The Herx Reaction

The Jarisch-Herxheimer Reaction, or herx reaction for short, is a reaction to endotoxins released by the death of harmful organisms within the body. The release of these endotoxins occurs much faster than your body can remove them. This reaction was first discovered by Adolf Jarisch of Austria in 1895 and a few years later confirmed by Karl Herxheimer of Germany. Both were dermatologists, and the two both observed reactions in treating syphilis patients with mercury. 


They both noticed that when the mercury was used to kill off the syphilis bacteria, the bacteria’s death triggered a release of these endotoxins in which contaminated the patients blood and tissues. This reaction to the toxins caused patients to have worse or different symptoms than to begin with, and they would feel worse.  The patients would still feel sick until the toxins were released from their bodies. Syphilis was later treated with penicillin, and the same reactions occurred.


It was first thought that the herx reaction was from syphilis alone, but now more diseases, such as Lyme (also a spirochete bacteria) have been proven to have the same reaction. 


That is why when a Lyme patient says that you get worse before you get better, this is what they mean by that. It is hard for people to believe it, however, as I have explained it dozens upon dozens of times to people who see myself getting worse, it is NOT the antibiotics that are causing my symptoms to worsen, it is the die-off and the toxins in my body.  Not only do we get the pleasure of being sick, we get to get even sicker before we get better… yayyyy! 


Some other diseases that can carry a herx reaction are Bartonella, Q fever, Leptospirosis, Babesia, and Rheumatic diseases. If you have any other tick-borne infections, you can be in for a real treat! 


Sometimes it can take a day, or even weeks to experience this phenomenon. Some don’t experience them at all. For myself personally, depending on the medication, can definitely experience a herx reaction in less than a full day. 


Symptoms can range in a multitude of ways. Sometimes it is flu-like symptoms and worse pain issues, sometimes your symptoms are exacerbated, and sometimes new symptoms can arise that you hadn’t had before. It can be difficult to distinguish if you are having a herx reaction or a symptom flare. An easy way to distinguish this is to know that Lyme disease progresses very slowly. If you all of a sudden have a very new symptom that you didn’t two days ago, and it only lasts for a day or two, you are likely experiencing a herx. 


It is also good to know if you are having a DRUG ALLERGY or a herx reaction. Also can be confusing. Two good ways to tell are your EOS% on your bloodwork… greater than 30% is probably an allergic reaction. Herx reactions can also tend to linger for weeks and weeks, while a reaction generally subsides after a few hours. Herx reactions can also cause rashes. If the rash shows up immediately, likely an allergy. A few days down the road, more likely a herx. 


Interesting information for you ladies out there, I was recommended to go on birth control, to quit ovulation as symptoms tend to flare or herx reactions can become worse when you are ovulating. That seemed very true for me as my symptoms always tended to flare right after my time of the month. I also had very painful periods, and had a lot of ovarian cysts, which is common among women with Lyme, and birth control helps shrink them. I went with the depo provera shot, which works out since I get a shot once every 3 months. All the while preventing pregnancy! Probably the last thing on my mind for getting the birth control shot these days… LOL


There is a lot of controversy as to if it is a good thing or a bad thing to have a herx reaction. Some doctors feel Lyme patients should not have any herxing. However, without herxing, you might not be having an aggressive enough treatment to be killing the bacteria. Some people don’t always have the same herx reactions or intensities as everyone else though. You are also more likely to have worse herx reactions if you have had the disease for much longer. You are going to have more bacteria to die-off if you have been sick for 20 years versus 6 months. 


The good news is, it is a scientifically proven fact you know a treatment is working if you are experiencing a herx reaction. It is very important to know there is a BALANCE. You should NEVER be having severe herx reactions. This can in fact be far more damaging than good. 


Always better to ask your doctor about this one. I was always too afraid to complain until either Dave or my parents made me, and have definitely suffered way more than necessary. Every single time I finally sent an e-mail, I would usually get some sort of a “that’s not good!” and we changed game plans. Like I said, don’t be afraid to ask! A good doctor should be willing to help you along the way with any questions or concerns.


Dr J believes that herx reactions are a good way to indicate improvement and to see how a treatment is working. As I have mentioned before, his protocols are all pulse therapy. He wants to see how you are doing off of the antibiotics. If you relapse, it is a sign you are not ready to stop treatment. If you fail to have a herx reaction during treatment (his protocol is pretty aggressive), it is an even better sign as there is less to die-off! Makes sense. 


Sometimes antibiotic dosages need to be altered because the herx reaction is too great. There are many tools to help ease some of the herxing such as aspirin, Benadryl, hot baths, minimizing stress as much as possible, getting enough rest and sleep, eating a well balanced diet, and drinking plenty of fluids.


The most important thing you can do is to detox. Your body is flooded with toxicity, and you need to rid yourself of the dead bacteria. I do the lactated ringer IVs on most of my off antibiotic days to help, but I know not everyone can do that. If you are on IV and do not to lactated ringers, I would strongly recommend you suggesting them to your doctor. Epsom salt soaks, lymph drainage massages, green tea, lemon water, Burbur drops, etc. are all great ways to detox.  


Hope this helped some! 


Have a good day! Just another manic Monday 😉,,,,,,, photo courtesy

18 thoughts on “The Herx Reaction

  1. Another excellent post – you have a talent for explaining things clearly and accurately!

    My son has 3 tick infections and probably had them for 5 years before starting treatment, so his herxes have been very severe. He’s also had CFS for 9 years which means he was starting out with poorly functioning systems. He was severely disabled for 18 months when he started doxycycline. Like you said, our doctor said there’s no value in herxing that badly – it means you can’t clear the toxins so you aren’t making any progress against the infections. We backed off to just 1 doxy pill every 3 days, and it was still severe at that level! We finally needed to address blocked methylation pathways in order for him to start to feel better and tolerate a normal dose of abx. This is a very common problem for people with CFS and can develop in those with long-term Lyme, too.

    Here’s a post I wrote about herx reactions:

    For more information on methylation, follow the link in this post to the updated protocol:

    Again, great job with a complex subject!


    Live with CFS

    • Yes, I do a methalation process as well for the MTHFR 677 mutation. Ugh. Doxy is rough stuff. That is what I started on and it was too much for me to handle. I was throwing up constantly, very parkinsonsy, and needed help to walk. I will definately read your blogs, thanks for the info 🙂

  2. Bartonella is no walk in the park either… I was diagnosed in the summer of 2011, after my high school graduation. And I began feeling like crap. I had so many anxieties that I never knew I had before. One of which makes it difficult to swallow in places I’m not comfortable with and sometimes I just feel tired randomly and I cannot eat at all.None of the LLMDs know what I’m talking about and anxiety meds do not help. If this was taken care of, I could actually live life perfectly.I don’t have chronic pain anymore, memory problems are a thing in the past, and I exercise every day. My diet is gluten free, sugar free, and dairy free.

    I feel like it left something in my brain that is irreversible. I might still have it but I’m unsure ATM. Haven’t herxed in awhile and I’m on 2 enzymes (inflamase) which kills biofilm, too many herbs to name that kills cyst, and 4 antibiotics =/

    Anyone have a similar symptom? Hard to swallow, unfamiliar anxieties? Lethargic after treatment?

    • My hardest treatments so far have been for Bart. It does mess with your head a lot. Anxiety, panic attacks, among a lot of other neuro issues affecting mood and for myself, likely the verbal and physical tics.

      I would ask in a forum, as I am not sure how to answer you, as this is a private blog. I have only been on limited Bart treatment, and still have a lot of Lyme and babs issues, so maybe you can find someone that has more bartonella geared symptoms only now.

      Hope you find the answers you are looking for!

  3. Thank you very much for sharing your information concerning Lyme Disease. This is all new to me since I was only diagnosed in July of this year. I have experienced this herx type episode while first on Doxycycline. I am drinking lemon juice and taking Epsom salts baths. It helps! I’m staying away from sugar as much as possible too!

    • No problem Terri! I have taken the approach on my blog to not only share my story, but also share information for Lymies and non-Lymies alike. Doxycycline is harsh. Read throughout my blog and I hope you find as much valuable information as possible! Also try lymphatic drainage massage. It works wonders. Make sure you stay away from gluten too. That one is probably the biggest among Lymies, aside from sugar. There are plenty of great alternatives to eat instead so you don’t feel quite as deprived.

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  5. Pingback: Burbur (Desmodium molliculum) | Find Me A Cure

  6. Pingback: Herx Reaction vs. Allergic Reaction | kimmiecakeskickslyme

  7. I started antibiotic treatment around two months ago and it’s now VERY difficult to walk…even using a walker. I know from your excellent writings that this is from the die-off and NOT the antibiotics. I just can’t seem to move these darn dead toxins out of my knees/legs. I’ve tried Burber drops, activated charcoal, Alka seltzer gold…all with no success thus far. I think my lymphatic system is completely clogged with the dead bacteria. Suggestions?

    • Try epsom salt baths, or I love lymphatic drainage massages. Lemon water. Watching out for Candida can be good too. Discuss this with your doctor, as that can make the die-off process worse and also make it harder to eliminate toxins.

  8. Well I finally got a Dx of Lyme disease because I was bitten again last week and developed a circular rash immediately on my arm but the bite was my ankle. Neuro has already Dx with late stage chronic neuro Lyme a yr ago. So as of two days ago I started Doxy 100mg twice a day for 28 days (I have severe and multiple reactions to
    other antibiotics) it’s day two and I’m vomiting constantly with dizziness. So I have two questions….
    1. What are the ramifications of being bitten again while having neuro chronic Lyme for over a year?
    2. Anyone else experience severe vomiting on Doxy or is it Herxing day 2?
    Excellent article!

    • Doxy is rugged. Lots of vomiting for me too. Glutamine powder helped some, as well as eating beforehand (no dairy though). If you already have Lyme and co infections and are treating all, my doc believes as long as you are treating you are ok. If you are only treating with Doxy, I would see if you could add in other things to prevent any other little “invaders”.

      • Thanks for the info. I will be on a different antibiotic on day 29. Because of how sensitive I am to many antibiotics my neuro is starting me gradually and working the way up to combination antibiotic treatment. Wants to see how my body handles doxy first. Taking it step by little step. Lol. I’ve started making sure I am detoxing my systems daily with natural ways. No chemical ways. Still having herx reaction but not as bad as they were.

  9. Do people who are well and take doxycycline herx ? The reason I ask this is because I have been on antibiotics before and have never felt so ill while on them.

    • No. It is one of those things that you will have no herx reaction. A herx reaction is Lyme die-off (among a very few other things). So, it is die off. Nothing would happen otherwise.
      I will say though, Doxy is EXTREMELY rugged. Make sure you are taking probiotics 2 hours apart to save your tummy.

  10. Pingback: The Herx Reaction | Slices Of Lyme Pie

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