Die-Off (Herxheimer) Reaction
What are Herxheimer (Die-Off) Reactions?
Herxheimer reaction (also known as die-off reactions) occurs in patients infected by certain bacterial infections, within 24 hours after they are treated with antibiotics. [1]
This phenomenon was first documented in patients with spirochete infections like syphilis, leptospirosis, and Lyme disease. [1] However, emerging research and anecdotal evidence suggest that die-off may be more common than previously thought and may occur in patients with other conditions too, such as candidiasis/yeast overgrowth, other bacterial, fungal or parasitic infections, and SIBO. [2] It is common that when undergoing treatment for these conditions, symptoms will get worse before they get better.
Die-off reactions can occur more than once over the course of treatment for the same condition. They can occur if a new medication is introduced, if the dose of medication is increased, or possibly with any change to a treatment protocol. [3]
It is especially important to consider management for die-off symptoms for children with autism due to their impaired ability to detoxify.
Signs/Symptoms
Die-off symptoms can start within a few hours of beginning treatment and may last up to a week. There may be a worsening of existing symptoms or onset of new symptoms.
Health-care providers should monitor patients to be sure that symptoms are not due to an allergy to a treatment/medication. This is done by monitoring the liver for abnormalities, in addition to continuing treatment and monitoring symptoms for improvement or resolution. [3]
Symptoms typically include:
Fever and chills
Shivers
Nausea and vomiting
Constipation or diarrhea
Fatigue
Anxiety
Potential Root Causes
Herxheimer reaction often happens as a result of antifungal or antibiotic use because the pathogens are killed off quickly and as they die, their toxins are released into our bloodstream, which triggers an immune and inflammatory response in our bodies which leads to the symptoms mentioned above. [1]
Next Steps
Nutritional Considerations for Die-Off Reactions
Drinking plenty of fluids and eating fiber-rich foods can help support the bowels with the elimination of toxins through stool.
Eating anti-inflammatory foods like vegetables (especially those high in sulforaphane) and fruits, nuts, and fatty fish may help counter the effects of toxins in the body. Avoiding things like sugar, refined carbohydrates, and processed foods can help to reduce the contributors to inflammation.
Supplement Considerations for Die-Off Reactions
Supplements that help the body detoxify are typically recommended to help manage die-off symptoms. The liver is the primary detoxification organ so liver support supplements may be appropriate.
Vitamin C, vitamin A, and Glutathione (or its precursor NAC) are powerful antioxidants and can help support detoxification as well.
Activated charcoal may help by binding toxins in the gastrointestinal system and flushing them out. We like GI Detox by Bio-Botanical Research and have noticed positive results with use for Herxeimer reactions.
Probiotics may be beneficial in repopulating the gut with beneficial bacteria.
Lifestyle Considerations for Die-Off Reactions
Toxins need to exit the body so it is very important to keep the body’s elimination pathways open when undergoing treatment for conditions that could elicit die-off. This can be done by:
Daily elimination of urine and stool
Sweating with regular exercise
Epsom salt baths can aid relaxation and detoxification.
Getting adequate rest during periods will allow the body to recuperate.
It may also be helpful to eliminate the burden of environmental toxins on the body. This can be done by ensuring that drinking water is filtered to eliminate contaminants, indoor air is filtered to remove toxins and by limiting toxins entering our body through food. This can be done by reducing or eliminating food chemicals and additives or purchasing organic products to minimize harmful chemicals like glyphosate, which has been associated with autism.
DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.
Die-Off & Autism in the Research
The research as it relates to Herxheimer reactions and autism is limited.
Inflammation and Die-Off Reactions
There is some research showing that in patients with syphilis, those with higher levels of C-reactive protein (CRP) before treatment may be more likely to undergo die-off reactions during treatment. [5]
CRP is a marker of inflammation and infection. CRP levels have been found to be elevated among children with autism, compared to typical children. Along this line of logic, it is possible that children with autism may be more likely to undergo die-off reactions. [6]
Aspergillus and Die-off Reactions
A child with symptoms placing him within the autism spectrum and with urine biochemical markers consistent with fungal (Aspergillus) colonization of the gastrointestinal tract was first treated with the antifungal probiotic Saccharomyces boulardii.
A dramatic Herxheimer reaction provided strong clinical indications that mold colonization might be a factor in causing autism in this child. Doctors treated the fungal infection with increasing doses of itraconazole which resulted in a complete loss of all symptoms of autism over the course of three months. This rapid complete reversal of autism is consistent with several articles proposing mold in general and Aspergillus specifically as a potential major cause of autism. [7]
-
[1] Dhakal A, Sbar E. Jarisch Herxheimer Reaction. In: StatPearls [Internet]. StatPearls Publishing; 2021.
[2] Muscianese M, Magri F, Pranteda G, Pranteda G. A case of Jarisch-Herxheimer reaction in candidiasis treated with systemic fluconazole. Dermatol Ther. 2020;33(2):e13244.
[3] Straub RK, Powers CM. Chronic Fatigue Syndrome: A Case Report Highlighting Diagnosing and Treatment Challenges and the Possibility of Jarisch-Herxheimer Reactions If High Infectious Loads Are Present. Healthcare (Basel). 2021;9(11):1537.
[4] Alabdali A, Al-Ayadhi L, El-Ansary A. A key role for an impaired detoxification mechanism in the etiology and severity of autism spectrum disorders. Behav Brain Funct. 2014;10:14.
[5] Tseng YT, Chou PY, Tai MH, et al. High Baseline C-Reactive Protein Level Can Predict the Occurrence of the Jarisch-Herxheimer Reaction in Patients with Active Syphilis. Infect Drug Resist. 2021;14:5121-9.
[6] Yin F, Wang H, Liu Z, Gao J. Association between peripheral blood levels of C-reactive protein and Autism Spectrum Disorder in children: A systematic review and meta-analysis. Brain Behav Immun. 2020;88:432-41.
[7] Baker S, Shaw W. Case Study: Rapid Complete Recovery From An Autism Spectrum Disorder After Treatment of Aspergillus With The Antifungal Drugs Itraconazole And Sporanox. Integr Med (Encinitas). 2020;19(4):20-7.
