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The Jarisch-Herxheimer reaction (referred to as "Herx" often) is believed to be a reaction caused by organisms (bacteria) dying off and releasing toxins into the body faster than the body may comfortably handle it. It was originally observed in patients with syphilis who received mercury treatment [*]. 93% of patients with syphilis has Hughes Syndrome, it is estimated that 92% of CFS patients has Hughes Syndrome.

Most CFIDSers will have moderate to severe herx effects from antibiotics that will usually have no effects on normal healthy individuals[83% in one R.A. study, 51.4% in Lyme Disease, 89% with B. recurrentis infection]. The reason for this may be the diminished blood flow system caused by the thickening of the blood commonly found with CFIDS patients. Alternatively, "it seemed to occur when injured or dead bacteria released their products into blood and tissues, provoking a sudden and exaggerated inflammatory response"[*] - thus the response may be connected to the specific organism being killed off. Many non-antibiotic treatments (Hale's breathing, glutathione - whey products ) are reported to also produce a herx effect -- whether it is bacteria die off or simply toxin release, the effect is the same: misery!


  • What is a Herxheimer Reaction? 
  • The Herxheimer Reaction History [History and current theories (technical)]
  • The New England Journal of Medicine -- August 1, 1996 -- Vol. 335, No. 5

Intensifiers if on Antibiotics

Onset of Reaction

Depending on illness and antibiotic: from 1-2 hrs to 10 days after antibiotics started


The most common ones include:

  • increased joint or muscle pain
  • headaches
  • chills
  • Heavy perspiration and night sweats
  • Nausea
  • Burning micturition
  • Bone pain
  • swollen glands
  • bloating
  • constipation or diarrhea
  • fever (usually low grade)
  • hypotension (low blood pressure)
  • Itching, hives and rash (sometimes mistaken for an allergic reaction - this must be an MD's call)
  • heart palpitations, elevated heart rate, orthostatic

Tachycardia are reported on

Treatment (reduction)

Treatment consists of two approaches: improving the blood flow to clear the toxins faster (see vascular constriction), or, neutralizing the toxins (or both)

  • Probenecid (Dr. Jadin [*])
  • Benadryl (antihistamine)
  • Therma-Flu or equivalent
  • Aspirin (Bromelain may increase it!)
  • Meptazinol [*, *]
  • Increase in blood thinning supplements
  • Lemon/Olive Oil drink (may be done with water or Grape Juice)
  • 2 Tbsp Lemon Juice (Organic) or 1/2 lemon rind)
  • 1 Tbsp cold pressed Extra Virgin Olive Oil Water or juice ... stir
  • Concord Grape Juice with flavoids (widens blood vessels)
  • NSAIDs (non-steroidal anti-inflammatory drugs),
  • pain medication (see ibuprofen risks..)
  • muscle relaxers,
  • hot baths / hot tub
  • steam (dry or hot) sauna
  • a saltz bath: add 1 cup salt, 1 cup soda, 1 cup epsom salts, 1 cup aloe vera, to a
  • hot bath, remain in and keep hot for about 1-1/2 hours all the while consuming
  • about 2 quarts of warm water.
  • Hale's breathing
  • Control panic attacks, anxiety and worry (they constrict the blood vessels, worsening the effect).

Differentiating between a Herxheimer, a flare and an allergic reaction to the drug

"Laboratory tests can help differentiate between a worsening of disease (RA flare), a  Herxheimer reaction to microbial toxins, and an allergic reaction to medication.

  1. WBC will elevate in a Herxheimer and lower in a flare.
  2. A Herxheimer will also exhibit a coincidental elevation of SED rate, gamma globulin and total globulin ,and a fall in serum albumin and hematocrit. Patients who exhibit this flare reaction accompanied by anemia, depression of serum albumin, elevated total globulin and gamma globulin are probably reflecting a more intense reaction pattern to anti-L substances than in hematologically mild cases.

  3. A marked increase in eosinophils (for instance about 30%) is an indication of an allergic reaction to the drug."




Original 2001 WebSite as PDF for download

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