What is a Herxheimer Reaction

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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

__________________________________________________________________________

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@...

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