endotoxin release. [2,5] That is toxin(s) within the

spirochete that are released as the B.b are killed or broken down. This

may be a result of the toxin(s) itself or the body's immune response

to such.

Symptoms:

As mentioned, the general description is a temporary increase in

symptoms, but also included is the development of new ones. More

specifically the most common events include: increased joint or muscle

pain, headaches, chills, fever (usually low grade), hypotension,

uticaria (hives) and rash. [1-5] A multitude of other symptoms have been

described.

Worth noting is that hives and rash are sometimes mistaken for an

allergic reaction. [2] It is up to one's physician to determine

this. However, with close observation and proper treatment (see

Treatment) may prevent unnecessary cessation of therapy.

In more severe cases of J-H, a reduction of the dosage or temporarily

cessation of the treatment has been recommended [5].

Timing, Frequency and Duration:

This is individualistic and herxheimers can occur within days to weeks

after the institution 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 any exacerbation. Some physicians use this as a

guideline for treatment. Further, it may help differentiate herxheimers

from the normal symptoms or progression of Lyme disease.

Treatment:

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 Benadryl helpful even in the absence of rash or hives.

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. Though the lack of a herxheimer reaction

should not cause anxiety if symptoms are improving.

Other considerations:

Something often overlooked but can present with similar symptoms is

Candida (yeast) infection. Treatment with acidophilus and if needed

prescription medications such as Nystatin or Diflucan can be utilized.

Sources of Information:

Lyme Disease 1991 - Patient/Physician Perspectives from the U.S. and

Canada The Jarisch-Herxheimer Reaction H. Katzel M.D.

Managing Lyme Disease 1996 ph J Burrascano M.D.

Principles and Practice of Infectious Diseases 4th Ed. Mandell,

and

Seronegative chronic relapsing neuroborreliosis. Lawrence C, Lipton RB,

Lowy FD, Coyle PK Eur Neurol 1995;35(2):113-117

The New Lyme Disease 1998 ph J Burrascano M.D.

See Jarisch-Herxheimer / Jarisch-Herxheimer-like Reactions

Lyme disease, Tick-borne Relapsing Fever and Allergy

Document and reference collection (in progress) November 15, 1999

http://www.x-l.net/Lyme/abstracts/herx/herx.collection.html

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This document is for informational purpose only and not written by a

medical professional. This article may be copied for personal use. For

republication in any format please contact the author at

dherrell@...

Copyright © 1997

Lyme Disease Information Resource http://www.x-l.net/Lyme/HERX.html