Re. Coxon et al., THE EFFECT OF ANTIBODY AGAINST TNF-ALPHA ON CYTOKINE RESPONSE IN JARISCH-HERXHEIMER REACTIONS OF LOUSE-BORNE RELAPSING FEVER, Quarterly Journal of Medicine, 90(3), 1997, pp. 213-221
Severe Jarisch Herxheimer reaction (J-HR) precipitated by antibiotic t
reatment of louse-borne relapsing fever (LBRF) is associated with a tr
ansient, marked rise in circulating tumour necrosis factor alpha (TNF
alpha), interleukin 6 (IL-6) and interleukin 8 (IL-8). Ovine polyclona
l anti-TNF alpha antibody fragments (Fab) were used in a randomized do
uble blind placebo controlled trial in an attempt to prevent this reac
tion. Within 4 h after penicillin, in controls (n = 29), a several-fol
d rise in cytokines occurred, concomitant with a fall in spirochaetes
and maximal clinical manifestations of the J-HR. An intravenous infusi
on of anti-TNF alpha Fab, 30 min before penicillin in 20 patients redu
ced peak plasma levels of IL-6 and IL-8 (but not IL-1 beta) compared w
ith controls (p = 0.01 and <0.001, respectively) and the incidence of
the J-HR, indicating some neutralization of TNF alpha. An apparent fal
l in TNF alpha reflected interference of anti-TNF alpha in the immunoa
ssay.