HERXHEIMER'S REACTION: REVIEWING THE HEALING CRISIS

"HERX IS NOT A SIDE EFFECT!"

By: Josh Schueller, PT

As non-invasive treatments such as electromagnetic and neuro-stimulation devices have shown significant evidence as a safe and effective option for wellness and pain relief within recent decades, one possible bodily reaction may occur that can feel adversely as pain or discomfort- possibly being misunderstood as a side effect of the treatment.  This physiological reaction is called Herxheimer Reaction. This can occur when dead microbes or bacteria release endotoxins into your body at an accelerating rate.   This accelerated release is quicker than the body can eliminate.  The body then initiates an immune response which can bring on an inflammatory response.  Otherwise known as "Herk reactions", this reaction is commonly a temporary and short term (normally only last a couple hours to days) detoxification reaction in your body.  Common symptoms can resemble the flu- headache, joint and muscle ache, malaise, chills, nausea, sore throat etc.   This reaction is caused by the detoxification of the body.  Staying hydrated is one way to help flush your body and decrease the symptoms.   

A TEMPORARY REACTION TO DETOXING

The buildup of toxins in the cells can decrease your health and wellness.  Cell phones, computers, TV, air quality, improper hydration, and poor-quality foods can all lead to poor cellular health.  When treatments that help detoxify, the body initially occurs occasionally this is when the Herx Reaction occurs. Herx reaction is not common but can occur.  Education and communicating to the user on the possibility will improve outcomes and the persons reaction.  These symptoms peaks eight hours after treatment and disappears normally within 24-36 hours. 

As with any new exercise keeping your cells hydrated and healthy is the best remedy.  Other helpful ways to lessen the effects is to get plenty of sunshine, minimize exercise during this time, keeping your diet pure (avoiding alcohol) and using a sauna or sea salt bath. Herx Reactions more commonly occur if during the first few treatments the intensity and/or duration is too high for the treatment.  As with any new activity, starting low and slow and incrementally increasing intensity and duration is essential to avoiding any unwanted effects.  Some indications for a possible Herz reaction are how long the person has suffered from the condition.  Chronic conditions can demonstrate more likely increase in the amount of toxins in the system and poor cell health.  If a Herx reaction occurs- decreasing the intensity and duration for a couple of treatments is the most appropriate action needed.  

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PART 2: THE HEALING CRISIS
By: Dr. Roberta Kline

Introduction
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. 

References:

[1] Aayush Dhakal and Evelyn Sbar. Jarisch Herxheimer Reaction. StatPearls April 28, 2022.

[2] 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

[3] 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

[4]  Thora Jenny Gunnarsdottir and Helga Jonsdottir. Healing crisis in reflexology: Becoming worse before becoming better. Complementary Therapies in Clinical Practice 16 (2010);239-243