Dealing with the Herx

In my prior posts, there were probiotics and herbs that may cause a mild, moderate or severe Jarisch-Herxheimer reaction.


I prefer to start from a model instead of random actions or incidental reports from various people. A model leads to alternatives.

With the model that the herx is largely the dumping of inflammatory toxins into the system. These toxins decreases blood flow:

  • by swelling blood vessels,
  • reducing the flow of oxygen and blood to the brain

This suggests several approaches:

  • vascular dialators (see this Wiki article for references)
    • niacin (as nicotinic acid only) – the FLUSHING TYPE – fast acting
    • L-arginine
    • heparin
  • Increasing blood flow /oxygen delivery
    • Anticoagulants:
    • Hot baths (with Epson salts) or infrared sauna
    • Increasing fluids – done with electrolyte mixtures such as Recuperation. Avoid those with sugars added.
  • Anti-inflammatories -these may slow down the rate of toxins being dumped into the blood systems as well as reducing inflammation.
  • Some herx in CFS appears to be associated with histamine
    • Anti-histamine such as Benadryl. The problem is that many anti-histamines can cause brain fog similar to herx, so it becomes unclear it is increasing or decreasing.

I skipped anti-inflammatories and anti-coagulants that have a significant risk of causing additional herx. For example. biofilm breakers.

Of course, the last alternative is to decrease or stop what is causing the herx. A herx is not a required phrase for getting better.  A severe “herx” that does not fade out within 24 hours of pausing a supplement/antibiotic may be an adverse reaction. See comments on this post for a case report. If you are unsure, see your medical professional — there are tests that may clarify what you are experiencing.

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. White Blood Count 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.” [source]

Stopping and working up to a comfortable level is ideal. However, with probiotics, the time for the herx to stop may be longer (days) because some may take up residence.

I did a longer write up on Herx that may be downloaded as a pdf.