NATURAL MEDICINES & FAMILY PRACTICE
David Overton, PA-C 1315 Ruddell Rd. SE Lacey, WA
360-357-8054 website: natmeds.net
Healing Reactions
Adapted from Journal of American Academy of Physician Assistants, December 2009
Patients being treated for immune system problems are expected to improve but sometimes get worse before they get better. Alternative providers have long called this a healing reaction and conventional medicine now calls this immune reconstitution inflammatory syndrome (IRIS) or immune restoration disorder.
Healing reactions that occur while treating the immune system are now officially recognized by some conventional providers and well documented in the medical literature. Unfortunately, most patients have a hard time understanding and many clinicians do not recognize them or have little to no experience or training in treating healing reactions. I have personally experienced healing reactions and have managed many patients with healing reactions.
As we support your immune system or add antiviral, anti infective or antibiotic treatments, healing reactions may occur anywhere from 1 week to 1 year after starting treatments. 75% of patients will experience a healing reaction or immune restoration problem within 90 days. This reaction can be mild, moderate or significant and you should be seen promptly for evaluation and treatment. While is hard to understand, a healing reaction is a good thing when properly managed because it proves your immune system is getting better and/or it proves you have a resistant infection that requires additional treatment.
There are two types of reactions: unmasking or paradoxical. Both represent symptoms that occur as the immune system function begins to improve and cells in the immune system are restored.
With unmasking symptoms, that patient has an unrecognized infection or problem that has gone untreated for a long time (the so-called “silent” infection). In other words, an unrecognized infection is “unmasked” or appears. Commonly, skin symptoms or infection symptoms occur or increase as your treatments reestablish immune functions. With unmasking symptoms, the goal of treatment would be to identify the underlying infection and give the appropriate treatment. This means you should schedule an appointment if new symptoms occur or if previous skin or infection symptoms exacerbate. Common infections for typical patients would include parvovirus, coxsackie virus, herpes virus (strains 1, 2, 3, 6 & 7), cytomegalovirus, Ebstein Barr virus, mycoplasma (20 strains), Chlamydia pneumonia, helicobacter pylori and others. Common infections for AIDs patients and those on immunosuppressive drugs would include all the above and tuberculosis, mycobacterium avium and leprosy.
With paradoxical reactions, the patient is receiving appropriate treatment for a recognized infection. However, as the immune deficiency is corrected, the symptoms of the infection worsen. This causes concern because we must make certain other problems are not causing worsening symptoms. For example, if one develops aches and pains or chest pain, we have to make certain this is a paradoxical reaction or a different problem and treat accordingly. In addition, with paradoxical reactions, the initial treatment may have been optimal, but the worsening symptoms indicate a resistant infection. In this case, stronger antiviral or antibacterial treatments are added.
Healing reactions and immune restoration problems are fairly common, but usually misinterpreted or not recognized by patients and clinicians. Keep in mind that a healing reaction, when properly managed or mild is a good thing. It proves you have an immune problem or chronic silent infection that just needs to be managed effectively by an experienced clinician.
So who get healing reactions?
• patients with constipation, kidney problems or liver problems are more likely to have healing reactions. Schedule follow up for management of these problems.
• patients with immune conditions (recent infections, thyroid, alopecia, lupus, rheumatoid arthritis, Chron’s disease, others.) Schedule follow up for management of these problems.
• Circulation problems. Schedule follow up for management of these problems.
• patients on immune suppressive drugs (anti-inflammatory, antihistamines, steroids,
leukotriene blockers, HIV medicines, others). Schedule follow up for management of these problems.
• cancer patients, especially those treated with chemotherapy
• celiac disease and other problems are more likely to have healing reactions.
A healing reaction is also more likely to occur in patients who are the sickest at the onset of treatments. If needed, we can check CD 4 T cells, CD 8 T cells, natural killer cells, antibody levels, viral load tests or other immune tests to help predict or manage healing reactions. In other words, if your CD T cells, natural killer cells or other types of white blood cells are abnormal, you are more likely to experience healing reactions and we can start preventative measures.
There are so many effective ways to treat healing reactions and we individualize the treatments that it is pointless to try and list them. I will say that:
• we have a number of alternative medicines you can start to prevent healing reactions
• that you should always do basic lab tests and perhaps an ECG (electrocardiogram) before treating chronic immune problems or if a healing reaction develops. These tests help enormously to predict which patients are at risk for healing reactions or how to manage healing reactions, if they occur.
Remember, healing reactions occur as your immune system improves or if you have a resistant (hard to treat) infection. Mild reactions are usually not cause for major concern but more significant reactions should be seen promptly and managed effectively in order to relieve the symptoms and improve or restore immune system functions.
David Overton, PA-C works at Natural Medicines & Family Practice integrating conventional and alternative approaches under the supervision of Dr. Richard Faiola, MD, ABFM.