The effect of antibody against TNF alpha on cytokine response in Jarisch-Herxheimer reactions of louse-borne relapsing fever

Severe Jarisch Herxheimer reaction (J-HR) precipitated by antibiotictreatment of louse-borne relapsing fever (LBRF) is associated with atransient, marked rise in circulating tumour necrosis factor alpha (TNFalpha), interleukin 6 (IL-6) and interleukin 8 (IL-8). Ovine polyclonalanti-TNF alpha antibody fragments (Fab) were used in a randomized doubleblind placebo controlled trial in an attempt to prevent this reaction.Within 4 h after penicillin, in controls (n = 29), a several- fold rise incytokines occurred, concomitant with a fall in spirochaetes and maximalclinical manifestations of the J-HR. An intravenous infusion of anti-TNFalpha Fab, 30 min before penicillin in 20 patients reduced peak plasmalevels of IL-6 and IL-8 (but not IL-1 beta) compared with controls (p =0.01 and < 0.001, respectively) and the incidence of the J-HR,indicating some neutralization of TNF alpha. An apparent fall in TNF alphareflected interference of anti-TNF alpha in the immunoassay.