Autoimmune flares: what triggers them and how to get out of them

You might remember in our introductory autoimmune article that a telltale sign of an autoimmune (AI) condition is symptoms that wax and wane. When you are in the waxing (increasing) phase of an AI condition, you experience a sudden and severe onset of symptoms. This is called an AI flare, and it is what every AI patient dreads.

What is an autoimmune flare?

A flare involves a measurable increase in disease activity. If labs are done during a flare, you will see increased levels of AI markers. Each AI disease may have different symptoms in a flare. If you have Crohn’s disease, a flare may include diarrhea, abdominal cramps, mouth sores, nausea, or other symptoms related to the digestive tract. Though each AI disease may have its own set of symptoms, there are also some more general symptoms you may experience:

What’s happening in the body

During a flare, your AI condition is active and your autoantibodies are in the process of attacking your own body. This is when effector T cells are actively viewing parts of the body (such as tissues, an organ, or even a group of organs) as foreign invaders and attacking them. Unfortunately, during an AI flare, the regulatory T cells (also called Tregs), which are designed to control immune responses and maintain tolerance of the body’s OWN antigens, are not functioning properly to prevent this immune system attack. As you can imagine, this causes a lot of inflammation in the body.

Often, the triggers that drove the AI disease in the first place will be the triggers that cause a flare. Since AI conditions don’t ever go away, the focus of initial care is to put the disease into remission. This involves seeking out root issues for AI conditions and providing individualized immune support to improve T regulatory function. If a flare occurs, the goal is remission once again.

Flares last anywhere from weeks to months, unless there is a change in care to address them.

Triggers for autoimmune flares

Those of us involved in functional medicine understand that nothing simply “just happens” in the body. There’s always a reason why. If you have an AI condition, it’s extremely important to know what can trigger a flare. This may look different for each person. Working with a functional medicine doctor and paying close attention to your body — and what circumstances may have changed right before a flare — can help you figure out the puzzle. Below are some ideas of possible triggers. It’s important to note that these same triggers can be contributing factors for the development of AI conditions as well.

• Stress — a very common trigger for many AI flares. While we are still studying how this works, we believe that stress may trigger neuroendocrine hormones, which can lead to immune dysregulation.¹
• Medications — certain medications are also thought to trigger AI flares. An obvious one is antibiotics, as they can greatly alter the bacteria of the microbiome, and we know poor gut health is related to AI disease. Others include hydralazine (blood pressure), methyldopa (blood pressure), and procainamide (abnormal heart rhythms).²
• Seasonal changes — the lack of vitamin D in winter is correlated with increased disease activity in lupus, multiple sclerosis, rheumatoid arthritis, and psoriasis. Winter also brings an increase in infectious diseases, such as Epstein-Barr virus, which can be associated with multiple sclerosis and lupus flares.³ An increase in pollen in spring or leaf mold in fall may also contribute.
• Diet — food triggers can be different for each person and can include gluten, soy, dairy, corn, nightshades, grains, legumes, coffee, and/or eggs. Work with a functional medicine doctor to find out what diet is best for you.
• Environmental toxins — mold and other environmental toxins can both induce AI disease and trigger AI flares. It’s important to be aware of the environment you work and live in and make any necessary changes to avoid these toxins.
• Infections — as with seasonal changes, infectious diseases may cause flares. In Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), a flare can be caused by an underlying infection such as Lyme disease, mononucleosis, walking pneumonia, or the flu. Many other AI patients also flare when they are sick. If symptoms of an illness aren’t obvious, it’s important to look at underlying infections such as Epstein-Barr virus or Lyme.

What to do in a flare

It’s important to think about what caused the flare. If it’s an obvious food trigger — like the McDonald’s hamburger you decided to eat on a whim — don’t go back to McDonald’s for more. Preferably, don’t go back at all. ;) But you might have to do some hard thinking about what caused the flare, so you can avoid the trigger in the future. Here are some other things you can do in the meanwhile.

• Slow down — stress commonly triggers AI flare-ups. When in a flare, you can’t put normal life expectations on yourself. You may even need a day or two to just lay low. Reduce or simplify any commitments you’re able to. Ask for help. Prayer and meditation will also help to reduce stress levels.
• Sleep — make sure you give yourself time for more than 8 hours of sleep. Do not cut sleep short! If you have trouble sleeping during a flare, you may need to work with a functional medicine doctor to determine what your body needs to improve sleep.
• Exercise and sweat — if you can handle it, a workout might do your body good. While some forms of exercise can cause flares, there are also some that will help you out of one. A lot depends on how you’re feeling and your current fitness level. If you’re in too much pain to exercise, going to a sauna can help. Speak with your functional medicine doctor to determine what’s right for you.
• Address any infections — if you suspect a virus or underlying infection is contributing to your flare, talk to your medical practitioner to decide the best way to address it.
• Avoid sugar — sugar is an immunosuppressant and very inflammatory. Avoid eating it in general, but especially during a flare.
• Pay close attention to your diet — eat lots of veggies, good fats, and high-quality animal protein to support your cell health, hormones, brain, and nerve tissues. Juices and smoothies can help you pack in much-needed antioxidants. Try to avoid sweeteners, high-carb fruits, and grains. If you normally eat a paleo diet, following an AIP diet during flares may be helpful.
• Supplementation — proper supplementation to reduce inflammation and support T regulatory cell function during a flare will help reduce flare time as well as flare symptoms. It’s also important to be on a consistent protocol to help prevent future flares. Working with a functional medicine doctor can help you determine what’s right for you.

It IS possible to get more control of your flares as an AI patient. As you get to the root cause of your condition, if you do have a flare, you’ll have tools available to make the flare as short and painless as possible. Please contact our office with any questions — I would love to help you feel like your best self once again.