The Jarisch-Herxheimer reaction (or Herx for short) is an inflammatory response to antibiotic treatment for certain diseases (although some non-antibiotic treatments can produce the reaction). It’s also referred to as a “healing crisis” or “die-off,” meaning a detoxification of dead or dying bacteria and other pathogenic organisms in the body.
A Herxheimer reaction feels like a worsening of illness symptoms and can include:
- fever
- sweating and chills
- rapid heart rate or palpitations
- shortness of breath
- muscle and joint aches and pains
- headache
- brain fog
- insomnia
- swollen glands
- ringing in the ears
- sinusitis
- itching
- digestive issues
- unstable emotions
- general feeling of sluggishness
Blood pressure increases early in the reaction, but then usually drops quickly. Any rashes present before drug treatment can get worse. Hives are also possible. Most people usually have mild symptoms of sleepiness and fatigue. But a Herxheimer reaction can also cause serious reactions such as seizures and anaphalactic shock.
Herxing can come on quickly or grow in intensity over the course of several days. It can last from a day to a week or two in rare cases. Over time a person’s Herxheimer reactions decrease as their load of infection goes down.
The Herxheimer effect happens with only a few diseases. The first disease associated with Herx was syphilis. In fact, syphilis was the subject of the original scientific papers by Austrian dermatologist Adolf Jarisch and German dermatologist Karl Herxheimer, who each studied the effects of mercury treatment for syphilis at the turn of the 20th century. Similar reactions have been found to occur in two kinds of borreliosis (Lyme disease and relapsing fever), brucellosis, Q fever, and trypanosomiasis.
Why Herx Happens
A person with one of the Herx-causing infections has a certain number of tiny foreign organisms in their body. The number of infectious organisms can be in the thousands or millions. Each individual organism is made up of its own cell with its own internal structure and contents. If that cell dies through an attack by the immune system or an antibiotic drug, it bursts open and releases its contents. Millions of cells bursting at the same time introduces a significant amount of cellular material in the body. These spilled contents cause the Herxheimr reaction, When the spilled contents are cleared from the body, the reaction stops.
Historically, the theory has been that the reaction is caused by dying organisms releasing endotoxins. Recent experimental research suggests that the rapid and massive overstimulation of the patient’s immune system causes the symptoms. The immune system’s job is to recognize and attack foreign antigens in the body. When dead organisms spill their internal contents, a huge number of foreign antigens become present all at once. The body reacts by releasing immune system modulators (or cytokines) (e.g., Interleukin 6, Interleukin 8, and tumor necrosis factor, among others). These cytokines are what cause the fever, chills, and low blood pressure. Either way, the body gets assaulted and fights back.
How to Treat Herxheimer Reactions
It’s important if you’re starting antibiotic treatment for Lyme Disease to discuss the Herx reaction with your doctor. You’ll also need detox support for your liver, adrenal glands, and gut to help escort the dead bacteria out of your body. You should also discuss with your doctor any additional vitamins and supplements you may already be taking. Be aware that taking too many drugs at once, prescription and over-the-counter, can be very dangerous.
Not everyone treated for Lyme has a healing crisis. It depends on things like your load of infection, your unique body chemistry, and your reaction to the specific medications you’re taking. Most people who do Herx have mild to moderate symptoms that can be uncomfortable but tolerable and lessened with:
- rest
- pain management (aspirin, NSAIDs, acetaminophen, Alka Seltzer Gold)
- probiotics
- antioxidant support
- herbal teas
- lots of water with lemon juice
- enemas and colonics
- hot Epsom salts or steam baths
- massage therapy
- listening to relaxing music
- yoga or moderate walking
A word of warning: Doctors who aren’t familiar with Herx-causing diseases like Lyme may mistake a strong Herx reaction for an antibiotic allergic reaction. That’s why it’s important to talk about it with your doctor before starting antibiotic treatment. If your doctor has never heard of Herxheimer or downplays any strong, non-allergic reaction you may get from taking antibiotics, you should think about finding another doctor.
While a Herx usually subsides in a few days to a week, you should be on the lookout for symptoms that could be life threatening, Serious Herxheimer reactions include a large drop in blood pressure and difficulty swallowing or breathing. A few people have had seizures on antibiotics for Lyme. If any of these things happen, stop taking your medications immediately and call your doctor or go the the Emergency Room. Once the die-off has cleared, you’ll probably be able to go back on your medications slowly. Or change to another more compatible medication. Everyone is different; you and your doctor have to see what works best for you.
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21. February 2012 at 2:23 pm
Dear Pam,
Would you be kind enough to provide me with LLMD in Annapolis, Maryland area. I am currently being treated for Lyme Disease with Doxy; but, I am truly suffering from muscle aches and pains in lower back, spine, and extremities, depression, fatigue, etc.. I want to be able to pursue treatments for the symptoms aggressively—-this disease has been challenging me for sometime. Thanks.
21. February 2012 at 4:12 pm
Nancy, I sent you MD Lyme info. No doubt about it; Lyme is challenging disease. While you can treat it aggressively, that route isn’t always the easiest or most effective. You can tolerate treatment only as fast as your body can handle it. Sometimes the slower route does the job and allows you to live a more normal life in the process. Thanks for asking.
20. February 2012 at 7:47 pm
Please could you help me find a doctor near Columbus Georgia? I was bitten two years ago, but all my tests came back negative or questionable but I was put on a two week supply of antibiotics (anti malaria pills they give to the military before they deploy over seas)
Im having all the symptoms described by others on this site and it seems to happen when I am under stress. Im so very tired of being dismissed by the military doctors as being “hormonal” or “well thats what it feels like when you raise 3 kids” I just want to get well.
21. February 2012 at 4:37 pm
Platitudes and put downs. Ptooey! I’m sending you GA Lyme info so you can find someone who can really tell you what you have. Thanks for asking.
17. February 2012 at 2:29 am
I’ve been sick for so long my doctor wanted to start MS testing. I came across lyme symptoms and low and behold the list described me to a T. I’m 40 years old and am having a hard time being a wife and mother. I had to quit my job a year ago and we have been surviving off of one income since then. Times have been tough that’s for sure!
Just sent in my IGeneX test, anxiously awaiting the results. I will be absolutely flabbergasted if it comes back negative! I live in Canada and any information you could provide would be great! Even a doctor here, mine seems to “disagree” with the proven facts. I’m wondering about a real allergic reaction to antibiotics… what is the difference between a herx reaction and an allergic reaction. So when I start treatment I don’t run to the emerg with a herx only to be told it’s an allergic reaction when it’s not.
17. February 2012 at 3:04 pm
Most people with Lyme don’t have drug reactions, Lymedout. Especially not with the most common antibiotic used for Lyme, Doxycycline. For many people, herxes are tolerable, an increase in one or more symptoms for a time. But just to be safe, it’s better to be treated by a doctor who knows the reactions you can get to treatment.
Finding a Lyme doctor is hard, especially in Canada, which seems to not recognize that many of its citizens have it. I’m sending you the info I have. Sorry to say, you might have to travel to the US to get competent care. Hang in! You can be helped. Thanks for asking.
8. February 2012 at 6:20 am
Hi Pam,
My 7 year old son tested positive for lyme in September 2011, he was treated with a 21 day course of amox. He wound up in the ER last week because of swelling and severe joint pain in both knees. Dx at ER was juvenile rheumatoid arthritis….I believe it is still the lyme. They did another lyme test, which came back positive, waiting on the Western Blot. He was just started on a 30 day course of doxycycline.
He has an appointment with a pediatric rhuematologist next week. I am looking for an MD with lyme experience in the central New York area. Any information would be greatly appreciated!
Thanks,
Sarah
8. February 2012 at 1:19 pm
NY Lyme info is on its way, Sarah. Yes, do consult an LLMD. Unfortunately most rheumatologists and neurologists know little or nothing about Lyme. Glad you asked.
5. February 2012 at 2:34 pm
Hi Pam,
I’m 46 years old and live in the Cleveland, Ohio aree. My symptoms started about 18 months ago (almost everything on the Lyme symptom list). After 3 weeks I got better. 6 months later and my symptoms came back and have been getting more severe. I’m at my wits end right now because my GP and others can’t find an answer. I grew up in Missouri and was bitten by ticks several times as a kid. That was nearly 30 – 35 years ago. Could I have had Lyme this whole time and the symptoms just now appear within the last 18 months? Should I see a Lyme specialist in my area? Can you provide a list of Lyme Disease specialists?
Any help/support would be great. I’m trying to keep it together but it is frustrating. Thank you so much!
6. February 2012 at 11:19 am
David, I probably had Lyme for 40 years without knowing it. You could also have gotten it from a more recent bite from a mosquito, fly, mite, or flea (not something you see publicly about Lyme transmission). I’m sending you OH Lyme info so you can find someone who knows how to diagnose it correctly and treat it adequately if you have it. Thanks for asking.
17. February 2012 at 2:23 am
really? mosquito, fly, mite or flea? How about spiders? That’s news … and why don’t they talk about it publicly?
17. February 2012 at 2:57 pm
Probably some spiders too. Who’d want to talk about this publicly? No official, especially those with their fingers in pies involved with money, would want this to get out. Too expensive. You’d have people panicking everywhere.
3. February 2012 at 6:41 pm
I was diagnosed with lyme today, my result was a .9 and the ranges were .2-5.7. all my doctor gave me was a rx for 21 days of antibiotics, i’ve suspected this lyme for years. is there any good doctors near high bridge new jersey who are aware of lyme that i could talk to. any info would be helpful, i almost cried hearing the results, it was a long anticipated journey getting diagnosed.
5. February 2012 at 12:24 pm
Jamie: Congratulations on your Lyme diagnosis. Now to find someone who knows how to treat it correctly. NY Lyme info is being sent shortly. Thanks for asking.
2. February 2012 at 4:36 pm
My daughter is having this reaction to antibiotics. She is being treated for chronic tonsillitis, but I’ve suspected she has Lyme for a while now. I got her Western Blot back today and part of it says equivocal, but the overall test says negative, despite two bands being abnormal. Can you recommend and Lyme doctors in the Northern VA area?
Thank you.
3. February 2012 at 5:01 am
Va Lyme info is being sent ASAP, Kelly. Thanks for asking, and for being a persistent mom.
1. February 2012 at 10:33 pm
Hi Pam, My 8 year old was just diagnosed with Lyme IGM positive, I suspect based on previous symptoms she has had for a long time however the doctor says since she is IGG negative this is unlikely. Can you please comment or point me to information? Also she has started on Amoxicyllin, seems to be improving but now I am worried about a Herx reaction, my pediatrician did not mention this to me at all. She has something red in her belly button (she also has excema) but is otherwise improving. I am giving her Probiotics. Can you give me any advice, would it be likely to get a Herx at anytime or just starting? Finally do you have any LLMD’s that take insurance in the NY, CT or even NJ area that you can PM me? Thank you!!!!
2. February 2012 at 12:42 pm
Emis, Lyme tests are unreliable, so it is possible your daughter has had Lyme for longer than your doctor suspects. She may or may not have a herxheimer reaction on the Amoxy. Herxes can come on quickly or slowly. Be mild or strong. Sounds like you’re doing the right thing for her with the probiotics.
I’m sending you NY, NJ, And CT info so you have lots of choices. Unfortunately many LLMDs no longer take medical insurance. It’s more trouble than it’s worth for them in a business where their medical licenses could be on the line for the “unorthodox” treatment of Lyme. Thanks for asking.
30. January 2012 at 9:25 pm
Pam,
I am 23 and have had Lyme for four years now. It wasn’t until very recently that I put the rash that I had all those years ago and the accompanying symptoms since then together and started doing research. Sure enough, when I brought it to my doctor’s attention and he did the tests, it showed that I was positive for having the infection in my system. I have worsening neurological issues such as memory loss, irritability, brain fog, depression, confusion, etc. I’m in constant pain in my joints- especially in my chest and back and in my knees. I have a “mystery tachycardia” that has four different cardiologists scratching their heads. I’ve been on Atenolol for two years for that and it makes me feel even more horrible than I already do on a daily basis. I have two children. I feel like I’m an old lady. Do you know of any LLMDs around Arkansas? I’m willing to travel if I have to. I can’t keep living like this. Also, a separate question about the Herxs: Can you have them without antibiotics? Because for the past two years around the start of the winter months I’ve had a week where I’ll break out in spontaneous hives and will have trouble breathing. I can actually watch the hives spread. I went to the ER three times in one week with them.
Thanks in advance for your help!
31. January 2012 at 11:58 am
I’m sending Arkansas Lyme info, Jessica. You will probably have to travel to get good care. “Mystery tachycardia” is a symptom of Lyme and/or other co-infections that come with it, including Chlamydia pneumoniae. A Lyme doctor should test you for the multiple co-infections that are what we call Lyme, thinking it’s an infectin by one organism. Re: your hives, I don’t think that’s a herx, which usually come from prescription antibiotics. But it could come from something over-the-counter you’re taking for it I suppose. Thanks for asking.
26. January 2012 at 5:22 pm
Any doctors in Oregon that are knowledgeable about Lyme disease?. My grandson is seeing someone in San Francisco that I am not sure is a physician let alone a Lyme disease specialist. My grandson is 21, is having a difficult time – headaches many symptoms. Has been put on some sort of antibiotics, sleep problems, also change in disposition, never been angry and depressed before. He lives in Oregon, I wonder if the SF person is a holistic person without a great deal of knowledge. Please let me know if there is any Board Certified MD in Oregon who could help this young man.
27. January 2012 at 5:11 pm
I’m sending you OR Lyme info, M. There are some holistic practitioners who do know how to treat Lyme, so I wouldn’t rule all of them out. Also please be careful in trying to convince you grandson to get treatment elsewhere. I and many others have learned the hard way that well-meaning relatives can stir up a hornets nest that’s best left alone. Thanks for asking and for being a concerned grandparent.
20. January 2012 at 2:24 pm
Is there any lyme dr’s in columbus ohio ?
21. January 2012 at 8:28 am
OH Lyme info coming up, John. Thanks for asking.
18. January 2012 at 10:51 am
Does anyone know of Lyme’s Disease specialists (conventional or integrative) in the St. Louis or Springfield Illinois/Missouri areas? Thank you.
18. January 2012 at 1:27 pm
Welcome back, Stari. MO Lyme info is on its way. Thanks for asking.
15. January 2012 at 3:03 pm
I have had herx reaction to antibiotics, but recently I decided to try kombucha tea. After a couple of days I felt I was dying. Depression, headache, joints, muscles OK, but I had very bad heart symptomps, eg very slow or very quick heart beats with extrasistole in every minutes, and lasted more then a week, at that point I stoped taking it, but symptoms got better very slowly. It took another week. I was panicing. I didn’t know it was a herx, or allergic on Kombucha? And I wasn’t sure if I could die because of these symptoms? Could someone die because of that type of heart symptoms of herx?
15. January 2012 at 6:18 pm
Barbara, people can die from severe Herxheimer reactions. Kombucha is fermented yeast and bacteria; you might be allergic to it. A quick Google search turned up this NY Times article. Dr Andrew Weil says there are no scientific studies on the health benefits of Kombucha tea. Others warn that it can be contaminated. For you, best to stay away. Thanks for asking.
8. January 2012 at 12:40 am
You are right on target! I reacted to all but fever, shock and seizures. I had the bulls eye rash of Lyme’s. I live in Arkansas so I didn’t think I could have it. Thankfully, my doctor believed I did and put me on antibiotics. He did however lower the dosage. I hope the CDC will recognize and allow for additional research for the southern states and the strain of deer tic here.
3. January 2012 at 1:33 pm
Thanks for this write-up, I have a family member that is struggling with an infection. The symptoms that you describe sound somewhat similar to chemotherapy. I wonder if some of the treatments of chemotherapy symptoms could be useful here as well?
3. January 2012 at 6:10 pm
Interesting observation, Mike. I suppose there are some similarities in ways to ease treatment side effects for both Lyme and cancer. I’m not a medical practitioner, however, so I can’t comment more than that. Thanks for asking.
3. January 2012 at 10:40 am
Pam,
Thanks for the info on GA LLMD’s. Have you heard that Lyme could similarly affect neurons in a similar way that ADHD or Autism does? I have read this in several places. We began ADHD meds over the holidays and I have struggled with that decision but we needed something to get us through the very rough time my son is having at school The meds are not going well and I am wondering if these drugs would not work properly if we have Lyme instead of a true ADHD/Autism problem. We are having tons of side effects on the lowest dose available. Our ped has asked us to half the dose and see if that amount might help at all. I have a feeling we will be moving through several drugs in the near future and hate thinking about the side effects short and long term. We have an appt. with an autism/ADHD specialty center next week so that we can try to get a better diagnosis. We are having him tested for Lyme as soon as possible. Any thoughts?
3. January 2012 at 5:48 pm
Audrey, Lyme mimics over 350 diseases. Autism and/or ADHD may be among them as Lyme is mainly a neurological disease. If your son is tested for Lyme with the CDC tests, they’ll probably be negative since they’re known to report false negatives. Seeing an LLMD ASAP should be helpful. Good luck. Keep us posted.
28. January 2012 at 10:12 pm
Hi Pam:
Do you know of any LLMD’s near Wilmington, NC? Can’t find any so far… Thanks for all your help!
29. January 2012 at 2:04 pm
I”m sending NC Lyme info, Gracie. You may have to travel farther than you’d like to get competent Lyme care. Thanks for asking.
1. January 2012 at 3:54 pm
I have been doing a lot of research on the subject of lyme disease. I was diagnosed Aug 10, after having the bullseye rash for about 6 weeks. I thought it was just a odd rash, but it kept getting larger. It encircled my belly button and grew to cover most of my abdomen. The ER said he had no idea what it was, but did a lyme test to rule it out, but it confirmed it. I was put on doxy for 2 weeks, I went back and requested another. I am in the AF in Germany (where I caught Lyme) and they are sure that 3 weeks of treatment was enough. I am not so sure. About 6 weeks ago I went through a bought of depression and angry episodes that I could not explain. I had a few doxy pills left, took them for a couple of days and felt clear headed again. Now, about 6 months after my initial treatment I have this weird sensation in my right arm. It is numb, then piercing shooting pain and sensitive to touch. When I rub my arm it feels like I have a hundreds of BBs in my arm that hurt when I press on them but the skin is numb above them and inches around it.
This area seems to only be on my forearm and bothers me just to rest on something, or where long sleeves, the only thing that helps the numbness and pain is hot water, the hotter the better, but then it comes back.
Do to the fact that I am in the military and the Drs aren’t always the most knowledgeable, when I go back they say I should be fine and any new symptoms are not related to Lyme. I need to know what I might be able to tell them so they can help me, or could this be something totally different.
Thanks
Les
1. January 2012 at 5:10 pm
Les, three weeks of Doxy is rarely enough to get rid of Lyme. Plus you could also have one or more of the tick-borne co-infections that often come with Lyme. Unfortunately there’s nothing I could tell you to relay to your doctors that could get you the care you need if they know little or nothing about Lyme. It’s a complex illness that often needs different courses of antibiotics, not something a doctor can learn overnight. Plus every Lyme patient has different symptoms and usually needs an individualized approach to care, not one-size-fits-all. I’m sending you info for Europe that may give you some leads on how to get better care. Thanks for asking.
29. December 2011 at 8:20 pm
Hi Pam! 2nd appt with LLMD today. Test results back….Negative, negative, negative. But my CD57 is at 20. Are you aware of anything else that could make my levels that low? She is going to do a more accurate test for Lyme and Co-Infections so once again I am in a holding pattern….this waiting game kills me. Hope you are feeling well. Thank you for all you do.
30. December 2011 at 4:04 pm
Jo – A low CD57 (below 60) is a classic marker for Lyme. Many LLMDs will treat on clinical symptoms alone, with Lyme tests as a backup since none is 100% accurate. Sorry you’re still waiting. It’s a bummer. Thanks for your kind comments. Lyme’s hard to have without support from people who understand how complex it is and how woefully ignorant many doctors are about it. Hang in!
24. December 2011 at 10:18 am
Hi Pam,
Thank you for the great information, I found it the most succinct of everything I have read so far.
My 12 year old son (13 on New Year’s Eve) was diagnosed with Lyme Disease a week ago. I had heard of Lyme Disease, only really knew about the bullseye rash, certainly knew nothing about all the problems people have afterward, finding a proper doctor, and getting treated. Out of nowhere 2 Sundays ago he told me his knee hurt. I didn’t think much of it, but he plays sports so I figured we better go get an xray to rule out any sprains or fractures.
I brought him to his long time pediatrician, someone we truly have come to respect and almost think like family. Doctor took 1 look at the knee and said he was 90 percent sure it was Lyme. Took blood and confirmed it. Doctor started him on Doxy 2 times per day, for 30 days. The first two days were uneventful but every day since they he has had a moderate to high fever (highest was 102.7). He has also has mild headaches.
I took him back to the doctor yesterday after I heard about this “herxing” – and doctor seemed perplexed. He said he knows that term but none of his patients had ever experienced it. He told me he would call the infectious disease people but that he thought my son just had a bug, separate and apart from Lyme. He did say he wanted another blood draw to rule out Lyme meningitis.
At this point I am freaking out. I am a single mother to this child and one other, my husband and their father died October 2010. We are still reeling from this and now that I am learning this could very well be a chronic illness is scaring me. Although not half as bad as thinking I might be in limbo between the medical community and a separate group of people who are opposed to the way the medical community is treating the disease. I don’t understand why doctors don’t recognize this happens in patients if there is so much evidence from patients that it does?
Anyway, long story short, if you could send me any info for doctors in the D.C. area, preferably Maryland (but not Baltimore – suburban Maryland outside D.C but Northern Virginia would be o.k. too.). that would be great. Also do you think the symptoms my son is having is “herx” related? He has fevers every day, they go up and down and are completely eliminated with Motrin which I give him only if the fever goes over 101. The headaches are not excruciating, they seem to come on with the fever. The knee that was swollen actually seems to have responded to the Doxy so far.
Thanks so much for your website of information and answering my questions. Sorry this is so long. I can’t believe its Christmas Eve and we are worried about this – life can change so fast it is scary. Trying to keep hope and faith right now. Thank you.
24. December 2011 at 11:22 am
So sorry Lyme is messing up your Christmas weekend, Violet. I’m sending you DC Lyme info so you can find a doctor who knows how to diagnose Lyme correctly and treat it adequately. Your son could also have a tick-borne co-infection that often come with Lyme – Babesia, Bartonella, Ehrlichia, and Anaplasmosis. Most people with Lyme have at least one.
It sounds like your son is currently herxing. Make sure he’s taking a good probiotic (taken at least 2 hours away from the Doxy). Herbal tinctures for his liver and kidneys can also help move out the toxins too. Find them in a health food store.
It’s great that your son has a diagnosis and has begun treatment. Finding a Lyme doctor should help allay your fears. Lyme is treatable. Please do keep your hope and faith. You can handle this. Glad you asked.
26. December 2011 at 7:30 pm
Please send me information on a Lyme Disease Specialist in the Hickory, NC area I appreciate your help.
26. December 2011 at 8:30 pm
NC Lyme info coming up, Jennifer. Thanks for asking.
29. December 2011 at 8:26 pm
Violet,
I live in the Baltimore area and have a wonderful LLMD. My best friend, who also has Lyme, along with a complete stranger who overheard a conversation I was having recommended this LLMD. I have had 2 visits so far….so I am in the beginning of this journey. I’m sorry to hear about the loss of your husband. I too have 2 children – ages 3 and 8. Feel free to private message me (maybe Pam could get it and forward it to you so I don’t have to post my email here) if you would like the information on my LLMD or if you just want to chat about this lovely Lyme thing. Much love and luck to you and your family.
30. December 2011 at 4:14 pm
Jo – I forwarded your email addy to Violet. Thanks for offering to help her.