Herxheimer Reactions and Ozone Therapy

Herxheimer reactions or “Herx” are a common concern in ozone therapy, especially when it pertains to rapid pathogen die-off or intoxication. Like many other concepts in alternative medicine, it’s also widely misunderstood. This article will cover what’s currently documented in the clinical literature.

What Are Herxheimer Reactions?

The Jarisch-Herxheimer reaction, commonly shortened to Herxheimer or die-off reaction, describes a temporary inflammatory response that can occur when many microbial organisms are rapidly broken down in the body [1]. 

In alternative medicine, the term is often used interchangeably with healing crises, or when you feel worse before you feel better after introducing an effective remedy. However, a healing crisis may not always pertain to microbes—it can also happen after psychoemotional therapies, for example. 

Initially described in patients treated for syphilis in the early 20th century, Herxheimer reactions are attributed to the sudden release of microbial components. Microbe parts, such as endotoxins or cell wall fragments, stimulate the immune system when they enter the bloodstream or come out of biofilms.

Note that Herxheimer reactions are not a direct toxic effect of the therapy itself, but rather the body's immune-mediated response to microbial debris. 

Although most commonly discussed in infections caused by spirochetes (like Borrelia or Treponema), Herxheimer-like phenomena can occur in other contexts involving microbial turnover or intoxication that can stimulate the immune system. For example, some people feel temporarily worse while trying to detox mold or heavy metals. These symptoms can last longer than the Herxheimer reactions themselves.

Not every symptom flare or discomfort after therapy qualifies as a true Herxheimer reaction. True cases tend to be time-limited (typically resolving within hours to a few days) and are marked by objective signs of systemic inflammation, rather than vague or prolonged illness that lasts months or longer [2]. 

If you dose ozone therapy too high and experience a day of fatigue, it may not be a Herxheimer reaction. It may just be excessive oxidative stress beyond what your body can counteract, or you may have overdone the therapy.

Expectations of die-off symptoms or nocebo effects can also worsen symptoms that are in response to a treatment.

It’s critical to understand the distinction between true Herxheimer reactions and something else, especially when considering therapies like ozone that interact with the immune and microbial environments.

What Causes Herxheimer Reactions?

Herxheimer reactions are primarily triggered by the immune system's response to:

• A sudden surge of microbial byproducts that arise after antibiotics, biofilm breakers, and oxidative treatments. 
• Increased circulating toxins.

Disruptions of microorganism cells, for instance by antibiotics, immune responses, and oxidative treatments like ozone, can release microbial components into the bloodstream. These components may include lipopolysaccharides (LPS), lipoproteins, and inflammatory molecules.

These microbial fragments act as pathogen-associated molecular patterns (PAMPs), which are quickly recognized by pattern recognition receptors (PRRs) on immune cells [3]. 

This recognition triggers an acute release of pro-inflammatory cytokines. 

The resulting cytokine surge drives the symptoms associated with a Herxheimer reaction [4].

The severity of a Herxheimer response is not necessarily proportional to the pathogen load alone, it also reflects the individual’s immune sensitivity and regulatory balance at the time of treatment.

What Does It Feel Like and How Long Does It Last?

A Herxheimer reaction typically feels like a sudden, flu-like illness. Herxheimer may present as:

• Fever
• Chills
• Sweating
• Muscle aches
• Headache
• GI upset
• Skin rashes or hives
• Brain fog
• Fatigue
• Transient worsening of existing symptoms

In most cases, the reaction begins within a few hours to a day after therapy and peaks relatively quickly. For the majority of people, symptoms resolve within 24 to 72 hours without intervention [5]. 

Rarely, reactions may persist slightly longer, but they typically self-limit as the immune system recalibrates.

Understanding the expected timeline is important: symptoms that are severe, highly prolonged, or worsening beyond several days may warrant further medical evaluation, rather than being automatically labeled as a Herxheimer, or  “Herx,” response.

Herxheimer and Mold

Scientific Perspective

Mold exposure can lead to the accumulation of mycotoxins in the body [6]. 

When treatments mobilize these toxins, the resulting die-off can trigger an inflammatory response. 

This response may manifest as the symptoms previously talked about: fatigue, headaches, muscle aches, and cognitive disturbances. 

The severity and duration of these reactions can vary based on individual factors such as toxic load and detoxification capacity [7]. If the body cannot remove the mold toxins effectively, the mobilized toxins can create more damage, resulting in symptoms that may last longer than typical Herxheimer reactions.

Herxheimer reactions are increasingly recognized in contexts beyond bacterial infections, including during the detoxification of mold and mycotoxin-related illnesses. Mold exposure can lead to:

• Chronic immune activation
• Systemic inflammation
• Bioaccumulation of mycotoxins and their metabolites

When therapeutic strategies begin mobilizing these stored toxins, immune flare-ups resembling Herxheimer reactions can occur [8].

A case report study highlighted this dynamic through the example of a patient with chronic inflammatory response syndrome (CIRS) that was triggered by mycotoxin exposure [8]. The patient experienced symptom exacerbations, including headache, fatigue, and flu-like symptoms, after initiating detoxification therapies aimed at mobilizing mold-derived toxins. 

Importantly, these flares corresponded not to new toxin exposure but to the body's reaction to internal toxin release, a pattern mirroring classical Herxheimer physiology.

Clinically, the patient's worsening symptoms align with immune markers such as elevated proteins, like TGF-β1 and MMP-9 [9], [10]. 

After detox strategies were adjusted, which included introducing gentle binders and pacing of the treatment, the patient's symptoms stabilized. 

This case study highlights the importance of binders and gradual mobilization rather than aggressive detoxification in mold-sensitive individuals. As evidenced by the study, in mold-related conditions, symptom flares may reflect immune modulation rather than treatment failure. 

Similar to classical Herx reactions, cytokine surges drive the temporary worsening of symptoms. Recognizing this distinction is crucial: it prevents early discontinuation of therapy and guides appropriate supportive care.

Candida Die-Off and the Herxheimer Reaction

Candida is an opportunistic infection that can be very tough to eradicate. Candida and fungal infections may or may not happen in a person with mold exposure, although mycotoxins may weaken the immune system and increase susceptibility to fungal infections. 

Treatments of Candida overgrowth, particularly of Candida albicans, can cause Herxheimer-like reactions. This is well-documented in the clinical literature.

When antifungal therapies are initiated, rapid fungal cell death leads to the release of numerous toxic substances, including [11], [12], [13], [14], [15]:

• Candidalysin, a small protein that can lyse red blood cells and cause chronic inflammation
• Secreted aspartyl proteases
• Ethanol
• Acetaldehyde
• Various cell wall fragments
• Heavy metals [16]

These substances can cause inflammation that may look like a symptom flare.

The sudden toxin burden from Candida die-off places significant strain on the detoxification organs, especially the liver and kidneys, which work to clear these substances. 

Clinically, patients have been reported the following symptoms as they work to clear out Candida [17]:

• Fever
• Headaches
• Body aches
• Digestive upset
• Brain fog
• Skin rashes
• Mood disturbances 

In sensitive individuals, the Candida overgrowth and die-off can throw off the gut flora. This can worsen mucosal immunity and systemic resilience to the infection [18].

Candida causes your T cells, mast cells, and macrophages to amplify the inflammatory responses during the die-off [19], [20]. If your immune system is already a bit sensitive, the Herx reactions could be worse. This is when immune modulation becomes very important.

Management strategies can include introducing the following prior to gradually introducing antifungals:

• Binders
• Immunomodulators such as curcumin, quercetin, resveratrol, and green tea catechins. These herbs, where tolerated, can help modulate the immune response and have mild anti-fungal properties [21], [22], [23], [24]
• Other detox support, such as mild laxatives, saunas, and body work

In the context of ozone therapy or broader detoxification efforts, understanding Candida-related Herxheimer reactions is crucial. Ozone therapy can address Candida in five ways.

1. It jumpstarts a stagnant immune system, for instance in cases where weakened immune responses allow for opportunistic infections like Candida. At the same time, it modulates the inflammation, mitigating some of the die-off reactions.
2. Gut treatments like rectal insufflation, drinking ozone water, and ozone oil capsules may break biofilm and increase oxidative stress, making the body inhabitable to Candida.
3. Rectal insufflation may increase liver detoxification of substances from Candida that can lead to die-off reactions [25].

Patient Experiences of Treating Candida with Ozone Therapy

Since the literature on Herxheimer symptoms from ozone therapy of Candida is very limited, we turn to online forums for individual anecdotes.

Most reported Herxheimer experiences arise from prescription or herbal antifungals, such as:

Mysticmango113 shares “I’ve struggled with candida for years after several rounds of antibiotics for Lyme disease in my youth and teens, which led to overgrowth in my gut. Been trying now for 2 years to get rid of it. Undecylenic acid, prescription antifungals, keto, biofilm disruptors etc. I definitely seem to be making some progress but it’s not linear. Every time I hit it with a round of something, it fights back hard. Sugar cravings, nausea, awful anxiety, histamine intolerance, sweating, insomnia… taking a binder seems to help but it’s not a complete fix…”

LosAngeles215 shares “Hi- I am female, 34 years old and I'm having some weird symptoms after I started an antifungal detox. I was on 2 pills of Gl MicrobX and instantly got really bad, fatigue and exhaustion. And then I had pressure behind my eyes, not painful, not a headache. The next day it moved to the side of my eyeballs for two days. Then on the next day it was in the front. My eyesight was a little blurry, but I could blink it away like a biofilm. I've also been having diarrhea multiple times a day and mucus from my nasal back drip. Also a rash twice, the first time was on my neck and then it moved to my cheeks for three days and then the last time was all over my chest and upper arms. It isn't itchy or painful. It resolves on its own both times ….”

On the other hand, those who used ozone therapy generally reported positive results without major mention of any Herxheimer or side effects. This doesn’t mean that ozone therapy doesn’t cause Herx reactions with Candida overgrowth, but it suggests that ozone may be a powerful support modality. 

One Reddit user, “durangoho,” noted that “If you have systemic inflammation then yes it will help a lot. Rectal ozone, while weird, is extremely effective. Or at least it was for me. Enough for me to purchase my own machine.”

Another Reddit user on the same thread discussing the efficacy of ozone therapy went into detail, stating that:

“It depends what kind you’re talking about, but the short answer is YES!

“I’ve done quite a few of them. I’m a big fan of [ozone oil] supplements ...The suppositories are the first time I’ve seen a literal chunk of hyphal Candida come out of me (big fluffy thing!). 

“I take ozonated olive oil supplements once daily on an empty stomach after my biofilm busters. They are seemingly effective and a bonus that they also work against SIBO.” 

An individual’s immune system’s sensitivity can vary considerably over time based on the body’s cumulative toxic burden and resilience status. Ongoing monitoring is vital to ensure that no other complications arise. 

While Herxheimer reactions during mold detoxification can be distressing, they are predictable, self-limiting, and manageable with a well-tailored treatment plan. 

If you’re sensitive, it’s crucial to follow the steps to optimize your terrain, immune functions, and detoxification before introducing ozone therapy. Then, gradually introduce ozone therapy from low doses to high. 

Herxheimer and Lyme

The Herxheimer reaction was first identified in patients treated for syphilis, but it is now most famously associated with Lyme disease, an infection caused by Borrelia burgdorferi [26].

Lyme patients can experience Herxheimer reactions when antimicrobial treatments rapidly break down bacterial cells and biofilms. This triggers inflammatory molecules that can lead to an acute immune response. With Lyme, Herxheimer reactions often present with worsening of baseline symptoms shortly after initiating treatment. 

These reactions are thought to involve massive cytokine release, including TNF-α, IL-6, and IL-8, similar to what is observed in traditional bacterial Herx reactions. The inflammation is not due to active infection worsening, but rather to the immune system reacting to bacterial remnants [27].

For Lyme patients, understanding the Herxheimer phenomenon is critical because it helps distinguish between expected immune reactions versus signs of treatment failure. Most Herx reactions in Lyme disease peak within 24–48 hours after starting therapy and resolve within a few days, though the intensity can vary widely based on microbial load and immune sensitivity.

In the context of therapies like ozone, where immune modulation and microbial interactions are at play, a temporary increase in symptoms may reflect this same immune activation pattern, although each case must be assessed carefully to rule out alternative explanations.
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Patient Experiences of Herxheimer Reactions During Lyme Treatment

According to Reddit, Patients undergoing treatment for Lyme disease often report a range of symptoms during antimicrobial treatments. Often, these can last for months. 

These reactions can be particularly intense in individuals with co-infections like Bartonella. Many Redditors also employ detoxification strategies such as increased hydration, sauna therapy, and supplements like chlorella to alleviate symptoms. ​

The duration and intensity of Herxheimer reactions can vary significantly among individuals. Some experience mild reactions lasting about 24 hours, while others report more severe and prolonged symptoms. 

For instance, one patient noted that after a week on doxycycline (the gold standard treatment for Lyme disease), they experienced a Herxheimer reaction characterized by significant pain and difficulty moving or talking, which subsided after 24 hours, leading to gradual improvement with continued treatment.

In the Lyme subreddit, many users discussed the potential of ozone therapy, with some sharing personal insights. 

One Reddit user, “Secure-Afternoon3204,” went into detail regarding treatments, stating: 

“I got IV ozone done 5 times within one year... The ozone definitely helped a lot, though the herxing was hard to get through. Each time I got ozone I would feel very weak for 3-5 days after. I wasn't doing enough to detox though, so that is highly recommended. It helped bring my immune system back to life & lower fatigue.”

Another user on the same thread, in their quest to find effective symptomatic treatment for Lyme disease, stated:

“IV ozone helped me each time I did it but it didn’t last. But so far ozone has been the only thing that even nicks the surface for me, IV glutathione feels like a saline drip.”

These firsthand accounts underscore the importance of personalized treatment approaches and the need for healthcare providers to prepare patients for potential Herxheimer reactions during Lyme disease therapy.

Herxheimer and Ozone Therapy

Ozone therapy, especially systemic routes, modulates the immune system and influences microbial balance [28]. 

Given its oxidative nature and ability to stimulate immune activity, there is theoretical potential for Herxheimer-like reactions in some individuals undergoing ozone therapy, especially in cases where microbial turnover is rapid.

Systematic reviews of clinical evidence have occasionally reported transient symptom flares after ozone therapy [29], [30]. These may include Herxheimer-like reactions, such as:

• Nausea
• Fatigue
• Mild headache
• Low-grade fever 

While these symptoms resemble Herxheimer reactions, ozone therapy is unlikely to kill pathogens in the human body in the same way that high-dose antibiotics do.

Instead, in ozone therapy, ozone's primary effects involve indirect modulation of [31], [32], [33]:

• Redox balance
• Immune signaling (including NF-κB and Nrf2 pathways)
• Mild stimulation of cytokines and other growth factors

Given this information, when symptoms arise after ozone therapy, they may reflect temporary immune recalibration, oxidative stress adaptation, or the body's response to enhanced detoxification processes. This does not necessarily mean a classic Herxheimer reaction is being created by massive microbial die-off.

Understanding this nuance is important: most post-ozone symptoms are brief, self-limiting, and often manageable by adjusting dosage or frequency. 

Severe instances of true Herxheimer responses are relatively rare, and undocumented in literature, especially when the ozone treatments are appropriately applied. 

How to Prevent and Address Herxheimer Reactions

Minimizing the risk of a Herxheimer reaction and managing it if it occurs begins with careful preparation and clinical supervision. 

Working with an experienced practitioner ensures that therapies like ozone are appropriately customized to individual needs, rather than following a one-size-fits-all approach.

Addressing the Foundations

Before initiating ozone therapy, it’s essential to stabilize a patient’s foundational health, which may include:

• Adequate sleep
• Regular elimination (bowel, kidney, and lymphatic function)
• Proper nutritional support
• Movement
• Nervous system regulation

A dysregulated nervous system can amplify inflammatory responses, so practices that calm the limbic system, such as DNRS (Dynamic Neural Retraining System) or the Gupta Program, may further buffer the body’s resilience.

The Gupta Protocol and Herxheimer Reactions

The Gupta Protocol is a mind-body retraining program designed to target limbic system dysfunction. 

Limbic dysregulation affects brain regions involved in emotional processing, threat detection, and autonomic regulation [34].

A randomized controlled trial (RCT) investigating the Gupta Protocol demonstrated significant benefits for individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), improving fatigue, anxiety, and overall quality of life compared to standard pacing therapies [35].

At its core, the Gupta Protocol employs neuroplasticity-based techniques to calm overactivation of the amygdala, insula, and cingulate cortex. These brain areas are often implicated in perpetuating chronic stress and heightened immune sensitivity. 

The protocol retrains maladaptive threat responses and restore autonomic balance through techniques like:

• Meditation
• Visualization
• Breathing exercises
• Cognitive behavioral interventions 

This approach holds particular relevance for individuals prone to Herxheimer reactions, whether triggered by microbial turnover, detoxification, immune recalibration therapies like ozone, or nocebo effects.

Emerging research suggests that an overactive limbic system may amplify inflammatory signaling and sympathetic nervous system responses, making mild biochemical shifts feel disproportionately intense [36]. 

By calming neuroimmune circuits and promoting parasympathetic (rest-and-digest) activity, the Gupta Protocol may help reduce the severity and emotional intensity of Herxheimer symptoms.

While it does not prevent the physiological processes underlying Herxheimer reactions, limbic retraining may create a more resilient and adaptive internal environment. 

This can allow the body to process transient inflammatory flares with less perceived distress and systemic amplification.

In this way, interventions like the Gupta Protocol offer a complementary strategy, addressing not only the biochemical terrain but also the neural regulation of inflammatory and detoxification responses to enhance the safety and tolerability of integrative therapies.

Dynamic Neural Retraining System (DNRS) and Herxheimer Reactions

Dynamic Neural Retraining System (DNRS) is a neuroplasticity-based intervention developed to address limbic system dysfunction [37]. The system targets individuals with chronic illnesses where environmental triggers, infections, and toxins have led to maladaptive brain responses. 

Most chronic illnesses, especially the following, involve a hypersensitive threat detection circuit within the brain’s limbic structures, particularly the amygdala, hippocampus, and cingulate cortex.

• Multiple chemical sensitivities
• Mold-related illness
• Chronic fatigue syndrome
• Post-infectious syndromes 

DNRS works by using structured cognitive, behavioral, and visualization exercises to retrain these brain circuits, shifting the body out of a chronic fight-or-flight mode and reestablishing normal autonomic, immune, and endocrine regulation. 

Through daily practice, individuals aim to dampen exaggerated inflammatory responses and reduce systemic overactivation.

In the context of Herxheimer reactions, DNRS may provide a valuable adjunctive approach. 

While Herxheimer symptoms are biochemically triggered by immune responses to microbial breakdown products, an overactive limbic system can intensify the body’s perception of inflammation and distress [38]. 

DNRS helps interrupt these maladaptive feedback loops, promoting greater calm and resilience during temporary symptom flares.

Rather than suppressing necessary healing processes, DNRS may optimize how the brain and body interpret and respond to these inflammatory signals. 

This can improve the tolerance for therapies like ozone, antimicrobials, and detoxification by minimizing neuroimmune overreaction and reducing symptom amplification.

Together with programs like the Gupta Protocol, DNRS offers a neuroscience-informed strategy to support the body’s healing journey. This works not by replacing physical therapies, but by enhancing the nervous system’s ability to adapt to biological stressors gracefully.

It is important to note that at this point in time, no randomized studies have been conducted on the ability of either the DNRS or Gupta Protocol to reduce a systemic inflammatory state. Current research is based on subjective participant feedback. 

Binders

If binders are used to support detoxification, they should be introduced before ozone therapy. Binders can help reduce the recirculation of microbial and metabolic byproducts, potentially lessening the intensity of symptoms.

Binders such as activated charcoal, bentonite clay, and cholestyramine play a critical role in supporting the body during periods of microbial turnover or detoxification, particularly when Herxheimer reactions are a risk. 

Their main function is to bind and sequester toxins, microbial parts, and metabolic byproducts in the gut. This prevents the harmful substances from being reabsorbed into circulation (enterohepatic recirculation) [39]. Different binders have different affinity for toxin types, so some practitioners run tests to guide their choice of binders.

Activated Charcoal

Charcoal is a highly porous material that acts by adsorbing a wide range of organic and inorganic molecules [40]. It is particularly effective in binding:

• Lipid-soluble toxins [41]
• Bacterial endotoxins [42]
• Mycotoxins [43]

By reducing the systemic burden of these irritants, charcoal could help blunt the intensity of cytokine-driven inflammation associated with Herxheimer reactions.

Bentonite Clay

Composed primarily of montmorillonite, bentonite clay has a unique structure that allows it to trap positively charged toxins and microbial byproducts [44]. 

In addition to its binding properties, bentonite may also support gut barrier integrity by reducing local irritation and assisting in the repair of compromised mucosal surfaces. These benefits can be very helpful during episodes of heightened inflammatory stress [45].

Cholestyramine

A prescription bile acid sequestrant, cholestyramine is highly effective in binding negatively charged molecules, including bile-bound mycotoxins and endotoxins [46]. 

Originally used for lowering cholesterol, it may have utility in mold illness and biotoxin-related conditions. 

By interrupting the enterohepatic circulation of inflammatory compounds, cholestyramine could significantly reduce the ongoing immune stimulation that fuels Herxheimer-type symptoms [47].

By lowering the overall inflammatory load and reducing toxin re-exposure, binders can provide a way to reduce the peaks of immune reactivity that characterize Herxheimer reactions. 

Timing is critical: Take binders at least two hours away from supplements, food, or medications to avoid unintended nutrient binding.

When used thoughtfully, alongside adequate hydration and elimination support, binders can serve as a gentle but powerful tool to smooth the healing process, particularly when toxins are mobilized, such as during:

• Ozone therapy
• Antifungal treatments
• Mold detoxification protocols 

Pacing Ozone Protocols

When starting ozone therapy, the principle is “low and slow.” Especially when there is a fear of triggering a Herxheimer reaction, practitioners may recommend beginning at a quarter dose, observing the body’s response, and only then gradually titrating upward. 

Rushing into high-dose protocols with intensive methods like EBOO is riskier for first-time ozone users, as it may overwhelm adaptive systems.

By emphasizing preparation, gradual escalation, and ongoing monitoring, it’s possible to harness the benefits of ozone therapy while significantly minimizing the risk of a disruptive Herxheimer reaction. 

Thoughtful pacing allows the immune system to recalibrate naturally, making for a safer and more sustainable healing journey.

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1 Wood, J. M. and Sbar, E. (2025) Jarisch-Herxheimer Reaction. In StatPearls [Internet], StatPearls Publishing

2 (2013) The Jarisch–Herxheimer reaction: Revisited. Travel Medicine and Infectious Disease, Elsevier 11, 231–237 https://doi.org/10.1016/j.tmaid.2013.04.001

3 Tang, D., Kang, R., Coyne, C. B., Zeh, H. J. and Lotze, M. T. (2012) PAMPs and DAMPs: signal 0s that spur autophagy and immunity. Immunological reviews, Immunol Rev 249 https://doi.org/10.1111/j.1600-065X.2012.01146.x

4 Moriyama, K. and Nishida, O. (2021) Targeting Cytokines, Pathogen-Associated Molecular Patterns, and Damage-Associated Molecular Patterns in Sepsis via Blood Purification. International Journal of Molecular Sciences 22, 8882 https://doi.org/10.3390/ijms22168882

5 Butler, T. (2017) The Jarisch–Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis. The American Journal of Tropical Medicine and Hygiene 96, 46 https://doi.org/10.4269/ajtmh.16-0434

6 Rick, S. (2024, January 3) Antioxidant Therapy Mold Detox Benefits. Sponaugle Wellness Institute https://sponauglewellness.com/mold-toxicity/antioxidant-therapy-mold-detox/

7 Caitlin. (2025, March 16) Understanding Herxheimer Reactions In Mold Illness: A Complete Guide. Dr Becky Campbell https://drbeckycampbell.com/understanding-herxheimer-reactions-in-mold-illness-a-complete-guide/

8 Straub, R. K. and Powers, C. M. (2021) Chronic Fatigue Syndrome: A Case Report Highlighting Diagnosing and Treatment Challenges and the Possibility of Jarisch–Herxheimer Reactions If High Infectious Loads Are Present. Healthcare 9, 1537 https://doi.org/10.3390/healthcare9111537

9 Sanjabi, S., Zenewicz, L. A., Kamanaka, M. and Flavell, R. A. (2009) Anti- and Pro-inflammatory Roles of TGF-β, IL-10, and IL-22 In Immunity and Autoimmunity. Current opinion in pharmacology 9, 447 https://doi.org/10.1016/j.coph.2009.04.008

10 Lee, H. S. and Kim, W. J. (2022) The Role of Matrix Metalloproteinase in Inflammation with a Focus on Infectious Diseases. International Journal of Molecular Sciences 23, 10546 https://doi.org/10.3390/ijms231810546

11 Naglik, J. R., Gaffen, S. L. and Hube, B. (2019) Candidalysin: discovery and function in Candida albicans infections. Current Opinion in Microbiology 52, 100 https://doi.org/10.1016/j.mib.2019.06.002

12 Naglik, J. R., Challacombe, S. J. and Hube, B. (2003) Candida albicans Secreted Aspartyl Proteinases in Virulence and Pathogenesis. Microbiology and Molecular Biology Reviews 67, 400 https://doi.org/10.1128/MMBR.67.3.400-428.2003

13 Yajima, D., Motani, H., Kamei, K., Sato, Y., Hayakawa, M. and Iwase, H. (2006) Ethanol production by Candida albicans in postmortem human blood samples: effects of blood glucose level and dilution. Forensic science international, Forensic Sci Int 164 https://doi.org/10.1016/j.forsciint.2005.12.009

14 Reddy, M. G. S., Kakodkar, P. and Nayanar, G. (2022) Capacity of Candida species to produce acetaldehyde at various concentrations of alcohol. Journal of Oral and Maxillofacial Pathology : JOMFP 26, 161 https://doi.org/10.4103/jomfp.jomfp_494_20

15 Nelson, R. D., Shibata, N., Podzorski, R. P. and Herron, M. J. (1991) Candida mannan: chemistry, suppression of cell-mediated immunity, and possible mechanisms of action. Clinical microbiology reviews, Clin Microbiol Rev 4 https://doi.org/10.1128/CMR.4.1.1

16 Rodríguez, I. A., Cárdenas-González, J. F., Juárez, V. M. M., Pérez, A. R., de Guadalupe Moctezuma Zarate, M. and Castillo, N. C. P. (2017) Biosorption of Heavy Metals by Candida albicans. In Advances in Bioremediation and Phytoremediation, IntechOpen https://doi.org/10.5772/intechopen.72454

17 Jaiswal, N. and Kumar, A. (2024) Candida die-off: Adverse effect and neutralization with phytotherapy approaches. Toxicon : official journal of the International Society on Toxinology, Toxicon 237 https://doi.org/10.1016/j.toxicon.2023.107555

18 Kumamoto, C. A. (2011) Inflammation and gastrointestinal Candida colonization. Current opinion in microbiology 14, 386 https://doi.org/10.1016/j.mib.2011.07.015

19 Richardson, J. P. and Moyes, D. L. (2015) Adaptive immune responses to Candida albicans infection. Virulence 6, 327 https://doi.org/10.1080/21505594.2015.1004977

20 Qin, Y., Zhang, L., Xu, Z., Zhang, J., Jiang, Y.-Y., Cao, Y., et al. (2016) Innate immune cell response upon Candida albicans infection. Virulence 7, 512 https://doi.org/10.1080/21505594.2016.1138201

21 Chen, E., Benso, B., Seleem, D., Ferreira, L. E. N., Pasetto, S., Pardi, V., et al. (2018) Fungal-Host Interaction: Curcumin Modulates Proteolytic Enzyme Activity of Candida albicans and Inflammatory Host Response In Vitro. International Journal of Dentistry 2018, 2393146 https://doi.org/10.1155/2018/2393146

22 Singh, B. N., Upreti, D. K., Singh, B. R., Pandey, G., Verma, S., Roy, S., et al. (2015) Quercetin Sensitizes Fluconazole-Resistant Candida albicans To Induce Apoptotic Cell Death by Modulating Quorum Sensing. Antimicrobial Agents and Chemotherapy 59, 2153 https://doi.org/10.1128/AAC.03599-14

23 Okamoto-Shibayama, K., Yoshida, A. and Ishihara, K. (2021) Inhibitory Effect of Resveratrol on Candida albicans Biofilm Formation. The Bulletin of Tokyo Dental College, Bull Tokyo Dent Coll 62 https://doi.org/10.2209/tdcpublication.2020-0023

24 Hirasawa, M. and Takada, K. (2004) Multiple effects of green tea catechin on the antifungal activity of antimycotics against Candida albicans. The Journal of antimicrobial chemotherapy, J Antimicrob Chemother 53 https://doi.org/10.1093/jac/dkh046

25 Zaky, S., Fouad, E. A. and Kotb, H. I. M. (2011) The effect of rectal ozone on the portal vein oxygenation and pharmacokinetics of propranolol in liver cirrhosis (a preliminary human study). British Journal of Clinical Pharmacology 71, 411 https://doi.org/10.1111/j.1365-2125.2010.03851.x

26 Mahajan, V. K. (2023) Lyme Disease: An Overview. Indian Dermatology Online Journal 14, 594 https://doi.org/10.4103/idoj.idoj_418_22

27 Karim, M. and Sapadin, A. N. (2022) A case of Lyme disease complicated by the Jarisch-Herxheimer reaction and coinfection with Babesia. JAAD Case Reports 32, 68 https://doi.org/10.1016/j.jdcr.2022.11.023

28 Chirumbolo, S., Valdenassi, L., Tirelli, U., Ricevuti, G., Pandolfi, S., Vaiano, F., et al. (2023) The Oxygen–Ozone Adjunct Medical Treatment According to the Protocols from the Italian Scientific Society of Oxygen–Ozone Therapy: How Ozone Applications in the Blood Can Influence Clinical Therapy Success via the Modulation of Cell Biology and Immunity. Biology 12, 1512 https://doi.org/10.3390/biology12121512

29 Serra, M. E. G., Baeza-Noci, J., Abdala, C. V. M., Luvisotto, M. M., Bertol, C. D. and Anzolin, A. P. (2023) The role of ozone treatment as integrative medicine. An evidence and gap map. Frontiers in Public Health 10, 1112296 https://doi.org/10.3389/fpubh.2022.1112296

30 Hidalgo-Tallón, F. J., Torres-Morera, L. M., Baeza-Noci, J., Carrillo-Izquierdo, M. D. and Pinto-Bonilla, R. (2022) Updated Review on Ozone Therapy in Pain Medicine. Frontiers in Physiology 13, 840623 https://doi.org/10.3389/fphys.2022.840623

31 Zeng, J., Lei, L., Zeng, Q., Yao, Y., Wu, Y., Li, Q., et al. (2020) Ozone Therapy Attenuates NF-κB-Mediated Local Inflammatory Response and Activation of Th17 Cells in Treatment for Psoriasis. International journal of biological sciences, Int J Biol Sci 16 https://doi.org/10.7150/ijbs.41940

32 Galiè, M., Covi, V., Tabaracci, G. and Malatesta, M. (2019) The Role of Nrf2 in the Antioxidant Cellular Response to Medical Ozone Exposure. International Journal of Molecular Sciences 20, 4009 https://doi.org/10.3390/ijms20164009

33 Viebahn-Haensler, R. and Fernández, O. S. L. (2023) Ozone as Redox Bioregulator in Preventive Medicine: The Molecular and Pharmacological Basis of the Low-Dose Ozone Concept—A Review. International Journal of Molecular Sciences 24, 15747 https://doi.org/10.3390/ijms242115747

34 Torrico, T. J. and Abdijadid, S. (2023) Neuroanatomy, Limbic System. In StatPearls [Internet], StatPearls Publishing

35 Bratty, A. J. (2023) Neuroplasticity Intervention, Amygdala and Insula Retraining (AIR), Significantly Improves Overall Health and Functioning Across Various Chronic Conditions. Integrative medicine (Encinitas, Calif.), Integr Med (Encinitas) 22

36 Alvarez, G. M., Hackman, D. A., Miller, A. B. and Muscatell, K. A. (2020) Systemic inflammation is associated with differential neural reactivity and connectivity to affective images. Social Cognitive and Affective Neuroscience 15, 1024 https://doi.org/10.1093/scan/nsaa065

37 (2023, August 21) Brain Rewiring Exercises. Dynamic Neural Retraining System^TM https://retrainingthebrain.com/

38 TCIM. (2021, November 2) The Limbic System: A Little-Known System That Can Cause Huge Dysfunction. TCIM https://www.tcimedicine.com/post/the-limbic-system-a-little-known-system-that-can-cause-huge-dysfunction

39 Roberts, M. S., Magnusson, B. M., Burczynski, F. J. and Weiss, M. (2002) Enterohepatic circulation: physiological, pharmacokinetic and clinical implications. Clinical pharmacokinetics, Clin Pharmacokinet 41 https://doi.org/10.2165/00003088-200241100-00005

40 Silberman, J., Galuska, M. A. and Taylor, A. (2023) Activated Charcoal. In StatPearls [Internet], StatPearls Publishing

41 Uzunget, S. C., Evrin, T., Uzunget, S. B., Ertürk, Z. K., Akıncıoğlu, E., Özdemir, S., et al. (2018) Evaluation of activated charcoal and lipid emulsion treatment in model of acute rivaroxaban toxicity. The American journal of emergency medicine, Am J Emerg Med 36 https://doi.org/10.1016/j.ajem.2017.12.039

42 Pegues, A. S., Sofer, S. S., McCallum, R. E. and Hinshaw, L. B. (1979) The removal of 14C labeled endotoxin by activated charcoal. The International journal of artificial organs, Int J Artif Organs 2

43 Ahn, J. Y., Kim, J., Cheong, D. H., Hong, H., Jeong, J. Y. and Kim, B. G. (2022) An In Vitro Study on the Efficacy of Mycotoxin Sequestering Agents for Aflatoxin B1, Deoxynivalenol, and Zearalenone. Animals : an Open Access Journal from MDPI 12, 333 https://doi.org/10.3390/ani12030333

44 Moosavi, M. (2017) Bentonite Clay as a Natural Remedy: A Brief Review. Iranian Journal of Public Health 46, 1176

45 (2024) Evaluating bentonite clay’s potential in protecting intestinal flora and alleviating pseudomembranous colitis following antibiotic usage. Medical Hypotheses, Churchill Livingstone 191, 111443 https://doi.org/10.1016/j.mehy.2024.111443

46 Riaz, S., Patel, P. and John, S. (2025) Cholestyramine Resin. In StatPearls [Internet], StatPearls Publishing

47 Thébaut, A., Debray, D. and Gonzales, E. (2018) An update on the physiopathology and therapeutic management of cholestatic pruritus in children. Clin. Res. Hepatol. Gastroenterol. 42, 103–109 https://doi.org/10.1016/j.clinre.2017.08.007