Can Ozone Therapy Cause A Herxheimer Reaction?

by | Last updated: Sep 12, 2021 | 16 comments

Can ozone therapy cause a Herx

The idea that ozone therapy can cause a Herxheimer reaction is one of the most discussed topics in the ozone community. Yet, there is as good as no mention of it in the professional literature. So, is this a real thing or just an urban myth? 

It is a real thing: ozone therapy can cause very distinct Herxheimer reactions. It is an often observed, but little researched phenomenon. Non-invasive ozone treatments tend to have a higher risk of Herxheimer reactions than invasive (ozone IVs) ones. 

And in fact, given that ozone is a broad spectrum anti-microbial, it shouldn’t come as a surprise that ozone therapy can produce strong die-off reactions.

What is a Herxheimer reaction?

A Herxheimer reaction is short for a Jarish-Herxheimer reaction [1]. It’s a phenomenon which was first observed around 100 years ago by two medical doctors who were treating syphilis patients.

They noticed that after the patients were given an anti-microbial, they would often get worse first before eventually getting better.

Since then, this event has been observed with Lyme and other spirochetal and bacterial infections, but is also believed to occur in fungal and protozoan (parasitic) infestations [2].

The underlying mechanism is still a matter of speculation, but it's assumed that it's due to lipoproteins, so toxins and debris which are produced by the dying pathogens. These can trigger an inflammatory reaction. It is believed that this inflammatory process causes the Herxheimer reaction. 

A Herxheimer reaction is also called a herx, a healing crisis, a die-off, or a detox reaction. It's also often used as a verb, e.g. “I'm herxing every time I do an ozone treatment”. 

Many ozone users as well as some ozone practitioners believe that any type of infection can trigger a herx during an ozone course, including viruses. Dr. David Brownstein, an ozone doctor, believes that even anti-cancer treatments can cause Herxheimer reactions [3]. 

In general, herxing is regarded as a sign that the ozone treatment works.


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How does an ozone therapy induced Herxheimer feel like?

An ozone induced healing crisis can feel like a “normal” healing crisis caused by antibiotics. 

Which means that ozone therapy can trigger the following typical die-off symptoms [1] [4]:

– flu-like malaise / muscle pain

– joint pain 

– chills 

– rigor

– light hypotension (low blood pressure)

– tachycardia (increased heart rate)

– hyperventilation 

– vasodilation with flushing

– exacerbation of skin lesions

– anxiety

– fevers 

– body aches 

– rashes 

– nausea 

– headaches 

– sweating 

– fatigue 

In addition, there are Herxheimer reactions which seem to be specific for certain non-invasive (those which do not require the puncturing of the skin) ozone treatments, like: 

  • Ozone saunas often trigger an itchy rash (small red dots), and increased need for sleep
  • Vaginal insufflations can cause a sensation of warmth, itching and burning
  • Drinking ozonated water can cause some very violent reactions like nausea, stomach cramps, expulsion of phlegm, weakness,
  • Ear insufflations have a very high risk of producing pain, liquid discharge, swelling, inflammation, itching
  • BOOO (Breathing Ozonated Olive Oil) can trigger coughing up phlegm, or a runny nose
  • Nasal ozone insufflations or nasal irrigations with ozonated water can also cause a runny nose, or the coughing up of phlegm while the body is ridding itself of an infection
  • Rectal ozone insufflations often cause bloating, cramps, various discharges (rope worm like expulsions and sand-like loose stools), although it's not clear whether those are side effects or Herxheimer reactions

How likely is a Herxheimer reaction after an ozone treatment?

Based on observations among ozone users and ozone therapists, the likelihood of a herx after an ozone treatment depends on a number of factors: 

In general, intravenous (invasive) ozone treatments show a lower risk of a healing crisis than those which do not require the puncturing of the skin (non-invasive). A complication of ozone IVs is that many require heparin, an anti-coagulant which comes with a long list of side effects [5] which may be mistaken for an ozone induced Herxheimer reaction.

– How sick is the patient? The higher the pathogenic load, the more severe the Herx can be.

– How intensely are the ozone treatments performed? The more ozone is done and the more often, the higher the risk of a Herx. Someone who receives one ozone treatment per month is unlikely to go through a meaningful herx. Someone who does ozone applications daily has a very high likelihood of experiencing some die-off effect.

– How well can the patient deal with the herx? Is it an older, or a younger patient? What underlying conditions are there? Are the elimination pathways functioning well or are they impaired? The healthier the patient is and the better his body functions, the less likely it is that it will be overwhelmed by a die-off reaction. 


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Which ozone treatments are the most likely to cause a Herxheimer reaction?

Certain ozone treatments have a very high risk of side effects. Those are, roughly from highest to lowest (this is a very subjective and not an exhaustive list):

– Ear insufflations. In my estimate, 9 out of 10 patients will experience pain, itchiness, liquid discharge, scabbing and more after ear insufflations. This may start with the very first EI or it can take several weeks. 

– Ozone saunas. Here, as well, in my opinion, 9 out of 10 patients will experience an extremely itchy rash if the saunas are performed often and frequently enough. 

– Rectal insufflations. Around 7 out of 10 people will experience bloating, cramps, rope worm / mucous like stools, or sandy stools, although it’s not clear whether this is a die-off reaction or simply a side effect. 

– Drinking ozonated water: 3 out of 10 people will experience side effects like nausea, cramps, vomiting, spitting out phlegm, pain, diarrhea, or constipation.

Treatments which rarely cause Herxheimer reactions, or are short lived and minor: intravenous ozone, vaginal insufflations, BOOO (breathing ozonated olive oil), or applying ozonated oils on the skin.

According to Dr. David Brownstein around 1 to 5% of his patients experiences a Herxheimer reaction after ozone treatments, although he does not specify the type of ozone methods this applies to. [3]

How can you deal with an ozone herx?

There are many different ways to deal with an ozone induced Herxheimer reaction, like supplements, anti-oxidants, binders, or anti-inflammatory medication or interventions.

Most people try to manage symptoms of an ozone herx by reducing either the frequency, ozone amount, ozone concentration, or duration of the ozone treatments, or a combination of those factors. 

There is also the approach of using more ozone to to deal with an ozone induced Herxheimer reaction. This is an unusual approach which nevertheless has served me many times over the past 12 years.

Ozone induced herxes are believed to be caused by an activation of dormant pathogens or a flushing out of toxins from tissues. Once this process begins and starts causing problems by triggering inflammation, more ozone can often resolve them.

What do ozone experts say about Herxheimer reactions after ozone therapy?

Although Herxheimer reactions are one of the most discussed topics in the ozone community, it’s nearly completely absent from professional literature.

Neither Prof. Bocci, Dr. Viebahn-Hänsler, or Dr. Shallenberger, Dr. Dehmlow, nor Dr. Hand Wolff discuss it in their books. 

It is also not referenced a single time in the “Madrid Declaration on Ozone Therapy”, which many regard as the most important ozone therapy guide. 

The only ozone doctor I am aware of who mentions it is Dr. David Brownstein in his book “Ozone, the Miracle Therapy”. 

There, he presents the case of Miranda, a 51 year old patient who was suffering from fibromyalgia.

Miranda was treated with MAH, Major Autohemotherapy, and after each ozone treatment she felt a flu-like malaise which lasted several days. Once the malaise had passed, she would feel nearly free of fibromyalgia symptoms. This type of flare up came up after each successive ozone treatment, but would get progressively less. Until finally, she felt only an improvement after the ozone, without the previous herx.

This is indeed a textbook ozone herx. Some form of it is often experienced by ozone therapy patients.

Other ozone experts mention ozone induced Herxheimer reactions but say that they occur either very rarely, or are only a minor event which does not deserve much attention.

The reason for this may be that most ozone doctors primarily use intravenous ozone treatments which are less likely to produce Herxheimer reactions.

Another reason may be that ozone therapists often administer ozone together or in close proximity with anti-oxidants like Vitamin C or glutathione which are able to neutralize some of ozone's effect and also lessen any potential ozone therapy induced Herxheimer reaction.


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About the author:

PaolaI’m Paola the Crazy Old Ozone Lady behind The Power of Ozone. I’m a licensed naturopathic practitioner, natural health consultant, ozone therapy enthusiast, researcher, and ozone therapy analyst. I hold certificates in ozone therapy, hyperbaric ozone applications, Oxyvenierung, and the Andrew Cutler chelation. I own several ozone generators including a German hyperbaric 10 Pass machine. I have been using ozone for over 13 years, I’ve chelated with the ACC program for close to 5 years and I’ve been carnivore for nearly 1.5 years. This website serves as a resource for those who are interested in ozone therapy and other approaches to successfully manage chronic conditions.

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  1. IMB

    why do I get avaginal mustard yellow discharge when I do vaginal insuflations. And I also get a mustard yellow discharge from my ears when I do ear insulations

    • Paola Dziwetzki

      Hi IMB,

      I don't know why they are yellow, but it is some kind of detox reaction, most likely.


  2. Tatyana Moran

    I have been doing home ozone insufflations about 5-6 times a week for over a year (vaginal and rectal) with great success. A couple months ago I started having pretty severe skin rashes which are becoming bothersome, and I suspect it's from using ozone. I am not sure if I should reduce frequency/duration. I am also confused about why would this happen since I am the most detoxed person I know. I also do professional grade foot detox regularly and other things to keep my body in perfect health. I also do ear and sinus insufflations as needed for any respiratory symptoms or after exposure. Lately, I also noticed orangy itchy crust form in my nostrils and outer ears after doing ozone… Please advise…

    • Paola Dziwetzki

      Hi Tatyana,

      If the rash started appearing after over a year of doing ozone regularly, then it's unlikely that it's the ozone which is at fault.

      Have you changed anything recently? Have you started eating new foods or taking new supplements?


  3. Richard

    Diet; consume organically grown steel cut oats is typical b-fast. Juice greens and veggies. protein from healthy source that includes mostly poultry and some cold water fish. Drink ozone water occasionally and ionized water.
    Supplements include Q10, Vit E, C, B and I add a little hydration salts to my water

  4. Richard

    Hello, I have been diagnosed with prostate cancer with evidence of Lymph involvement (PET scan).
    My diet is good, some supplementation including probiotics and digestive enzymes. Also, RI (400) for about 2 months now, 3 times a week.

    I noticed some typical reactions (mucous, headaches) but overall feel pretty good.

    Just recently began experiencing bowel movements that are very large, hard and painful. Additionally, I have been getting cold sweats. I do not feel sick or have a fever and there are no other symptoms.

    My diet hasn't changed. Is this a possible herx reaction? Your thoughts?

    • Paola Dziwetzki

      Hi Richard,

      what is your diet like exactly?
      What are the supplements you take? Would you mind listing them all?


  5. Jim

    Get those detox pathways open. Lymphatic massage and visceral therapy were a life saver before starting ozone.

  6. Audrey Steele

    Is ozone therapy safe for my daughter whose genetic detox pathways are compromised (SOD, NRF2, Methylation) and who went through 2.5 years of chemotherapy for Leukemia at 13 years old? She has multiple chemical sensitivity, food and environmental allergies, gall stones, liver and kidney issues, SIBO, and decreased motility and intestinal permeability. When she uses even low levels of glutathione, infrared sauna, or detox supplements she gets very ill. When doing regimens to kill fungus and bacteria in her gut she becomes very ill. She is super toxic and has numerous microbial overgrowths. I am concerned that the oxidative stress and lipid peroxidation induced by the ozone will overwhelm her body's capacity to respond.

    • Paola Dziwetzki

      Hi Audrey,

      the chemotherapy drugs typically used to treat Leukemia are a type of vitamin A / retinoic acid like isotretinoin.

      This is known to damage the liver.

      The issues you are describing are pointing towards that.

      I suggest you look into a low vitamin A diet (muscle meat and beans), also in addition binders like soluble fiber (psyllium husks, apple pectin, more beans), activated charcoal.

      Those bind the toxic bile coming from the liver and help restore the liver's health by interrupting the enterohepatic recirculation of bile.

      I suspect that glutathione stimulates bile flow. If the bile ducts are compromised, this can potentially worsen cholestasis and hence the symptoms.

      Heat also opens bile ducts and so spurs a bile dump.

      Producing more bile is a good to get rid of the toxins. But if bile ducts are narrowed, inflamed, or blocked, the increased bile can make a person sicker.

      The trick here is to use gentle approaches like the one mentioned. Especially beans / soluble fiber.

      Ozone therapy could help with the restoration of liver health but I also suggest to move very carefully. I would do not more than drink half a glass of ozonated water, first once or twice a week.

      Everything that can detox the liver by stimulating bile flow and also make liver toxicity symptoms worse if the bile dump is too much for the bile ducts. I believe that ozone also makes the liver produce more bile, but I think it does much more than that. There is a study that shows that ozone has direct liver supportive properties.

      Move slowly and carefully.

      Let me know if you have any other quesetions.


  7. Kara Scott

    I am getting ready to (finally) set up my ozone sauna. I have had the parts for over a year but never set it up….so here I go! Question. What is best to put under the sauna tent that I sit in ? I can put it on a carpet or on hardwood floor . What would be best to put down to protect the floor?

  8. david

    Thanks for you and your site. I do DIV, sauna o3, RI, knee, and other joint injections. Purchased your DIV book. I was looking for a detailed “how to” book for ozone with protocols and procedures for different joints, varicose veins, spider veins, etc. Any suggestions? I read you have another book coming.

    • Paola Dziwetzki

      Hi David,

      there is a how to guide for subcutaneous joint injections here:

      Varicose veins are also treated through DIV – there is a chapter on that in the DIV book.

      Spider veins are similar to DIV but a different needle is necessary.

      I have another book coming but it will not cover injections, only non-invasive home ozone treatments.


  9. Mary Michelle OSullivan

    Paula , It started with a dentist that drilled out a very large silver filling with no protection , it went everywhere .No vacume ,dam. assistant .Tumor under right breast right away ( but I didn't know what it was) then lump years went by went to dr stage 4 then biopsy that day he spread it that was 7 months ago May I talk to you I could use you guildance , Shelly O 239 410-3075

    • Paola Dziwetzki

      Hi Mary,

      I hope I will be able to be of help, but I don't give any guarantees.
      You can book a call with me through this page:


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