"HERX IS NOT A SIDE EFFECT!"
PART 2: THE HEALING CRISIS
By: Dr. Roberta Kline
In health care, it is common for physicians to witness manifestations of what is commonly referred to as a “healing crisis”. This experience can appear in many different ways, including physical, emotional and spiritual symptoms that are then followed by a greater sense of well-being. While many “healing crises” have been in response to treatment of Lyme disease and Candida, nutritional changes also occur - from “detox” programs and energetic healing. There may be lower rates of healing crises within less aggressive and more personalized interventions, but the condition seems to exist here too.
This phenomenon is not widely recognized within the conventional medical community. Even among complementary and alternative medicine (CAM) practitioners, where there is more recognition of this phenomenon, it is still poorly understood. Through the course of scientific evolution, we hope to find an answer to whether it is possible to better predict predisposition to experiencing a healing crisis or Jarisch-Herxheimer Reaction. If so, perhaps we can develop personalized treatments to minimize these symptoms while still creating an effective healing response.
THE JARISCH-HERXHEIMER REACTION
First described in relation to treatment of a syphilis patient by the Austrian dermatologist Adolf Jarisch in the late 1800’s (and similarly reported by German dermatologist Karl Herxheimer), the Jarisch-Herxheimer Reaction (JHR) has been reported with treatment of other spirochete infections, including leptospirosis, Lyme disease, and relapsing fever, as well as with some fungal, protozoan and bacterial infections. Abridged as the Herxheimer's (or Herx) Reaction, it is today's best-known example of a healing crisis. This transient phenomenon occurs within 24 hours of antibiotic or antifungal treatment, and often includes fever, chills, headache, nausea and vomiting, tachycardia, hypotension, myalgia and exacerbation of skin lesions. It is not a rare reaction, occurring in over 50% of patients in some studies. While supportive care is indicated, it is rarely life-threatening.
While efforts to understand the underlying mechanisms have focused on scientific studies related to spirochete infections, the exact pathophysiology still remains elusive. Theories have mostly focused on the concept of “die-off” – that a sudden burden of dead spirochetes releases toxins and induces an inflammatory reaction. (1)
More recent research has expanded to include B. Burgdorferi, the spirochete associated with Lyme disease, and better technology has shed some additional light on the process underlying this phenomenon. No longer is the theory of spirochete “die-off” considered a primary trigger, as the symptoms appear long before the antibiotics actually result in death of the organisms.
It appears to be mediated by a multifactorial inflammatory process, potentially provoked by the uptake of the spirochete into the polymorphic neutrophils. This complex inflammatory response likely also includes nonendotoxin pyrogen and organism-specific lipoproteins, that then trigger an inflammatory cascade driven by tumor necrosis factor alpha (TNF-alpha), and downstream cytokines including interleukin 6 (IL-6) and interleukin 8 (IL-8). But it is still not clear how much of this inflammatory response is causal, and how much is the result of the Jarisch-Herxheimer reaction, and further research is needed. (2)
Interestingly, reports of a condition known as cytokine release syndrome are emerging as a result of treatment with CAR T-cell therapy, which is a form of immunotherapy for cancer. The symptoms occur within hours to days, and are very similar and can include fever, tachycardia, hypotension, and rash. The syndrome is thought to be caused by a large and rapid influx of cytokines – very similar to the findings from studies on the JHR. (3)
CROSSROADS BETWEEN PAIN AND WELLNESS
Various other healing modalities have also reported responses to treatment called “healing crises” that appear to be similar to JHR. Although many people refer to them generically as Herxheimer reactions (“herxing” for short), they do have some differences. Often pain, including reactivation of “old” pain, is seen in addition to changes in heart rate, respiration, more frequent urination and bowel movements, fatigue, fever, headaches, skin rashes and/or disrupted sleep. It is believed that many of these symptoms are the body’s way of eliminating accumulated waste products and toxins that are now being released as a result of the therapy. (4)
Even the reactivation of pain in locations that had not bothered the person for years is seen as part of this process. Oftentimes the healing crisis is followed by improvement in emotional and spiritual wellbeing, in addition to physical health. But while this phenomenon is recognized by many CAM practitioners, there is very limited research available and most of our understanding is anecdotal. Much more is needed to enhance our knowledge so we can educate both healthcare professionals as well as their patients.
 Aayush Dhakal and Evelyn Sbar. Jarisch Herxheimer Reaction. StatPearls April 28, 2022.
 Thomas Butler. The Jarisch–Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis Am J Trop Med Hyg 2017 Jan 11; 96(1): 46-52
 Noelle Frey and David Porter. Cytokine Release Syndrome with Chimeric Antigen Receptor T Cell Therapy. Biol Blood Marrow Transplant. 2019 Apr;25(4):e123-e127
 Thora Jenny Gunnarsdottir and Helga Jonsdottir. Healing crisis in reflexology: Becoming worse before becoming better. Complementary Therapies in Clinical Practice 16 (2010);239-243